"Breastfeeding and Empowerment" - Fogsi
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
“Breastfeeding and Empowerment”
President’s Message Grantly Read
Dear FOGSIans Breast in Obstetrics and gynecology is a neglected area, as we
Greetings! are still trying to decide, in whose domain it falls, let me clarify to
all that we deal with the problems of half of our population and
Greetings, hope each one of you is
this half comes to us first for any untoward sign or symptom of
doing well and in the best of spirits.
anything, we cannot shy away from our duty and educating and
Here comes August, it may mean
guiding them in the right direction is our prime responsibility.
a lot of different things to different
Similarly breast cancer has attained the position of major killer
people, starting from Sawaan,
cancer in our country and it is one cancer, which if detected
Janamashtami and Rakshabandhan.
early has a reasonably good survival rate. Early detection needs
To a hard core Obstetrician , it
educating the women to do self examination or mammographies
is a month dedicated to Breast
wherever required, protocols need to be set for this and awareness
feeding and especially the first week of August is dedicated to
created so that the disease burden is reduced and quality of life
breastfeeding. Now why is there a need for celebrating this week,
in these patients is improved. All in all I would request all my
we have come a long way and away from breast feeding and with
colleagues to include breast in their armamentarium and help
the over medicalization of everything, simple natural bonding of
women in encouraging breast feeding and early detection of
a mother with her child has become an issue, so much so that
breast cancer.
each mother though wanting to feed her baby is under stress
of how to initiate, whether there is adequate supply, whether it Looking forward to each one contributing towards sensitising
will spoil her figure and so on and we obstetricians also need to women of our country about two major messagesregarding Breast
emphasise enough. In a recent study it was found that only 47% feeding and staying alert towards breast cancer.
of us initiate breast feeding and most of us do not spend enough Please feel free to interact with me.
time to counsel during pregnancy and many of us also never
examine breast during pregnancy. We must remember that we are
not only responsible for safe delivery, but we are also responsible
Warm regards
for the well being of the baby.
Lots of Love
A newborn baby has only three demands. They are warmth Om Shanti
in the arms of its mother, food from her breasts, and security in
the knowledge of her presence. Breastfeeding satisfies all three. Jaideep Malhotra
1
Current Perspectives Regarding Role of
Tumor Markers in Breast Cancer
Shuchi Jain, Neha Gangane, Ketki Thool
Breast cancer is the second most HER 2 Neu: It amplification or over expression has been
common type of cancer after shown to be associated with higher tumor grade and poorer
lung cancer (10.4% of all cancer prognosis. HER 2 Neu proto-oncogene is amplified and/
incidence) and the fifth most or over expressed in approximately in 25–30% of invasive
common cause of cancer death. primary breast cancers. HER 2 Neu receptor is important
Early detection of breast target for antibody-based therapy with trastuzumab
cancer both primary and (Herceptin).
recurrent, is of considerable The P53 mutation is associated with more aggressive
clinical importance, to make disease and worse overall survival. Mutant P53 does not
treatment decisions while tumor function as a tumor suppressor but can also exert tumor
burden is low, and when patients are most likely to respond promoting effects. Impaired P53 activity promotes the
to adjuvant therapy. Tumor markers provide a minimally accumulation of DNA damaged cells, which leads to a
invasive cost-effective source for monitoring disease course, cancer phenotype.
determining prognosis, and treatment planning. Plasminogen activating proteins such as urokinase-
The American Society of Clinical Oncology (ASCO) type plasminogen activator (uPA). High concentrations
has updated its recommendations for use of tumor of plasminogen activator inhibitor-1 (PAI-1) predicted
markers. Thirteen categories of breast tumor markers were an adverse outcome in node-negative patients. Patients
considered. with high uPA and PAI-1 levels benefit from adjuvant
Carcinoembryonic antigen (CEA): It is a single-chain chemotherapy. Levels of uPA, PAI-1, and uPAR in breast
glycoprotein of 641 amino acids with a molecular mass tumors may be used in routine assessment of prognosis in
of 150–300 kDa containing 45–55% carbohydrate CEA patients with newly diagnosed breast cancer.
