Why Cancer Is Rising Among Women (And What You Can Do Early)

Why Cancer Is Rising Among Women (And What You Can Do Early)

Author Name:Dr Pal

Youtube Channel Url:https://www.youtube.com/@DrPal

Youtube Video URL:https://www.youtube.com/watch?v=wNKwE-vXCgo



Transcript:
(00:00) uh more than 50% of the women are of less than 50 years of age who are affected by breast cancer and more than 25% are of less than 40 years of age in India. >> Why is that? >> Uh the planning that children >> if you don't breastfeed what happens to those cells >> just increases the risk >> risk >> but if you breastfeed that doesn't mean you're safe from breast cancer.
(00:20) That is also true. >> Do males have breast cancer? >> Dr. PMA Subramanium is a radiologist >> helping women understand what their bodies are telling them. She helps women navigate breast health with confidence not fear. >> People fear a lot about chemotherapy. Where there is hair loss, you have breast cancer.
(00:38) They the first question they'll ask me is whether I'll need chemotherapy. >> There's a lot of misconception about lactation. >> While the baby feeds, there is one more hormone called oxytocin. So when you are already stressed up or focusing on something else while feeding, there will be lesser secretion of oxytocin which again reduces the milk supply.
(00:57) How do people know that there is a lump? Is it painful? >> The thing is people often associate illness with pain. So breast cancer will be the most dangerous form of illness. It should be associated with more pain. That is what people think. The thing is uh >> in your practice what is the youngest age that you have seen breast cancer? >> 26 years.
(01:17) She has just completed her pregnancy. The lifestyle factors, obesity, not doing regular exercises, increasing stress levels. There is also a separate thing called which is very rare pregnancy. >> Before we dive in, can I be honest with you? It blows my mind that 57.9%age of you who listen regularly still have not subscribe to our channel.
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(01:55) Now let's get into today's episode. This is Dr. Pal Manikam. Welcome to another episode of our podcast series get feeling with Dr. Pal. In this episode we have interviewed Dr. Prema Subramanyam consultant breast imaging and interventionist in gym hospitals. What she has done amazingly is to put together a breast clinic as a one-stop shop where patients can actually get certified recommendations so that they can get a multid-disciplinary approach of breast cancer treatment.
(02:23) We talked a lot about early diagnosis, prevention. I wish every women listen to this podcast. I wish there should be no breast cancer or cervical cancer ever. >> Hi Dr. Prema, thank you so much for being my podcast. >> Thank you so much sir for having me here. I'm really excited to be here. >> Oh, nice, nice, nice.
(02:42) You're doing a great job. Okay, so there's a concept called breast clinic in the US and you're trying to put that together in gem hospitals in Kimaturur as a separate breast clinic as a one-stop shop. So, this podcast is for people who wants to know about breast cancer, breast symptoms, pretty much everything about women and cancer prevention and also early diagnosis is what my uh goal is.
(03:05) So let's talk about a general uh cancer prevention techniques in women. Okay. If a 35 year old female is looking hearing this podcast, what should she do in from a diagnostic standpoint in terms of uh breast cancer prevention? >> Yeah. Uh the prevention starts with lifestyle changes because that is the only area which is in our control like avoiding uh maintaining a healthy weight uh doing regular exercises and >> so obesity increases risk of breast cancer.
(03:38) >> Yeah. Especially in post-menopausal women because uh the peripheral fat produces estrogen which uh which causes risk of breast which increases the risk of breast cancer. So I I know a study where says when the waist circumference is more you take an inch tape measure around the belly button and if it is like more than 100 cm you're at increased risk of multiple inflammatory conditions.
(04:03) So breast cancer comes under that >> breast cancer endometrial cancer all these are like uh the cancer cells are stimulated by estrogen. So when there is per peripheral production of estrogen there will be an increased risk of breast cancer as well. >> And these fat cells produce estrogen. >> Yeah. >> Uh okay.
(04:19) Most of your patients diagnosed with cancer have some kind of overweight. >> Yeah. Especially in a in the postmenopausal age group. >> When you say postmenopausal around like 40 45 or 50 >> 50 plus >> early. So you're you're saying that if there is estrogen predominant it has a delterious effect. >> Yeah. unoposted estrogen like uh early menarchy, late child birth and not breastfeeding your children, late menopause, all these factors are associated with increased estrogen in our body.
(04:53) So the some the cancer cells are uh stimulated by this estrogen and this produces uh breast cancer. >> Wow. Um I'm just trying to put that in a layman term. So in menopause basically there is no estrogen. >> Yeah. But if you're obese in the menopausal period, the fat cells produce estrogen. >> Yeah, exactly. That is the reason uh postmenopausal obesity is a risk factor for breast cancer.
(05:16) >> Breast cancer. Wow. And you mentioned few of the significant risk factors as well. One is not feeding the baby through breast milk. >> Yeah. >> How is that helpful? So by breastfeeding there is prolonged uh levels of est progesterone in our body during breastfeeding and also the breast cells attain the complete maturity by breastfeeding.
(05:40) So this reduces the risk of breast cancer. >> Wow. So the cells in the breast attains complete maturity when you start feeding your baby. >> Yeah. >> Wow. If you don't breastfeed what happens to those cells? So they'll be in a dominant condition and they can undergo mutations then it can lead to breast cancer. >> Ah so there could be changes happening in the breast cells if you don't breastfeed and they can increase the risk of breast cancer.
(06:08) It's not like not every woman who doesn't breastfeed will get cancer. >> Yeah it just [clears throat] increases the risk >> but if you breastfeed that doesn't mean you're safe from breast cancer. That is also true because we have lot of other risk factors. Being a woman itself is a major risk factor for breast cancer. Uh-huh. Uh-huh.
