Breast cancer - the second most common type of cancer in Pakistan

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  According to researcher breast cancer is the most common female cancer in both developing and developed countries.

  Breast cancer is the second most common type of cancer after lung cancer in Pakistan and ranked first in the Pakistani women. There is a significant increase in the number of cases in Pakistan has since the 1970s, partly due to the modern lifestyle. Around 1 in 7 to 8 women in Pakistan get breast cancer during their lives. Pakistan faces a high burden of breast cancer disease with late stage presentation being a common feature. It has been seen that more than half of the patients present in advanced stages (stages III and IV).

  Fact and figures provided by different researchers:

  Dr Junaid S Khan from University of Health Sciences stated that more than 90,000 of the 1 million global cases of breast cancer are from Pakistan, and half of that number from Punjab.

  Sohail & Alam,2007 reported, Pakistani women get the disease at a far younger age than Western women, with larger lesions, and are more prone to metastatic cancers. The predominant morphology is a higher rate of infiltrating ductal carcinoma.

  Dr Jo Anne Zujewski said that Pakistan has emerged as one of the countries with the highest rate of breast cancer mortality rate with around 40,000 deaths a year. Quoting different researches, she said that the Western lifestyle is one of the major reasons behind the increasing cases of breast cancer worldwide, but since that lifestyle is not prevalent in Pakistan, the reasons for increasing cases of breast cancer in the country are yet to be found through research.
  There is a need for mass awareness in the country so that every woman could have an early check-up for breast cancer.

  The main cause of breast cancer is still unknown:

  But different factors can become the cause.

  ·         The risk factors that can trigger the disease are sex, age, childbearing, hormones, a high-fat diet, alcohol intake, obesity, and environmental factors such as tobacco use and radiation.

  ·         Hereditary factors play a role, but research is still on its way to find the cause of breast cancer.

  ·         Consuming vegetables and fruits polluted with pesticides, nuclear radiation.

  ·          The Western lifestyle is some of the reasons behind breast cancer, but its causes are unknown in Pakistan.

  ·         There is a possibility of men being afflicted with breast cancer as well, but it depends on the family history.

  ·         A significant increase in risk of breast cancer can be  associated with history of smoking,  family marriage,  family history of breast cancer, late age at first full-term pregnancy (above 25 years) & higher body mass index (greater than or equal to 28). 

  ·         Late age at menopause can be a strong detem1inant of postmenopausal breast cancer risk.

  ·         Cousins marriage is still a common practice here which can be the main cause of breast cancer.

  Ignorance plays a big role in the too-late-to-be-effective diagnosis of breast cancer in Pakistan. Here, it’s culturally unheard of to get yourself checked/ go for a routine mammogram/breast sonogram unless you have a noticeably hard lump and are forced by family members to consult a doctor.

  Ahmed, Mahmud, Hatcher, Khanm, 2006 reported it that breast cancers in Pakistan often go undetected for so long that the majority of people are already in their 3rd or 4th stages by the time they realize they have it.

  Compared to the West, the average age to be afflicted with breast cancer is much lower in Pakistan due to a different life expectancy in the region.

Breast cancer myths

Breast cancer myths

Michael Russell and some other researchers clarify the myths about breast cancer. Breast Cancer is one of the leading causes of death in women, yet, did you know that men can also be affected by it? It is not solely a disease that women can get, although it is less likely, men are still at risk as well. This fact may startle some, and many individuals still hold onto various myths pertaining to such a disease.

 Myth: Breast cancer only affects women.

This, of course, is not at all true. In fact, men also get it, although it occurs less frequently. Actually, about one percent of all breast cancer occurs in male patients. Further, it is even more dangerous for men, because men do not typically do self-examinations. Thus, when the cancer is finally detected, it is far more advanced.

Myth: Most breast lumps are cancerous.

Second myth is associated with this disease is that if one has found a lump during an examination, it is cancer. Again, this is not always the case. Roughly 80% of lumps in women's breasts are caused by benign (noncancerous) changes, cysts, or other conditions. In fact, both men and women can develop lumps in their breast tissue for a variety of reasons and only a doctor can determine whether or not a lump is cancerous.