proteins. Circulating levels of CEA in breast cancer patients Procathepsin: using the monoclonal antibodies specific
are directly dependable on the size of both primary and for the pro-form, it has been shown that the procathepsin D
metastatic tumor. Sławicki et al. reported that CEA alone is level increases in plasma of patients with metastatic breast
nonspecific for diagnosis of breast cancer. Carcinoembryonic cancer. Also, cathepsin D overexpression was associated
antigen is elevated in 30–50% of patients with symptomatic with an increased risk of recurrence and death.
metastatic breast cancer.
Cyclin E is cleaved to lower molecular weight (LMW)
Cancer antigen (CA) 15-3: It belongs to the MUC1 fragments, the LMW fragments confer resistance to
family. The MUC1 gene is overexpressed in malignant breast
tamoxifen and increase genomic instability. Elevated levels
tumors. It is more useful in determining the prognosis of
of cyclin E protein have been consistently associated with
breast cancer and to monitor the efficacy of therapy. Darlix
et al. reported that serum CA 15-3 level is independent poor and increased risk of recurrence.
prognostic factor in metastatic breast cancer patients.
Cancer antigen 27.29: It is a carbohydrate-containing
protein. It is produced by the MUC1 gene. CA 27.29 is
highly associated with breast cancer, as 80% of women with
breast cancer have an increased CA 27-29 levels. Rack et al
indicated that there is a close relationship between CA27.29
levels and tumor mass.
Estrogen receptor (ER): In invasive and metastatic
disease steroid hormone status will identify patients most
likely to benefit from endocrine therapy such as tamoxifen,
and raloxifene. Clinically, a positive ER status correlates
with favorable prognostic features, including a lower rate
of cell proliferation and histological evidence of tumor
differentiation and site of gross metastasis.
Progesterone receptor (PR): Loss of PR in ERþ tumors
may be a marker of aberrant growth factor signaling that
could contribute to the tamoxifen resistance found in the Figure 1: Anti-P53 staining using DAB chromogen showing
tumors leading to a poorer survival in women treated with nuclear stain in >50% of tumour cells scored as 3, nuclear staining
tamoxifen. detected in >10% tumor cells was taken as positive, (IHC× 200).
2
epididymis. Galgano et al. reported that HE4 is also
expressed in ductal carcinoma of the breast. However, the
serum expression levels and their diagnostic and prognostic
value in breast cancer remain to be elucidated.
Carcinoembryonic antigen and MUC1 antigen are
the most useful serum tumor markers in patients with
breast cancer. Serial determination of these markers may
be beneficial in monitoring the response to therapy and
for early detection of recurrence or metastasis. The main
disadvantages of these markers are lack of sensitivity for
low-volume disease and lack of specificity. So, they are of no
value in either screening or diagnosing early breast cancer.
Steroid receptors and HER-2 are tissue-based markers
Figure 2: Anti-HER 2 staining using DAB chromogen showing strong accepted in clinical practice, having the ability to predict the
complete membrane staining in >10 % of tumor cells scored
as 3+ and 2+, 3+ were treated as positive, (IHC× 200).
response of the tumor to hormonal therapy. Plasminogen
activator inhibitor-1 (PAI-1) and uPA are recently validated
Nestin is a marker of neural progenitors, in mammary as prognostic factors for lymph node-negative breast cancer
gland. Nestin is a potential biomarker for basal epithelial patients and may be used for selecting those patients who
breast tumor. It is considered as an excellent diagnostic tool may not need to receive adjuvant chemotherapy. Other
for a cancer of regenerative mammary cells. markers for breasst cancer such as HE4, p53, cathepsin D,
Human epididymal protein 4 (HE4) is a secretory cyclin E and nestin look promising, but further studies are
protein initially identified in epithelial cells of the human needed before their clinical utility is well-established.