(06:25) Do males have breast cancer? >> Yeah, rarely. Male can al also have a breast cancer especially uh men who have braa mutations, they are at increased risk of developing a breast cancer. >> Uh how do we know we have braa mutation? We don't know. So uh when you have a strong family history in the sense uh when you have close relatives affected by breast or ovarian cancer and multiple uh first degree or second degree relatives who are affected and especially at a younger age you have if they are affected they have to undergo genetic testing to know whether they
(06:56) have any uh germline mutations or not. Ah >> so if your family member have a lot of breast cancer history then you do genetic testing. >> Yeah. for both men and women. >> Yeah. Only for women. >> Only for the patient who's affected by cancer, they have to undergo testing. If they turn positive, we have to check the family members. Both men and women.
(07:17) >> Is that right? Okay. Okay. Okay. I didn't know. Okay. Is uh genetic testing is common now for >> Yeah. Especially in India the young can uh cancer in young women are racing. M >> so uh breast cancer in young means women uh when they are affected less than 40 years of age we call it as breast cancer in young uh compared to western countries the younger population is affected more in India uh to say it exactly uh more than 50% of the women are of less than 50 years of age who are affected by breast cancer and more than
(07:50) 25% are of less than 40 years of age in India but it is uh when it when you compare to western population it is a decade earlier in India. >> Ah why is that? >> So uh it could be probably due to lifestyle factors such as uh late uh the planning their children late again the lifestyle factors obesity >> uh like not m uh not doing regular exercises increasing stress levels >> I see all this play a role.
(08:19) >> Yeah. >> Can we talk a little bit about delaying the pregnancy? um you know we have mainly people in the podcast uh you know supporting and also saying okay this is some risk factors. >> So the this is one of the risk factor but uh it also the person the woman's life also has to be taken into not everyone can plan the pregnancy earlier.
(08:41) So if possible it is better to have your first child before the age of 30 years that can reduce the risk of breast cancer. So if you have a child below before the age of 30 years it reduces the risk of breast cancer because why is that? >> The same thing the uh we have uh we are cutting down the anopost estrogen.
(09:01) There is a pregnancy is a progesterone rich status one thing and when you breastfeed the children the breasts undergo complete the breast cells undergo complete purity before the age of 30 years that reduces the risk of breast cancer. >> Okay. Okay. So early pregnancy, breastfeeding, all this make sure that the cell cellularity >> at the molecular level gets matured.
(09:22) >> So it doesn't get multiplied into some precancerous cells undergoing mutation. I see. I see. Okay. >> So I'm just summarizing this what you said. So there are two hormones estrogen and progesterone. Okay. Progesterone is actually better to prevent breast cancer. And uh during pregnancy progesterone is high.
(09:41) >> During breastfeeding progesterone is still there. Yeah. >> So even though estrogen is there, there is still progesterone. So that is why you keep mentioning the word unopposed. >> Yeah. >> Unopposed is when estrogen is there, but when there is no progesterone, that is where the problem is. >> Yeah. >> In your practice, what is the youngest age that you have seen breast cancer? >> I've seen a woman with breast cancer at 26 years.
(10:07) She has just completed her pregnancy. And uh there is also a separate thing called which is very rare pregnancy associated breast cancer. So even during pregnancy and uh within first year of uh delivery if you develop breast cancer it is called pregnancy associated breast cancer. Uh so >> wow that is there. >> Wow.
(10:26) How do people come to you? How do people notice that there are some changes? >> The most common symptom of breast cancer is a lump in the breast. That is painless lump in the breast. That is the most common symptom. The other uh changes are nipple changes such as nipple ulceration, invert pulling of the nipple, nipple discharge especially when it is uh spontaneous without squeezing the nipple and it is blood stain.
(10:51) If it is from one side which is persistent. So that that can all be a sign sign of breast cancer. >> You you you're giving beautiful points. I'm just going to dissect that a little bit more. Okay. So discharge from the nipple uh and it could be bloody. >> Yeah, >> it could be bloody. >> There could be various types of discharge from the nipple.
(11:11) It could be white in color, green in color, yellowish p like puslike discharge can be there in infection >> and uh blood stain discharge. So of this white discharge and a brownish greenish discharge they are all more can be normal but blood strain discharge or a clear fluid coming out that that could be a sign of underlying pathology >> and uh when the discharge is coming spontaneously without even squeezing the nipple that traces more alarm than when it comes by pressing the nipple.
(11:43) So when you press the nipple when the discharge is there it is uh not as bad as the discharge coming out by itself. Yeah, there will be normally even uh women who are not breastfeeding there could be normal secretions within the ducts that can come out when you squeeze the nipple. One or two drops of those that liquid coming out is okay. normal.
(12:03) Uh uh >> even uh I've seen women panicking about that kind of discharge like when they press there'll be one or two drops of liquid coming out. That is totally normal. >> Unless it is like persistent, it is coming out on its own or it is blood stained or very clear fluid coming out. You have to be alarmed. >> You would be alarmed. Okay.
(12:23) And um how do people know that there is a lump? Is it is it painful? >> No. Uh the thing is people often often associate illness with pain. >> So breast cancer will be the most dangerous form of illness. It should be associated with more pain. That is what people think but that is totally wrong. The thing is uh breast cancer will present as a painless lump.
(12:45) In fact most of the other cancers when they start there won't be any pain. That applies here with uh here in breast cancer as well. So uh it is the painless lump that you should be more worried about. I've seen many women coming in the later stages of their cancer. If I asked them why you didn't come earlier like when you felt the lump it was not painful so I thought it is normal that is what their standard reply and even a few weeks back I was in a awareness talk I was stressing about this point and later one week later one woman like she was in
(13:14) her early 40s and she was a very well educated woman she came to me saying doctor you stressed upon that point I have a lump in my breast I wanted to get it checked and it was turned out to be a stage two cancer. >> Wow. She came because she acted on that piece of awareness. That is why awareness is very important with regard to breast cancer.