Myth: This disease is solely hereditary

Roughly 70% of women diagnosed with breast cancer have no identifiable risk factors for the disease. But the family-history risks are these: If a first-degree relative (a parent, sibling, or child) has had or has breast cancer, your risk of developing the disease approximately doubles. Having two first-degree relatives with the disease increases your risk even more.

Myth: All women have a 1-in-8 chance of getting breast cancer.

This disease only affects older people. This is not so. Although the chance of getting breast cancer increases with age, women as young as 18 have been diagnosed with the disease. Risk increases as ladies get older. A woman’s chance of being diagnosed with breast cancer is about 1 in 233 when she's in her 30s and rises to 1 in 8 by the time she’s reached 85.

Myth: Exposing a tumor to air during surgery causes cancer to spread.

Surgery doesn't cause breast cancer and it doesn't cause breast cancer to spread, as far as scientists can tell from the research so far.
Myth: Breast cancer is contagious

 Some individuals still think that breast cancer is contagious? Unlike the common cold or flu, it is not a contagious disease. Thus, it cannot be directly passed from one individual to another through human contact.

Myth: Breast size has nothing to do with getting breast cancer

Some individuals foolishly believe that breast size determines whether or not one gets cancer. Again, this is a misconception. Women with smaller breasts are at equal risk of getting the disease and this fact is confirmed in that men, individuals that possess almost no breast tissue, also get the disease.

Obesity and hypothyroidism- common problem of developing countries

Hypothyroidism and obesity correlation

Obesity is very common problem in our society. Obesity arises from multiple factor, particularly hypothyroidism in many victims.

Hypothyroidism is the disease state in humans caused by insufficient production of thyroid hormone by the thyroid gland or impaired internalization of thyroid hormone into cells where it actually functions.

Hypothyroidism is a condition associated with

·         weight gain,

·         inability to lose weight,

·         fatigue,

·         depression,

·         decreased libido, and

·         high cholesterol

Mechanism by which thyroid dysfunctions cause obesity:

Thyroid hormones are potent regulators of energy; they modulate the enzymes and fat synthesis. Hypothyroidism and obesity always co exists, because

 it deposits more musin to the skin and other organs.

 Secondly salt and water retention disturbs the cell function and swells up.

Increased body weight and deficient thyroid hormones in the blood feedbacks the pituitary to secrete more Thyroid Stimulating Hormone (TSH). In many case of sub acute Hypothyroidism, the case reports with high levels of cholesterol. Postpartum Thyroiditis occurs in few individuals with hyperthyroidism initially, in which they lose their weight and hypothyroidism follows with gain in weight in many individuals. Many women become obese after delivery, particularly after second baby.

Thyroid Dysfunction and Body Weight

Thyroid dysfunction is associated with changes in body weight and composition, body temperature, and total and resting energy expenditure independently of physical activity. Weight gain often develops after treatment of thyroid dysfunction.

Both subclinical and overt hypothyroidism is frequently associated with weight gain, decreased thermo genesis, and metabolic rate. It has been noted that small variations in serum TSH caused by minimal changes in L-T₄ dosage during replacement therapy are associated with significantly altered resting energy expenditure in hypothyroid patients. The clinical evidence that mild thyroid dysfunction is linked to significant changes in body weight and likely represents a risk factor for overweight and obesity.

When one is discussing the various causes of weight gain, thyroid gland dysfunciton ought to pop up into the conversation. Thyroid gland, essentially regulate the body’s metabolism. And metabolism determines the rate at which a person can burn calories and thus has the ultimate effect on one’s weight. If something goes wrong with the thyroid, a person can endure intense weight problems that can lead to a slue of other serious medical conditions.

Often thyroid disorders have subtle symptoms that only appear gradually and as a result, they are typically misdiagnosed. Someone may be struggling with obesity because their thyroid is dysfunctional and as a result, they have a severe energy imbalance they can’t control.

Thyroid Function in Obese Subjects

TSH levels are at the upper limit of the normal range or slightly increased in obese patients, are positively correlated with BMI. TSH seems to be positively related to the degree of obesity. A positive correlation has been identified between serum leptin and serum TSH levels in obese individuals which could reflect the positive association between TSH and BMI, the increase in TSH and leptin levels in severe obesity could result from the increased amount of fat. Thyroid hormone levels have been reported to be normal, increased, and decreased in obese patients.