3
Role of Atosiban in Preterm labor
Dr Vimee Bindra
Preterm birth
PPIUCD Inserter - Innovation in Postpartum
Family Planning - Ready to use PPIUCD
Dr (Ms) Sharad Singh
Dear Friends,
I am happy to share the innovation
on postpartum intrauterine
contraceptive device (PPIUCD)
insertion within 48 hours after
normal vaginal delivery is now
available for use in India. The Postpartum intrauterine contraceptive device insertion with
traditional IUCD inserter cannot
this new device is easy and able to place the IUCD close to the
accommodate the shape of a
fundus. Clinical trial conducted in India proved that fundal
woman’s larger postpartum uterus.
placement with the PPIUCD
Newer Markers of Breast Cancer
Dr Rashmi Vyas
There are recent advances in Human Epidermal Growth Factor
the fields of genomics, tumor Receptors
biology, and immunology.
The human epidermal growth factor receptor (HER)
These give us insights into the
family is a critical cell signaling pathway encompassing a
heterogeneity between breast
tumors, oncogenic factors , and family of four surface proteins Human Epidermal Growth
the role of the immune system factor Receptor/HER1, HER2, HER3, HER4. Oncogenic
in the natural history of breast role of HER2 protein through amplification of the gene is
cancer. found in approximately 20% of breast cancers by Slamon’s
This helps to develop new group in the late 1980s.
therapeutic strategies using different medicines, targeted These tumors usually cluster within the molecular
drug delivery systems, and immunomodulator agents in subtype known as HER2 enriched with tumors that
the treatment of both the early and metastatic stages of display a higher level of HER2-activated gene expression
the disease. responding better to HER2-targeting agents.
This review article is about the major developments in This culminated in the development of the anti-HER2
newer markers of breast cancer and how they relate to our monoclonal antibody trastuzumab for both metastatic
understanding of breast cancer and its various biologic and nonmetastatic disease.
subtypes and treatment. Work by scientists such as Erlich and Schrieber has
All of these advances, indicate that a tumor is a showed how the immune system shapes the evolution of
complex ecosystem composed of tumor cells and also of cancer over time and has provided groundwork for the
various immune/stromal/circulatory elements that must development of cancer immunotherapy.
be targeted to eradicate established cancer . Antibody-drug conjugates are also under trial which
target HER2 receptors in previously treated HER2-
Estrogen and Progesterone Receptors positive metastatic breast cancers. New researches are
Estrogen receptor (ER)–positive breast cancer is the focusing on combination therapies involving these.
most prevalent molecular subtype of breast cancer,
approximately 60% of all breast cancers are ER positive. Cyclin—dependent Kinase 4 and Cyclin-
Estrogen receptors can be in the a or b form and can dependent Kinase 6
function as either cytosolic proteins that migrate to the Cyclin-dependent kinase 4 (CDK4) and CDK6 are cell
nucleus when bound to activate ER-responsive genes or cycle regulators that promote cell growth.
as membrane-bound ERs that can activate a variety of The cyclin D-CDK4/6-pRb pathway is commonly
secondary signaling pathways involved in growth and dysregulated in hormone receptor (HR)–positive breast
survival. cancer, resulting in uncontrolled tumor growth; therefore,
Most ER-positive breast cancers cluster within the this pathway is an attractive target for cancer therapy.
luminal A and luminal B subtypes, with the latter subtype The CDK4/CDK6 inhibitor palbociclib in combination
is a higher risk group with resistance to endocrine therapy with letrozole, an aromatase inhibitor, received accelerated
and worse outcomes. approval in 2015 as a first-line treatment for metastatic
Recurrent metastatic ER-positive breast cancers either ER-positive, HER2-negative breast cancer.
have de novo resistance or develop acquired resistance to Two other oral CDK4/6 inhibitors, ribociclib and
endocrine therapy with aromatase inhibitors or tamoxifen abemaciclib, also have demonstrated promising results.