(13:35) This uh I mean the painful lump myth is a like it is a very dangerous myth with regard to breast cancer. >> So lumps is usually painless. Painless >> and how do uh women listening to this podcast what are the things that they can do? There's something called self breast examination that a patient can do to assess themselves whether there is any lump.
(13:54) >> What is your take on that? Yeah definitely especially as the cancers in young people are increasing every woman should know like how their look breast look and feel like it can be done from the age of 20 years self breast examination the aim is the just simple you should be aware of what are the normal changes of your breast so that you can pick up there are any abnormalities earlier and you can consult a doctor can be done once in a month especially after first week of your periods so that time the breast
(14:24) will be softer >> so around Eighth day, ninth day. >> Yeah. Within one week. >> Oh, I'm sorry. Within one week or after one week? >> Within one week. >> Within one week. Uh so the before 7 days after your periods. >> So you examine your both breast. >> Yeah. Both breasts. Uh there are two steps.
(14:43) One is to uh inspect like to look for any visible changes in the breast, nipple, areola, the skin of the breast or in the armpits >> on the mirror. >> On the mirror. >> Mirror. >> Yeah. M >> and the second step is to feel the uh area breast and armpits to look for any new lumps. >> And then is it a technique for that like a massaging technique? >> Yeah, you you have to use three fingers fingers >> pad of three fingers to feel every area of the breast.
(15:07) >> So like this and then they divide into four quadrants. Correct. >> You have to use pads of middle three fingers to feel the breast. You can use the circular motion up to down or horizontally any any pattern you can use. Um you have to feel all the areas of the breast as well as the armpits to know whether there are any uh lumps, new lumps, >> armpit.
(15:28) >> Yeah. >> Um can you educate the audience why they should examine the armpit as well? >> Because uh first uh some of the women the breast tissue can also extend to armpits. So you can develop a cancer in armpits too. Also there could be some small cancer sitting in the breast which can uh spread to lymph nodes in the axilla.
(15:48) uh those women they'll present first as a lump in the armpits rather than in the breast. So uh any new lump in the armpits that could also be a sign of breast cancer. So you should get it checked. >> Oh. Uh from what age they should do this? >> From 20 years of age. >> 20 years of age. >> It should be within 7 days of your last menstrual period.
(16:07) Uh the thing is uh because breast will be softer during the first week of your menstrual cycle like probably up to 10 days of menstrual cycle because uh breast is composed of milk glands >> which are very sensitive to hormones. So as your hormone levels raise and fall breast will undergo significant changes throughout the menstrual cycle.
(16:27) M so after ovelation the breast will become fuller harder and it'll be there will be heaviness of the breast lumpiness of the breast all those things will be there just before periods it is nothing but your body preparing your breast for the possible pregnancy >> if pregnancy does not occur the hormone levels fall so the breast also uh with menstruation the breast also will become softer so that is why you have to check in your first week of your menstrual cycle where the breasts are softer so so that if there are any new lumps you can
(16:55) observe it easier Yeah. Easily. >> So let's say a patient comes and then you know does this uh self breast exam within the 7 days of the menstrual period and observes a lump. >> When she comes to you how will you evaluate further? >> So uh it depends on the age of the patient. >> If she is less than 30 years of age we'll start with ultrasound.
(17:16) >> If she's more than 40 years of age we'll start with mamogs. If it is between 30 and 40 we'll decide based on the how suspicious the lump is. M >> so we'll start either with ultrasound or mamogram and [clears throat] uh and the very uh good thing is most of the lumps turned out turn out to be benign 80 to 90% they'll turn out to be benign >> emphasize that one more time it's very important >> so even if you feel a lump you need not get panicked you should get it checked 80 to 90% of the time they'll turn out
(17:48) to be benign even if it is a cancer it is it makes all the difference when you get it checked earlier So it is important to get all the lumps checked irrespective of your age, irrespect of your family history of breast cancer. >> Ultrasound is a small machine that they apply gel on the area and then you scan it similar to an ultrasound that they do for pregnancy >> and you look for some morphological changes that may be consistent with a precancerous condition.
(18:14) >> Mamogram is an X-ray of the breast. >> Yeah. >> And uh what will that X-ray show? >> The X-ray will show the normal glandular tissue. The glandular tissue will be different for each patient. Some will have entirely fatty tissue without less with less very less glands. Some will have more of glands.
(18:34) So depends on how much is the glandular tissue. The visibility of a breast cancer can also be different. So that is where we have 2D and 3D mamograms. 2D is just one picture of the breast where you can you have to see uh yeah you compress the breast. Compress means there will be uh >> an X-ray machine >> like an X-ray machine but uh there is there'll be a plastic p plate which was with which we'll compress the breast and the image is taken single image is taken in uh 3D mamogram we have slices of the like many images in slices layer by
(19:06) layer we can see the breast so that even the smallest changes can be picked up using 3D mamogram. >> Oh that's also an X-ray technique. Yeah, the same technique but the uh imaging technique is different so that we can see uh layer by layer. >> Wow. Okay. Okay. And then um so based on that you know do if there is suspicion they get a biopsy.
(19:27) >> Yeah >> they get a biopsy. >> Uh it's not like only cancers we'll do biopsy and many uh lumps we can dismiss them as benign with imaging alone. certain group of uh lesions uh to confirm that they are benign like they'll have slight suspicious features but they can turn out to be benign even for those lesions we would advise biopsy >> it's not that if you're doing doing biopsy it will turn out to be cancer >> ah so patient should not be anxious if the doctor is suggesting biopsy >> even few biopsies turns out to be a
(19:57) benign >> benign condition >> because the aim is not to miss a cancer >> so we do we end up doing benign biopsies but that is for the good we we don't We we should not miss the cancer at the early stage. >> Correct. Correct. You're erring on the negative side of this. Okay. A patient came to you and you do an ultrasound.