A moderate increase in total T₃ or free T₃ (FT3) levels has been reported in obese subjects. Progressive fat accumulation was associated with a parallel increase in TSH and FT3 levels irrespective of insulin sensitivity and metabolic parameters and a positive association has been reported between the FT3 to FT4 ratio and both waist circumference and BMI in obese patients.

Is dark chocolate good for health?

Dark chocolate has far more antioxidants than milk or white chocolate. These other two chocolates cannot make any health claims. Dark chocolate has 65 percent or higher cocoa content.

How dark chocolate benefits health:

Chocolate is made from plants, which means it contains many of the health benefits of dark vegetables. These benefits are from

Flavonoids, which act as antioxidants. Antioxidants protect the body from aging caused by free radicals, which can cause damage that leads to heart disease. Dark chocolate contains a large number of antioxidants (nearly 8 times the number found in strawberries). Flavonoids also help relax blood pressure through the production of nitric oxide and balance certain hormones in the body.

Heart Health Benefits of Dark Chocolate:

Dark chocolate is good for your heart. A small bar of it everyday can help keep your heart and cardiovascular system running well. Two heart health benefits of dark chocolate are:

·         Low blood pressure

·         Lower cholesterol: Dark chocolate has also been shown to reduce LDL cholesterol (the bad cholesterol) by up to 10 percent.

Other Benefits of Dark Chocolate:

Chocolate also holds benefits apart from protecting your heart:

·         it stimulates endorphin production, which gives a feeling of pleasure

·         it contains serotonin, which acts as an anti-depressant

·         it contains theobromine, caffeine and other substances which are stimulants

·         Anticancer

·         Brain stimulator

·         Cough preventor

Chocolate is still a high-calorie, high-fat food:

Most of the studies done used no more than 100 grams, or about 3.5 ounces, of dark chocolate a day to get the benefits. One bar of dark chocolate has around 400 calories. If you eat half a bar of chocolate a day, you must balance those 200 calories by eating less of something else. Cut out other sweets or snacks and replace them with chocolate to keep your total calories the same.

Cadmium- risk factor of breast cancer? New Swedish study

A new Swedish study suggests that ingesting higher levels of cadmium, a metal found in fertilizers, may be linked to an increased risk of breast cancer. The results showed that postmenopausal women with a relatively high daily dietary cadmium intake had a 21 percent increased risk of breast cancer than women who had the least amount of cadmium in their diets. This risk increased to 27 percent among women who were lean or normal-weight, the study showed

In a finding that strengthens the link between environmental pollutants and rising rates of breast cancer, new research finds that women whose diets contain higher levels of cadmium are at greater risk of developing breast cancer than those who ingest less of the industrial chemical in their food.

Major source of cadmium

Some of the main sources of cadmium in the diet are bread and other cereals, potatoes, root crops and vegetables.

Cadmium, a heavy metal long identified as a carcinogen, leaches into crops from fertilizers and when rainfall or sewage sludge deposit it onto farmland. Whole grains, potatoes, other vegetables and shellfish are key dietary sources of cadmium, which also becomes airborne as a pollutant when fossil fuels are burned, and is likely inhaled as well as ingested.

Those women who consumed higher amounts of whole grain and vegetables had a lower risk of breast cancer compared to women exposed to dietary cadmium through other foods.

How Cadmium enhance the breast cancer:

The reason for the link may be that cadmium can cause the same effects in the body as the female hormone estrogen, the researchers said. Estrogen fuels the development of some breast cancers.

Still Doubt on   cadmium effects:

Rull, researching cadmium's effects, said that scientists were unsure how best to measure women's exposure to the chemical. That fact, he said, had made it difficult to show whether and how strongly it might drive cancer incidence.

The latest research follows two other studies,that first singled out cadmium as a factor in breast cancer. Those studies measured cadmium in the urine of smaller groups of pre- and post-menopausal women, and found that those who had high cadmium exposures were more than twice as likely to develop breast cancer as those with the smallest exposures.

Future concerns:

The study offers new evidence in a large human population that environmental chemicals that mimic the effects of the female hormone estrogen may contribute to women's risk of certain cancers, including endometrial and breast cancers.