. This is because of the activation of various accessory
pathways, which allow tumors to escape the effects of Mammalian Target of Rapamycin Protein
estrogen deprivation. Many of the newer strategies seek Dysregulation of the serine/threonine protein kinase B
to block these pathways to prolong the duration of growth (PKB) pathway.
suppression in these tumors.
6
Phosphoinositide 3-kinase (PI3K) activates PKB Researchers have been focused on treatments to re-
and PKB activates the mammalian target of rapamycin engage the host immune system to attack and eradicate
(mTOR) protein. The activation of this pathway is believed established tumors.
to promote cancer cell proliferation and survival. In vitro Cytotoxic T lymphocyte—associated antigen 4
studies of rapamycin, an mTOR inhibitor, in tamoxifen- (CTLA-4) is a T-cell inhibitory receptor expressed on
resistant breast cancer cells demonstrated a dose- activated CD8+ T lymphocytes. Its role is to attenuate
dependent restoration of tamoxifen sensitivity. These
further activation during antigen presentation and to
results encouraged the development of mTOR inhibitors
downregulate immune reactions.
for the treatment of aromatase inhibitor–resistant breast
cancer. The programmed death (PD) receptor is expressed
on activated T cells; when it encounters its ligand PD-
DNA DAMAGE MARKERS BRIK1/ L1, suppression of T-cell activity occurs in the tumor
microenvironment.
BRIKA2
Triple-negative breast cancer (TNBC), which constitutes For Immunotherapy Antagonistic monoclonal
approximately 15% of diagnosed breast cancers, is so antibodies have been developed to block CTLA-4 and
named because of its negative staining for estrogen, PD-1/PD-L1 activation.
progesterone, and HER2 receptors. Up to 59% of TNBC tumors can stain positive (>1%
Unique aspects of these tumors include their cells) for PD-L1. Pembrolizumab is an inhibitor of PD-1
association with DNA damage markers, mutations shown and has completed a phase 1b trial in patients with TNBC.
in BRCA1, BRCA2 and p53 (a tumor suppressor) genes,
and higher numbers of tumor-infiltrating lymphocytes in Another group of drugs Antibody-drug conjugates
comparison with luminal tumors. (ADCs) act through two active domains: the antibody
which is specific for a particular tissue or receptor target,
The aggressive biology of TNBC and the lack of
approved targeted agents have contributed to the difficulty and the drug which is cytotoxic . A major benefit of these
in treating this disease. agents is that they have a high therapeutic index because
Approximately 20% of TNBC have either a somatic of their ability to specifically target proteins on the cell
or germline BRCA1 or BRCA2 mutation. Normal surface of cancer cells while sparing normal tissues. These
BRCA1/2 genes are responsible for DNA repair. Cancers agents have been approved in patients with HER2-positive
with mutations in these BRCA genes have defective [(ado-trastuzumab emtansine TDM1)] breast cancer, but
mechanisms in a major DNA repair pathway, leading is undergoing clinical trials for TNBC.
to high genomic instability. Some breast tumors exhibit
BRCA dysfunction known as “BRCAness.”[37] CONCLUSION
Poly Adenosine Diphosphate Ribose polymerase
Breast cancer treatment is undergoing a rapid transition
(PARP) proteins play a role in DNA repair. Because
from a histology-based approach to one based on
BRCA-mutated tumors are heavily dependent on PARP
the heterogeneous biology of each tumor to optimize
for DNA repair, it was postulated that inhibiting PARPs
in these tumors would lead to mitotic catastrophe and cell outcomes, especially in patients with metastatic disease.
death. Five PARP inhibitors have been developed and are Sequential and/or concurrent combination treatments
in clinical trials examining the treatment of TNBC with that are tolerable will be required to overcome the rapid
BRCA1/2 mutations or BRCAness. onset of acquired resistance to monotherapies.