(20:14) I'm just summarizing for the layman term to understand. Okay. So, uh they you're doing ultrasound and they saying, "Hey, no, it doesn't look anything precancerous at all. Don't worry about it. We can do a follow-up ultrasound sometime later." That is one category. >> Another category is you know it looks a little bit suspicious.
(20:31) um let's do a biopsy and making sure that everything is uh okay most of them looks benign even in that category as well. >> Yeah. >> And there is other category where the suspicion itself is high. >> Yeah. >> And those patients may end up in having different stages of breast cancer. That's what you're saying. >> That's okay. Okay.
(20:49) >> You're talking about symptomatic patients where they're having lump. >> If I'm a woman, I'm not having any lump. I'm not having any symptoms but I want to make sure that I don't get breast cancer. What is the technique? >> So if you're 40 years and above >> and even without any symptoms, even without any family history of breast cancer, you should get your annual screening mamograms.
(21:12) The benefit of mamogram is when we do self-ris examination, we can pick up the lump when it becomes like uh we can feel by the hands. When it becomes like two or 3 cm in size, we can pick uh we can notice that. But when we do mamogram we can pick up the cancer at a much earlier stage like stage one cancer which is less than 2 cm in size or even precancerous changes.
(21:34) Uh those changes we can pick up using mamogram. So that is why uh even if without any symptoms it is better to do mamogs once in a year after 40 years of age. >> 40 years of age. Yeah. In the US it was 45 before but now they have decreased to 40. In India, I think we should decrease even more because we are having more younger cancers.
(21:54) >> Wow. >> Like as I said earlier like we get cancers the age group is a decade earlier than the in in western countries. >> So maybe around 30 to 35 is where starting see patients. >> Yeah. And that is why we are bit liberal on doing mamogs for patients who are younger than 40. If they have symptoms which look suspicious, we start off with mamograms.
(22:15) >> And with uh this is for healthy women. They should start at 40 years and women who have family history of breast cancer where younger age group it has occurred we'll start mamogram even earlier maybe from 30 years of age 10 years younger than the affected family member >> affected family member so let's say the affected family member is 35 years so then you start screening at 25 years >> no 25 mamogs will not like till 30 we won't do mamogram the there the modality is MR >> MR >> MR is more sensitive and because the
(22:45) breast tissue will be lot more denser in younger women that is why we are not doing mamograms for the younger people. >> So mamogram is only after 30. >> Yeah. Only after >> only after 30. Uh okay. But if there's a positive is if there's a positive >> say if a woman with 45 years of age she was affected by breast cancer.
(23:03) Her daughter can start mamograms at 35 years 10 years earlier. >> Correct. Correct. Correct. But if it is a positive family history at 35 years of age you need to start at 25. But that modality would be MR and not >> mostly we won't start before 30 years of age screening unless there is a proven genetic mutation in the family. Okay.
(23:23) >> If she is tested positive for BRAA or her firstdegree relative is positive for BRAA, we can start screening at 25 years with MR. >> Okay. So you keep emphasizing that family history is something very important. I'm going to argue that many patients at least you know like my mom dad age they say that oh you know we had cancer that patient died of cancer but they don't know what cancer is it >> right do you do you experience that in >> yeah yeah uh that is there and also even if they are affected by younger age
(23:57) there would not be any genetic testing so we can't find out whether it was genetic mutation or not >> but the thing is uh the family history is not that much this thing because only 10% of the women who are affected by breast cancer is due to genetic mutations. >> Family history is important because uh they they are in a different uh means similar environment and they have the same risk factors.
(24:21) So that is where it increases the risk >> because 90% of the women who get breast cancer are not having any family history. >> My mom is 66. Okay. She has never done a mamogram ever. Okay. I've been forcing her but in the last 5 years we've been doing it every year. >> Okay. But the reason that she didn't do so far is that I'm healthy.
(24:43) >> I don't have any problems. Why would I even go and get a doctor's appointment and I think it is 2,500 rupees. >> Yeah, it varies. >> Somewhere around. What is the average cost? >> It is Yeah, what you said? >> Somewhere around that is a price. Yeah. Why would I spend 2,500 rupees? You know, there's nothing.
(24:58) What will you tell to my mom? actually uh the reason why we are doing mamogram is detecting the cancer early even at the precancerous stage change uh stages. So this uh not only increases the cure rate that is almost 100% when you deduct at stage zero or stage one also the treatment becomes very simple like instead of mastctomy you can go for only excision of that area which is >> mastctomy is removal of the breast >> rem of the entire breast.
(25:28) So you need not go for uh removal of entire breast when you when the when you detect cancers in early stage also uh even the chemotherapy might not be required for precancerous lesions. >> So all those are advantages. So that is why we have to the and the cure rate is 100% >> 100%. >> Sorry to interrupt but I really need to say this about [music] my mission and passion.
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(26:50) If I change one person's life, I know I'm changing the whole family. [music] Link is in the pinned comment. Now, let's get back to the podcast. >> You have been in this field for the last like 15 years. Do you think the awareness is there to get a mamog? >> Actually, everyone knows about breast cancer because it is a common disease.