Even this study, while showing a correlation, did not prove cause and effect, experts noted

Sugar increases the Breast cancer

Christine Horner, reported high insulin levels are one of the biggest risk factors and promoters of breast cancer. Women with high insulin levels have a 283 percent greater risk of breast cancer.
Cancer cells love sugar. It's their preferred fuel. The more sugar you eat, the faster cancer cells grow. Our pancreas responds to sugar by releasing insulin, the hormone that escorts sugar into your cells. When we eat refined simple sugars, such as white table sugar, candy, cookies, or other sugar-laden foods, our blood sugar levels rise very quickly. Our pancreas responds by releasing a lot of insulin. That's not good

Eating sugar increases your risk of breast cancer:

It delivers a major blow to the immune system with the force of a prize fighter. Immune system is a natural defense against such invaders as bacteria, viruses and cancer cells. Research shows that right after you eat a high-sugar meal, your immune system function drops drastically. Sugar decreases T lymphocyte (a type of white blood cell), function by 50-94 percent. This effect lasts for a minimum of five hours. This means that right after you've eaten a lot of sugar our body's ability to fight off invaders or destroy cancer cells is tremendously weakened for several hours. 

Over a period of time, eating too much sugar can create imbalances that lead to two more deadly diseases: obesity and diabetes. Both of these diseases dangerously increase the risk of breast cancer. 

Insulin is consider unfriendly to breast cancer

When it comes to breast cancer, insulin is no friend. One of the biggest reasons is due to the fact that both normal breast cells and cancer cells have insulin receptors on them. When insulin attaches to its receptor, it has the same effect as when estrogen attaches to its receptor; it causes cells to start dividing. The higher the  insulin levels are, the faster the breast cells will divide; the faster they divide, the higher the risk of breast cancer is and the faster any existing cancer cells will grow. 
Insulin increases the estrogen levels i.e increase cell division:

As insulin levels are up, free-estrogen levels are up, and both of them speed up cell division.

There's also another detriment that high insulin levels can inflict. It makes more estrogen available to attach to the estrogen receptors in breast tissue. Insulin regulates how much of the estrogen in the blood is available to attach to estrogen receptors in the breast tissue. When estrogen travels in the blood, it either travels alone seeking an estrogen receptor, or it travels with a partner, a protein binder, that prevents it from attaching to an estrogen receptor. Insulin regulates the number of protein binders in the blood. So, the higher the insulin levels are, the fewer the number of protein binders there will be and therefore the more free estrogen that will be available to attach to estrogen receptors. 

Lipoproteins - types and their role in body

Cholesterol is a fat that is made in the body. Our body needs some cholesterol to work properly. In order to get to all cells, cholesterol needs to travel through the bloodstream. But because cholesterol is a fat, it separates from the blood similar to the way that oil separates from water.

 In order to prevent this from happening, proteins form a shell around the cholesterol, creating a "cholesterol complex." It is then released into the bloodstream and travels to where it needs to go. A protein that is linked to cholesterol to form this cholesterol complex is called a "lipoprotein."

Types of Lipoproteins:

There are three main types of cholesterol that are tested

 Low density lipoprotein (LDL)

 High density lipoprotein (HDL), and

Very low density lipoprotein (VLDL). 

Triglycerides, another type of lipid in the blood, are also tested.

Low Density Lipoproteins:

Low density lipoproteins, also referred to as LDL, is known as the "bad cholesterol". LDLs are produced by the liver and carry cholesterol and other lipids (fats) from the liver to different areas of the body, like muscles, tissues, organs, and the heart.

Why LDL-C Known as Bad cholesterol:

LDLs transport cholesterol from liver and deliver it to the tissues that need it. But if a lot LDLs left over after all body tissues have been taken the required amount, the LDLs will "let go" of the extra cholesterol while traveling through blood. This LDL cholesterol can build up on the walls of arteries (blood vessels that carry blood from the heart to other parts of the body). This build up of cholesterol is called plaque and over time, it can cause narrowing or hardening of arteries. This condition is called atherosclerosis.

It is very important to keep LDL levels low, because high levels of LDL indicate that there is much more cholesterol in the blood stream than necessary, therefore increasing your risk of heart disease.

LDLs are calculated by using an equation involving total cholesterol, triglycerides, and HDLs--all of which are measured directly in the blood:

LDL = TC – (triglycerides/5) + HDL)

According to the National Cholesterol Education Program:

·         LDL levels less than 100 mg/dL ( 2.6 mmol/L) are considered optimal.