Olaparib has completed phase two trials as a Although immunotherapy treatments have shown
monotherapy in patients with advanced breast cancer and some promise, only a small number of patients respond.
BRCA1/2 mutations and demonstrated a 41% objective Understanding how to better manipulate the tumor
response rate. microenvironment and host immune response will be
necessary to expand the clinical benefit in relatively less
T Cell inhibitory receptor – CTLA-4 immunogenic tumors such as breast cancer.
Cytotoxic T Lymphocyte associated As our technology evolves to allow more extensive
Antigen 4 and Programmed Death identification of the key markers for each patient’s
Receptors tumor(s), it will help clinicians in improving outcomes in
Immune escape is an important aspect of cancer. a value-based manner.
7
Violence against women
Dr Seema Pandey
Violence against women (VAW), 5. Miscellaneous—sati pratha, devdasi system, childhood
also known as gender-based marriage, polygamy.
violence in its semantic form is, Legal provisions for women—here are few legal acts
violent acts that are primarily or which help protecting women from various atrocities:
exclusively committed against 1. Factories act 1948—prevents a woman from working
women. more than 8 hours, only between 6.00 AM to 7 PM
The WHO defined violence 2. Maternity benefit act 1961
against women in 1993, “any act here a woman is entitled
of gender-based violence that for minimum of 12 weeks
results in, or is likely to result maternity leave
in, physical, sexual, or psychological harm or suffering to 3. Dowry prohibition act
women, including threats of such acts, coercion or arbitrary 1961—asking for dowry,
deprivation of liberty whether occurring in private or before, afyer or during
public life.” marriage is an offensive act
Lots of attention has been given to this issue in recent 4. The child marriage restrain
past, one of the main reason being rising awareness amongst act of 1976—by which no
women regarding right and wrong and unacceptance girl can be married before
of subjugation and suffering in the name of family and 18 years and a boy before
religion. The history of controlling women or considering 21 years
them as a weaker sex goes a long way and if we refer to our 5. The medical termination of pregnancy act of 1971—
historical backgrounds, women were equal or treated as a safeguards against unnecessary and compulsory
treasure only in ancient or Vedic era. Medieval period was abortions
the worst part where the conflict of two major cultures lead 6. Indian penal code section 354 and 509 safeguard
to the introduction of ‘purdah system’ and ‘child marriage’ women’s interests
and domestication of women in various forms. For example, 7. Amendments to criminal law 1983—provides a
earlier women were free to attend any religious, social, punishment of 5 years in ordinary cases and 10 years in
custodial rape cases.
or political meetings but now their place was confined
to home and kids. This lead to a patriarchal or male International initiatives to curb gender violence
dominated society where men thought of controlling their 1. International bill for rights of women- passed in general
female partners by any means and this gradually became a assembly in 1967
regular and accepted practice. Few of the following factors 2. International women’s decade (1976–1985)—was
are responsible for increasing discrimination and gender- celebrated and through three key conferences all the
based violence in our society: agendas were discussed. They considered violence
1. Patriarchal or male dominated society against women as violation of human rights
2. Unacceptable social practices 3. Women: gender equality, development, and peace for
3. Restricted life style or gender discrimination 21st century.
4. Lack of effective law system. National initiatives to curb gender violence
1. National commission for
Types of violence
women—1992
1. Physical—murder, bride 2. Reservations for
burning women in local
2. Sexual—rape, molestation, government—1992
abnormal touch, abduction 3. The national plan of
3. Mental—eve teasing, action for the girl child—
inequality in education, job 1991–2000
and financial matters 4. National policy for
4. Domestic violence—mental empowerment of the
and physical assault by family women—2001
members 5. National mission for
8
empowerment of women—2010. mindset as a society. A social awakening and change in
attitude is desired at this stage, so that we don’t have to force
Recommendations them to accept woman as an equal but it comes naturally.