(27:08) >> But uh now I feel more women are coming forward for screening mamograms. M >> like compared to like four or 5 years earlier now they coming forward for screening mamogs though there are lot of myths surrounding breast cancer negativity about mamogs everything is there but now I feel the trend is that slowly changing >> what is the negativity about mamogram >> they feel it involves x-rays >> and mamogram is painful these are the two most common myths about mamogram >> is it painful >> no uh the women can feel a slight
(27:40) discomfort because uh the slight it the breast is slightly compressed between these two plates. They can it can be a little pain discomfort discomfort will be there but it is not painful >> also if they feel pain they can schedule the mamogram in their first 10 days of their menstrual cycle so that the pain will be lot lesser >> lot lesser huh >> and about x-rays uh the mamogram involves very minimal uh dose of radiation which is almost equivalent to 7 weeks of our background radiation so that is nothing when compared to the
(28:10) benefits of mamogs >> uh say that again one more time it's equal to 7 weeks of >> background ground radiation >> background radiation >> environmental radiation we'll uh have no sir so it is equivalent to 7 weeks of background radiation >> okay more environmental radiation is like a normal person >> normal person living in your uh >> exposed to so it is nothing basically uh it's almost similar to uh any other x-ray >> yeah even CT will have much higher radiation than mamogram >> so an MR doesn't have any radiation at
(28:41) all >> uh so that is something that we need to emphasize but MR M is expensive >> expensive and uh uh we cannot do MRA for all the patients and MRA cannot detect micro calcifications. >> Huh. So just because you can afford MRA that might not be the right test anyways. >> The first step is to do the mamogram.
(29:01) If there is anything abnormal if or you're very young where mamogram will not work you can go for MR. So a person listening to this podcast if she is 40 years old she should start getting mamogram right away once a year. Uh is it covered by insurance in India? >> No. >> No. >> It has to come out of their pocket.
(29:19) >> Out of the pocket. Okay. So in the US it is covered. Yeah. [clears throat] >> In the US covers >> also there are there are screening programs in US structured screening programs where every woman is screened when they are uh when they have insurance. But it is not the case in India.
(29:34) Women has to come out of their own interest to get the screening done. So only less than 10% of women eligible women are undergoing mamogs in India. >> Only 10 less than 10%. That's a lot less. >> Yeah. >> Wow. What is one situation that you saw a patient and then you wished that this patient have come earlier? >> So as I said the painful lump myth.
(29:57) So they they'll think that it'll be normal. So orh what they think is like there is a small lump but it is not causing me any trouble. it is not hurting me. Why to get it checked and get a diagnosis? And uh also people fear a lot about chemotherapy where there is hair loss. >> So that is a major once I tell that the diagnosis is this the breast cancer like you have breast cancer they the first question they'll ask me is whether I'll need chemotherapy.
(30:27) So they are like u there is a lot of stigma around breast cancer. They people want the neighbors to not to know about their diagnosis. Even if they get treated that is fine but uh their appearance and uh others knowing about the diagnosis that is lot more actually. >> Ahuh. Because chemotherapy can cause hair loss. >> Yeah. >> And that will be visible and people will start asking you know what is that what you're talking about? >> Yeah.
(30:49) >> Uh wow. So let's say that you know a patient forgot to do a mamogram did not come when there is a painless lump and then comes at an advanced stage and then you have a uh you have a diagnosible breast cancer treatment is always chemotherapy. >> No [clears throat] uh the that actually we use multimodality treatment depends on the stage of the tumor and how aggressive the tumor is.
(31:16) The treatment varies. uh if the patient has come in an early stage the first step is always do the surgery like without any lymph nodes only small lump in the breast the first step is to do a surgery most of the time it will be for early stage cancers breast conserving surgery that means only the cancerous area is removed the rest of the not the whole breast is removed >> it's called lumpctomy >> yeah lumpctomy >> where there's a lump you just remove the lump alone you look under the microscope and make sure that the margins of that
(31:44) >> actually they'll uh the if the lump is palpable They can take adequate margins during the surgery itself and they'll also make sure with pathology whether the margins are clear. >> Correct. And the pathology look at the microscope and then say that hey you know there is some cancerous tissue in the middle but outside margins are free.
(32:02) >> So you don't have to do anything further and that is why early detection is important. Am I right? >> Yeah. >> Okay. >> Also this breast lumpctomy always followed by radiotherapy. >> Is it right? >> Yes. M >> because uh when you remove the lump you want to make sure that it doesn't come back in the same breast again.
(32:19) So radiotherapy is given to the breast like when we when the breast conserving surgery is done. >> Can you educate the audience about what is radiotherapy? >> Radiotherapy is uh the treatment involving X-rays to reduce the risk of recurrence after breast cancer treatment. >> So what does X-ray do? The X-rays kills the cancer cells if microscopic cancer cells if at all they are there left after surgery.
(32:45) So this prevents recurrence of the cancer in the same area. >> Okay. >> And chemotherapy uh whatever if the invasive cancer generally they have to undergo chemotherapy except for few non-aggressive tumors in the older age women where they can avoid chemotherapy if they are in stage one. So most of the women will have to undergo chemotherapy and this the aim of chemotherapy is to reduce the risk of recurrence in rest of the body.
(33:10) So the microscopic cancer cells might have settled in some settled somewhere else which was not uh visible during initial evaluation like uh when we do PET scan if it is of significant size only we going to identify the cell level we won't be able to identify. So to cure those cancer cells chemotherapy is given.
(33:29) So as we give chemotherapy it affects the normal tissues also. That is why the hair loss and all is there but it is totally temporary. It is for few months only. Once we stop chemotherapy the hair cells start growing like lot denser than how it was previously. >> Oh is it right? How long is the chemotherapy for? Usually on average >> for uh 3 months 3 to four.
(33:47) >> Three months that's it. Uh and then >> so it is totally temporary. >> Temporary. Uh wow. It is still a debatable topic about hormone replacement therapy in the particular age. Even oral contraceptto pills if they take for a long-term estrogen containing thing that is >> that is a risk factor for breast cancer.