·         LDL levels between 100 – 129 mg/dL (2.6–3.34 mmol/L) are considered near or above optimal.

·         LDL levels between 130 – 159 mg/dL (3.36–4.13 mmol/L) are considered borderline high.

·         LDL levels between 160 – 189 mg/dL (4.14 - 4.90 mmol/L) are considered high.

·         LDL levels at or above 190 mg/dL (4.91 mmol/L) is considered very high.

High Density Lipoproteins:

High density lipoprotein, also known as HDL, is considered the "good" cholesterol. HDL is produced by the liver to carry cholesterol and other lipids (fats) from tissues and organs back to the liver for recycling or degradation. High levels of HDL are a good indicator of a healthy heart, because less cholesterol is available in your blood to attach to blood vessels and cause plaque formation.

HDL is a Good cholesterol:

HDL-C  is "good" because it picks up the extra cholesterol that was dropped off by the LDLs   and brings it to the liver. Liver can repackage it to use it later or simply get rid of it. Because HDL cholesterol removes excess "bad" cholesterol (LDL), it is good to have high levels of HDL and low levels of LDL.

According to the National Cholesterol Education Program:

·         Any HDL level above more than 60 mg/dL (1.56 mmol/L) is considered high.

·         An acceptable HDL range is between 40- 60 mg/dL (1.04–1.56 mmol/L).

·         An undesirable level of HDL is any level below 40 mg/dL (1.04 mmol/L). In this case, low HDL levels may help to contribute to heart disease.

Very Low Density Lipoproteins:

Very low density lipoproteins, or VLDL, are lipoproteins that carry cholesterol from the liver to organs and tissues in the body. They are formed by a combination of cholesterol and triglycerides. VLDLs are heavier than low density lipoproteins, and are also associated with atherosclerosis and heart disease. This number is obtained by dividing your triglyceride levels by 5.

Purpose of LDL:

VLDL is made in the liver in response to a high-carbohydrate meal. The liver converts the extra carbohydrates into fat triglycerides and puts them into VLDLs to be transported to fat cells and muscle within the body. The liver also puts some cholesterol into the VLDL. A VLDL particle is rather large, carrying a lot of triglycerides relative to the amount of cholesterol.

IDL

Once a VLDL delivers its triglycerides to fat cells or muscle, it is called an intermediate density lipoprotein (IDL). This IDL can return to the liver with its cholesterol so that the liver can repackage it to use it later or simply get rid of it. But in most cases, the IDLs remain in the blood and go through another transformation where they lose most of their remaining triglycerides. At this point, the IDLs are almost all cholesterol and are now known as LDL . About three-quarters of total cholesterol in the blood is contained within LDL particles.

why HDL-C is consider as a good cholesterol

 HDL

High-density lipoprotein (HDL) is one of the five major groups of lipoprotiens, VLDL, IDL, LDL and HDL,  which enable lipids like cholesterol and triglyceride to be transported within the water-based blood stream based. In healthy individuals, about thirty percent of blood cholesterol is carried by HDL.

HDL particles are able to remove cholesterol from within artery atheroma and transport it back to the liver for excretion or re-utilization, which is the main reason why the cholesterol carried within HDL particles (HDL-C) is sometimes called "good cholesterol.

 Reverse cholesterol transport 

The overall process by which HDL removes cholesterol from extra hepatic tissues and returns it to the liver is called reverse cholesterol transport.

Reverse cholesterol transport is a multi-step process resulting in the net movement of cholesterol from peripheral tissues back to the liver via the plasma.

Cholesterol from non-hepatic peripheral tissues is transferred to HDL by the ABCA (ATP binding cassette transporter). ApoA-1 acts as an acceptor, and the phospholipid component of HDL acts as a sink for the mobilised cholesterol.

The cholesterol is converted to cholesteryl ester by the enzyme LCAT (lecithin cholesterol acyltransferase). The cholesteryl esters can be transferred, with the help of the cholesterol-ester transfer protein (CETP) in exchange for triglycerides, to other lipoproteins  (such as LDL and VLDL), and these lipoproteins can be taken up by the liver  through its LDL receptors.

However, the receptor SR-B1(scavenger receptor class B1) present on the liver cells’plasma membranes mediates most of the liver’s uptake of cholesteryl esters from HDL in the absence of uptake of  apolipoproteins..