1. Change in the perception of society towards dignity of
women and to treat them as equal will abolish majority
eSa ukjh gw¡---
of domestic violence issues world-wide ujefnyh vkSj lqUnjrk dh izrhd
2. Awareness about gender biases through various eSa ukjh gw¡---
platforms
3. Imparting legal educations in the schools to sensitize ek¡ cu nqfu;k dks ,d u;k thou nsus okyh
them towards their rights and how to fight eSa ukjh gw¡---
4. Motivation of the girls and women specially from poor
societies to become independent and self-sufficient
iRuh vkSj thou lafxuh cu gj eqf’dy ls
5. Strict implementation of legal procedures without any yM+us okyh
exception so people start believing in our judiciary
system and think before doing it
fQj D;w¡--
6. Developing programs and workshop to make girls and rqe ckj&ckj esjk vieku djrs gks] dHkh lhrk
women morally stronger so that they don’t hide and
dHkh vfgY;k dh rjg esjh ijh{kk ysrs gks\
tolerate any atrocities
7. Setting of family counseling centres which work D;wa rqEgkjh oklukHkwr fuxkgsa esjk ih{kk djrh
regularly to motivate and counsel the people regarding gSa---
these issues and strengthen the family bond
8. Help of media to bring out the cases of injustice and D;wa rqe ew>s tUe ysus ls igys dks[k esa gh
atrocities in public. ekj Mkyuk pkgrs gks\
Conclusion vkf[kj D;w¡\\\
Only forceful law and legislature won’t stop violence against D;w¡ fd eSa ,d ukjh gw¡\\
women or bring the desired change, need is to change our
Wonder molecule of fertility - vitamin D
Dr Shraddha Agarwal
Vitamin D is a pleotropic molecule in increased sperm count and also increases level of
which exerts paracrine and testosterone resulting in increased libido. Vitamin D also
endocrine functions mediated by affects inhibin B levels in sertoli cells and leydig cells.
genomic or nongenomic action
on multiple target organs. It Females
has been found that vitamin D Vitamin D deficiency is also found to increase the risk of
receptors are present in male and uterine myomas, endometriosis and premature ovarian
female reproductive organs and failure (decrease in AMH levels). According to European
play a major role in improving journal of endocrinology, 2012 vitamin D appears to
fertility. affect IVF outcomes as well as the level of estrogen and
progesterone. It is also associated with increased insulin
Effects on male fertility resistance in obese woman leading to polycystic ovary
Vitamin D regulated protein, CYP24A1 expression in testis syndrome. It also increases the risk of PIH and preterm birth.
serves as marker for vitamin D metabolism in spermatozoa Systemic metabolism of vitamin D with expression of
and affects sperm function. Vitamin D receptors are found proteins in target organs.
in testis as well as sperms and activated form of vitamin
D increases intracellular Calcium concentration and Vitamin D supplementation
activates molecular pathways involved in sperm motility, To consistently raise the blood levels of 25(OH)D above
capacitation and acrosome reaction in mature sperms 75nmol/L at least 1500–2000 IU/day vitamin D is required.
which is essential for fertilization. Vitamin D is responsible The doses for adult, elderly people, pregnant, and lactating
for healthy development of nucleus of sperm cells resulting woman should not exceed 4000 IU/day.