(34:05) >> Birth control pills has estrogen in it >> and if you've been taking it for more than 10 years 20 years that increases your risk a little bit uh because of the unopposed estrogen again >> but multiple pregnancies multiple deliveries decreases the risk. Correct. >> Yeah. >> Uh because of the >> uh multiple pregnancies and breastfeeding reduces the risk of breast cancer. breast cancer. Wow.
(34:28) So, we talked a lot about breast cancer and I'm hoping that a person listening to this podcast will start mamogram once a year starting from age 40. Start doing self breast examination starting from age 20 within the first week of your menstrual period every month. Uh and then if you notice don't wait for until it becomes bigger.
(34:50) Even if it is painless please go and check and don't get panicked because most of them are benign. >> Exactly. >> Super wonderful. Okay. So now we're going to talk about uh lactation. Okay. So there's a lot of misconception about lactation in uh especially of Indian community. >> Uh in the US they actually don't breastfeed at all that much thinking that you know it will be they cannot maintain their physical shape.
(35:14) >> Uh that is something very huge and people always do formula fading and what is your take on that? uh as much as possible every woman should take an u I mean effort to breastfeed their children >> actually it is a beautiful thing that is nature has designed for the woman so you should not uh just like that for the physical shape or for the schedules are interfering you should not uh give up on breastfeeding especially in the first year of the baby's life >> so uh there are lot of changes as you said uh it'll be a roller coaster ride
(35:49) only uh when you start lactation because during pregnancy it is only enlargement of the breast, fullness of the breast because of the glands swelling and everything but once after the delivery uh mean until the delivery the milk production is under check only because of high levels of estrogen and progesterone.
(36:09) Once the baby and placenta delivers there is a uh slight I mean sharp decline in estrogen, progesterone levels which gives ne positive feedback to the brain to secrete a hormone called uh prolactin. M >> so this prolactin causes milk production >> and uh first 3 days of after delivery uh before this prolactin starts acting there will be a yellowish fluid which is uh produced that is called cholesterol that is the baby's first milk which is rich in antibodies the quantity will be lot lesser than what the mothers and grandmothers expect
(36:41) >> so they'll be ready to feed the baby with formula feeds so the thing is that is totally adequate for the baby and it is very nutritious you should not uh think that it is not adequate for the baby and after 3 days it'll be the opposite. The prolactin start doing its work. There will be increased blood supply to the breast and there will be engorgment that is full fullness of the breast and heaviness and the breast will become feel tighter because still the body has not understood what is adequate for the baby like uh so once after the
(37:12) first week it usually stabilizes like it understands the demand of the baby based on like how frequently the baby is feeding and how much milk it needs and then it stabilizes. So till that time you should be like patient and you should not think that milk is not adequate and it is too or it is too much because if you start feeding the baby with with formula feeds the uh naturally the baby will not feed from the breast.
(37:34) So that will reduce the milk supply milk production itself it will be less. >> So that is why you have to be confident and feed the baby frequently so that your milk supply is adequate for the baby. Also uh other thing is to have a nutritious food and uh reducing the stress because while the baby feeds there is one more hormone called oxytocin >> uh that that is stimulated by the baby's uh feeding from the breast.
(38:01) >> So that is called low hormone. So that increases the connect uh you feel with the baby. So when you are already stressed up or focusing on something else while feeding that that will be uh there will be lesser secretion of oxytocin which again reduces the milk supply. >> So that's why they say don't look at the phones while you're doing breastfeeding as much as possible.
(38:19) >> Yeah. >> But I feel bad for the mom because she's already so tired but uh as much as possible you decrease the distractions while doing breastfeeding. Okay. >> And even if you're stressed up it'll reduce the release of oxytocin. >> I see. So okay. Okay. Because cortisol decreases the oxytocin release. I see.
(38:38) Um how about expressed milk? Is that okay? So >> that is also fine. Like if you are not able to breastfeed your baby exclusively like uh by direct feeding can go for uh expressed uh milk and using a breast [clears throat] pump. >> Breast pump. >> So even when the thing is if you feed the feed or express the milk frequently the production also will be uh parallelly higher.
(39:01) >> Higher. Huh. Okay. Um any hidden signs that they should watch for while they are doing lactation? >> Uh during lactation uh the normally like after the first week generally before feeding the breast will become fuller and after the feeding it'll become softer. >> So when you have a persistent lump which is not going away even after feeding and if you have redness of the breast, skin thickening, fever all those signs could be a sign of infection.
(39:29) So you should consult immediately. And one more thing is when people have infection they suddenly stop breastfeeding. So this will further complicate things because there will be stasis of milk where bacteria can grow in that and it can form a pus like pus inside the breast which is called absis. So you should not stop feeding once just because you got infection.
(39:49) You should keep on feeding so that the uh milk is empty and your infection heals faster. >> Wow that's a very very good point. How about the premenstrual breast pain? Is it common? >> Yeah, it is very common. >> Uh like most of the women will experience uh even it it may not be there in all the cycles in some points they can experience. >> So uh people also get anxious about that premenstrual breast pain.
(40:14) It is uh nothing but it is because of hormonal changes. >> So uh some women it'll be very uncomfortable. So they can do some lifestyle changes to reduce the discomfort. They can cut down on caffeine mean including tea, coffee, chocolates they can reduce and have a balanced meal with fruits and vegetables less fried fried items and regular physical activity can reduce the risk and using comfortable and well fitted braces can reduce the risk.
(40:43) Also uh many women like when we say that it is nothing but due to hormonal changes they'll relax and the pain settles down actually >> otherwise they'll feel like more pain like pain is there they'll be stressed about it and it'll be like a pain. >> When does this happen? 5 days before the periods. >> Yeah. One week before the periods.