Once in the liver, the cholesteryl esters are converted to cholesterol and enter the general pool. Therefore, the liver can eliminate cholesterol from the body by secreting unesterified cholesterol into the bile or by converting cholesterol to bile acids. 

Uptake of HDL₂ is mediated by hepatic lipase, a special form of lipoprotein lipase found only in the liver. Hepatic lipase activity is increased by androgens and decreased by estrogens, which may account for higher concentrations of HDL₂ in women.

High and low HDL-C values correlation with cardiovascular health:

Those with higher levels of HDL-C seem to have fewer problems with cardiovascular diseases,  while those with low HDL-C cholesterol levels (less than 40 mg/dL or about 1 mmol/L) have increased rates for heart disease. While higher HDL levels are correlated with cardiovascular health, no incremental increase in HDL has been proven to improve health. In other words, while high HDL levels might correlate with better cardiovascular health, specifically increasing one's HDL might not increase cardiovascular health.  Additionally, those few individuals producing an abnormal, apparently more efficient, HDL Apo-A1 protein variant called Apo A-1 Milano, have low measured HDL-C levels yet very low rates of cardiovascular events even with high blood cholesterol values.

Thyroid disease and heart

  Thyroid disease and heart

Richard N, Fogoros reported that for people with almost any type of heart disease, disorders of the thyroid gland can worsen old cardiac symptoms or cause new ones, and can accelerate the underlying heart problem. This is why it is useful for those with heart disease to know a little about the cardiac effects of thyroid disease.

Hypothyroidism and the heart

In hypothyroidism the heart muscle is weakened in both its contraction phase, and also its relaxation phase. This means that the heart cannot pump as vigorously as it should, and the amount of blood it ejects with each heart beat is reduced. In addition, because the heart muscle does not relax normally in between heart beats, a potentially serious condition called diastolic dysfunction may result. Furthermore, hypothyroidism reduces the amount of nitric oxide in the lining of the blood vessels, causing them to stiffen.

Cardiac symptoms of hypothyroidism

Common symptoms include:

·         Shortness of breath on exertion and poor exercise tolerance.

·         Slow heart rate (bradycardia.) The heart rate is modulated by thyroid hormone, so that in hypothyroidism the heart rate is typically 10 - 20 beats per minute slower than normal.

·    Diastolic hypertension bcz the arteries are stiffer in hypothyroidism, which causes the diastolic blood pressure to rise.

·         Worsening of heart failure, or the new onset of heart failure.

·         Edema (swelling.) Swelling can occur as a result of worsening heart failure.

·         Hypothyroidism itself can produce a type of edema called myxedema, caused by an accumulation of abnormal proteins and other molecules in the interstitial fluid (fluid external to the body's cells.)

·         Worsening of coronary artery disease. While the reduction in thyroid hormone can actually make angina less frequent in patients who have angina, the increase in LDL-C (bad cholesterol) and in C-reactive protein seen with hypothyroidism can accelerate any underlying coronary artery disease.

Hyperthyroidism and the heart

In hyperthyroidism, caused by the overproduction of thyroid hormone, the heart muscle is "whipped" like a horse, and for a person with heart disease it's like whipping a tired horse. Thyroid hormone increases the force of contraction of, and the amount of oxygen demanded by, the heart muscle. It also increases the heart rate. For these reasons the work of the heart is greatly increased in hyperthyroidism. Hyperthyroidism increases the amount of nitric oxide in the lining of the blood vessels, causing them to dilate and become less stiff.

Cardiac symptoms of hyperthyroidism

Common symptoms include:

·         Fast heart rate (tachycardia) and palpitations.

·         Systolic hypertension. The forceful cardiac contraction increases the systolic blood pressure, though the increased relaxation in the blood vessels reduces the diastolic blood pressure.

·         Shortness of breath on exertion. This can be due to the skeletal muscle weakness cause by hyperthyroidism, or to a worsening in heart failure.

·         Heart failure. Hyperthyroidism itself can produce heart failure, but this condition is relatively rare.

·         Worsening angina. Patients with coronary artery disease often experience a marked worsening in symptoms with hyperthyroidism. These can include an increase in chest pain (angina) or even a heart attack.