(41:00) >> One week before the period >> after ovelation there will be uh gradually swelling of the breast in response to progesterone where the milk glands increase in size. So it'll be uh most uh most common during uh u week before the periods week. >> I'm just going to revisit my anatomy and physiology over here.
(41:17) Okay, I'll educate the audience as well. So uh the first phase menstrual cycle is 28 days on an average. The first two 14 days is the estrogen predominant phase and as soon as the ovelation happens around the 14th day the progesterone kicks in. the remaining two weeks is progesterone >> and when the embryo is not being formed the endometrial uterine lining is getting shed and that's why the bleeding happens.
(41:40) So what you are saying is that in the second half where the progesterone is there it is preparing you for possible pregnancy >> like just like how it prepares the endometrium for pregnancy it also acts on the breast but people won't connect that and they'll feel anxious about the pain. >> So for pregnancy you need milk glands to get developed.
(42:00) So it increases the blood supply to the breast and it gets engorged and that is where the pain starts >> and after the period the progesterone comes down. So the pain gets better and you saying that any local treatment like heart compressor something like that. >> No local treatment is not required like the lifestyle changes and uh even the stress is a contributing factor to for the premenstrual breast pain.
(42:23) >> So >> and it is a part of the PMS symptoms. >> Huh. Okay. Super beautiful. So we had an extensive discussion on breast cancer. Let's just uh move our attention to cervical cancer. Is it common in India? Yeah, it is the second most common uh cancer after breast cancer. Cervical cancer. >> Cervical cancer.
(42:43) And what is the age group that usually gets affected? >> By 40 to 50. Yes. >> 40 to 50. Okay. >> Endometrial cancer comes much later in postmenopausal women. >> Cervical cancer is uterine cancer. >> Yeah. >> Cervical cancer the common age group is around 40 to 50 years. >> 40 to 50 years. What is the symptom that they usually have? uh they can have interventional bleeding like bleeding between their periods or bleeding uh during their intercourse.
(43:09) So why it is discharged from the vagina continuous discharge from the vagina these are common symptoms of cervical cancer. >> Cervical cancer. How do they differentiate the discharge? Normally that happens with the menstrual period. >> If it is false smelling or continuous during the menstrual cycle there'll be a pattern of discharge.
(43:26) During ovelation they'll have a >> thin liquid >> thin liquid like d and after ovelation it'll be like curd like darch which is very less. >> So when when they have excess of dash throughout the menstrual cycle it's not related to the menstrual cycle. It should be it could be either be an infection or a >> or a possible mancy. Okay.
(43:47) Okay. And uh it is a preventable cancer. >> Yeah. >> Right. There is a vaccine. This is one of the cancers which can be prevented by uh vaccine by giving a vaccine. >> Ah in women cancer risk is there any other cancer that can be prevented by vaccine? >> No. No. >> Only cervical cancer. >> Only cervical cancer >> because cervical cancer is caused by uh most of the cervical cancers.
(44:08) More than 90% of them are caused by a virus called human papilloma virus. So there are different strains of viruses like the common ones are A16 and 18. So we give vaccine against this viruses. So they call it HPV >> HPV >> HPV8 HPV 16 HPV 18. So that is why we call this vaccine as HPV vaccin. So this viruses are the ones which are causing cancerous changes in the cervical cells.
(44:34) It can cause many other cancers like oral cancers, penile cancers and anis cancers of the anus. So al they can also be caused by uh uh human papilloma virus. That is why the vaccin is advisable even for uh male children. >> Is it right? >> Yeah. >> I know uh it's a very important discussion.
(44:55) What is the age group that a HPV vaccin to be given to a female child? >> 9 to 15 years of age. That is the ideal age they recommend like that is why they are giving vaccines for school children in our country and uh it's it's recommended till the age of 26 years. Now they have extended it up to 45 years. uh even if the woman is uh uh woman is sexually active and they exposed to certain strains of HPV vaccin there could be other strains which can cause though it is less effective it is recommended till 45 years of age >> 45 years of age >> actually three different types of
(45:28) vaccines uh one is two strain vaccin that is what is government is giving that is against HPV 16 and 18 >> uh they are the ones which are causing 90% of uh cancers due to HPV virus and the other one is four strain vaccin which has four strains of HPV virus And the other one has nine strains of HPV viruses. >> Wow.
(45:50) What do you recommend? Nine strains. >> Obviously nine strain is better. Uh but it is more expensive. >> Correct. >> So the most common ones are uh the two strains 16 and 18. So at least that >> at least that should be there. Yeah. What is the cost in case somebody wants to go for a ninth strain? >> It's around 13,000 per dose. >> Per dose.
(46:09) And how many doses are needed? >> Three doses. >> Three doses. uh between 9 and 15 years two doses are needed. It's a zero and six like first vaccin for six for 6 months later >> six months later you get the other vaccin >> and that's it no more required and after 15 years it is three dose 0 1 and six >> so first dose 1 month after 6 months after after 15 years and uh this is you know I always had this question I'm not sure it's the right question you know in US the sexual exposure is much younger >> uh for US kids I'm hoping that Indian community is not up to that level maybe
(46:49) it is increased changing does it does it uh depend on the sexual intercourse >> it is most effective and uh it is given before the sex any sexual exposure >> so the vaccin >> because they'll be exposed to viruses by the time when we give vaccin >> so it is better to give before any sexual exposure >> exposure and the more of transmission is mainly sexual exposure.
(47:14) >> Mainly prevention. >> So vaccine is prevention for uh cervical cancer. And tell us about papsmear for detection of cervical cancer. >> Papsmere detects cervical cancer much earlier than uh when it becomes a cancer like it can detect precancerous changes in uh in the cervix. So this uh simple test where the cytologies where the cells are taken from the cervix the surface of the cervix using a breast and uh uh it is tested.
(47:45) So it should be uh women can do like papsmear tests from 20 years of age. >> M and then there is a stop end date right? >> 65 years. >> 65. >> Yeah. >> Tell us how they do the papsmear actually. M >> it is like where your gynecologist examines your uh utal vaginal canal. >> So uh speculum will be put and there with using a brush cells from the cervix will be taken.
(48:13) It will not be a painful procedure. There is no injection injection or any uh testing of the tissues involved. It is just taking the surface cells of the cervix and testing it. >> Wow. So tell me a patient's case that you have seen with cervical cancer. Uh what happened? How does the patient come to you? >> So uh nowadays uh the many papsmears are happening.
(48:37) So even they come in like high-grade intraabilary leation that is a precancerous stage we are seeing those uh patients and >> and what happens if there if there is diagnosed then they what is the treatment they excise >> they excise that area of uh cervix which has cancerous changes and if the margins are negative they keep the women under followup and if there are invasive changes they'll uh go for hyerectomy >> remove the uterus >> in the early stage but if it is a later stage the treatment is radiotherapy and chemotherapy therapy >> and most of the cervical cancer even if
(49:08) they are like spread to just spread to the adjacent organs it can be curable by uh radiotherapy. >> Radiotherapy. Okay. >> Unless it is too advanced and it has spread to other organs. Most of the women like will do well with radiotherapy. >> What is the earliest cervical cancer age that you might have seen? >> 35 years.
(49:26) >> 35 35. Um okay super. So we for cervical cancer we have a vaccine from 9 to 15 is the best time >> but they can have the vaccine even before 45 years of age. Okay super and then starting from 20 years you do papsmear once every 3 years. >> This should be good enough to screen for or screen and prevent uh cervical cancer.
(49:48) I wish >> that is why the cervical cancer incences are reducing like nowadays >> nowadays. Yeah. And I hope many people are adopting this vaccination series. And what is your take on your patient population? >> Yeah, definitely if a cancer is preventable, it is uh you should take initiative to vaccinate all our children even the male children can be vaccinated so that her immunity develops and they they'll be protected against penal cancers.
(50:14) >> So uh >> oh I forgot about the male child. Okay. So does the same thing apply to the male child as well >> regarding vaccination? >> Vaccine. >> Yeah. But we can't do papsmear. So it's only vaccination. >> Same thing. 9 to 15 years. Two doses. >> My son is going to become nine next year. >> It is better to put this.
(50:35) You have kids? >> Yes sir. I have two sons. >> Did you are they? >> No, they are eight and six. >> So but but you will give HPV vaccine when he turns nine. Uh and then 6 months later you'll give one more. >> It's good to know because I'm not uh involving your personal family here but I'm just saying to raise awareness.
(50:53) Yes, >> as a doctor you are recommending for your own kids. Okay. Well, that's good to know. >> So, we talked about breast cancer, we talked about cervical cancer, uterine cancer. Is there any screening? >> Uh, in endometrial in uterine the most common cancer is endometrial cancer. >> Endometrium is a lining of >> Yeah. lining of the uterus.
(51:16) So uh that most commonly comes in postmenopausal women like after 50 years of age and most of the time they'll present early with the bleeding post menopausal bleeding that means uh when you get bleeding after one year after your period stops you should get it checked. >> Uh the checking is by first simple ultrasound scan where we'll check the lining of the endometrium how thick it is.
(51:39) >> If it is thick we have to go for further testing that is with sampling of the endometrium. So because it presents early it is most of the time completely cured cured. Yeah. So it's a symptomatic where you have bleeding where you supposed to be because you're menopause. >> Even in premenopausal women if if you have like irregular bleeding and intermenstrual bleeding like uh between periods if you have uh bleeding you should it should be checked.
(52:05) >> Uh will they have heavy bleeding? >> Heavy bleeding can also be a symptom of endometrial cancer or endometrial polyp. >> Polyps. Yeah. Okay. Okay. Super. Kudos to what you do. Okay. It is not an easy job. Uh I'm so glad that people are like you are raising awareness. So >> thank you sir.
(52:24) Like I feel every doctor should raise awareness because it is an important clinical tool and you are doing it in a massive way. So that's really great. >> Thank so >> so not only in your specialty you are like involved. >> Yes. I learned a lot from you. Oh I didn't know to give HP vaccin for my uh son.
(52:42) He may not like it, but I'm going to have him [laughter] have the injection. Um, okay. We'll summarize everything what we discussed. So, we talked about breast cancer and we talked about the early onset detection. How do we diagnose? How do we treat? Uh, most important point is uh mamogram at age 40 and every year >> and then uh self breast exam starting from age 20.
(53:03) For cervical cancer starting from age 20 would be your papsmear and then uh 9 to 15 would be your best time to put HPV vaccination. If you have crossed that stage, don't worry about it. You can still take it uh with three doses of HPV vaccine. Yes. And we talked about different strains and everything. And then you trend cancer, any intermenstrual bleeding, uh please do not hesitate to >> and postmenopausal bleeding.
(53:26) >> Postmenopausal bleeding. And most important thing that you said I absolutely love about that is if you have a lump in the breast, do not panic. Please get attention, medical attention right away. Most of them are going to be benign but just to be on the safer side we have to make sure that it is not precancerous.
(53:44) >> Exactly. So >> super super nice kudos to you. Wonderful job. Please keep doing the good work and expand the breast clinic raise awareness and make sure that we don't have any breast cancer so it'll catch. >> Sure. That is the aim even if the cancer is there it's the survey will like detecting early that is what is more important because nowadays with the advanced treatments with less side effects we can cure the cancer once it is detected early.
(54:09) >> Super super. Thank you so much. Thank you. Thank you. >> Thank you sir. Thank you so much.