9
Vastu Tips for Stress Free Home
Swati Jaggi
Home is said to be a place where your house as it creates a negative environment
you are most relaxed and calm We should avoid sharp edge furniture as they cut
as possible, especially in today’s the energy flow and changes its direction to go in
fast paced and hectic life, this is the wrong way, if you already have them then try to
the place where you prefer going keep it covered nicely
and spending quality time but Do not block North-East corner and central area of
sometimes our homes too are your house. It is very important to have these areas
the source of stress and anxiety. clean and uncluttered
Sometimes, I get clients saying Your sleeping position is also very important, i.e.,
they are not happy when they are your head should never be in north direction when
at home or some say they get frustrated when they are alone, you sleep, best is south, east is good, and west being
well in that case my explanation is, how we do yoga and average
meditation to keep ourselves healthy and positive, the same The kitchen should be in South-East direction and
way our space also needs balancing with Vastu principles while cooking you should face East
to create peace and happiness. As it is correctly said “Your If you hang wind chimes or bells in North-West
space is a reflection of your Life, Body, and Mind’’, here are corner, it brings enjoyment and joy in relationships
few simple tips to make your house stress-free: Though black color makes the bedroom look
Mirrors should not be in bedroom and should never tasteful, but according to Vastu it should be avoided
be in the position that will reflect the bed. If there in bedrooms
are any then make sure to cover them in the night The most important point I would like to highlight
Most important point to remember is the time here is, if you have a habit of complaining and
should never stop, i.e., the clock. If there are any grumbling all the time, it creates negativity in your
watches which are broken or stopped, remove them space and should be stopped, you should feel blessed
from the house along with unwanted, broken or because there are so many people who cannot even
junk items, never keep unrepaired electronic items dream about having their own house.
at home. Make sure your house should be clutter By following the principle of Vastu which is based
free on balancing the five elements, we can have peace and
Never put violent, dark, war or unhappy pictures in happiness in our house.
Tarot for August 2018
Aries: Good month, new opportunities coming your way, increase in Scorpio: Have patience and be optimistic, things might not be
finances, happy and satisfying month. Time to enjoy the fruits working out the way you want, but things are not as bad as they
of your labor. look. Work related travel will keep you very busy this month.
Taurus: If wanting a change in job this is the right time, change Sagittarius: This month will be good for you, increase in
of country also possible. Love life will be good. income, promotion is likely. Health will be good, good month
Gemini: Do not take bold decisions, try to take a conservative for marriage and romance.
approach. Do not make major changes in life, if wanting change Capricorn: Your boss might not be easy on you this month,
hold on for sometime. Health might not be very favorable. lots of work with no appreciation, unexpected hindrances, and
Cancer: This month lady luck smiles on you, expect very losses expected.
positive changes in your life. If wanting to buy a new vehicle Aquarius: Good phase to continue, you will excel in your work
the time is favorable. Health wealth and happiness, so bask in but lots of unnecessary expenses on the cards. Be careful with
the good time. money and try to avoid extra expenses.
Leo: This month will be tough, lots of competition, things not Pisces: Lots of work but you will be getting very good results.
working the right way. Unexpected events, you might just not your bosses will be very happy with you. Efforts will yield great
feel bright this month, small health problems may also crop up. results. You have the ‘Midas’ touch this month.
Virgo: Celebrations, some auspicious ceremony to take place. Manage and control your emotions, avoid unnecessary
You might get some unexpected gains. Favors from boss or confrontations and flare ups.
family likely. If expecting a promotion you are likely to get it. Rest is in God’s hands, have a blessed August.
Libra: New contacts will prove very beneficial, lots of travel
is indicated. You will enjoy work and will be appreciated. You
might just feel under the weather, but generally a good month. —Deepa Kochhar (Noida)
kochhar.deepa@gmail.com
10Caring for your breast - Breast Awareness
Dr Shubha Sinha
Breast awareness is being aware “Screening” is an alien word.
about symptoms of breast cancer, Most people present only when symptomatic and on an
looking out for them regularly average “symptomatic” cancers are stage 2B and beyond. So
and reporting them on time to a due to late presentation survival rate decreases.
doctor.
In the West, majority of cancers (>75%) present in stage
Breast cancer is the most
1 and 2 resulting in good survival. There is an increase in
commonly occurring female
number of patients presently with mammogram detected
cancer in the world.
cancer with no symptoms. To reach this achievement India
Breast cancer is commonest needs aggressive promotion of screening and awareness
cancer of urban Indian women and proper treatment.
and second commonest in rural Indian women.
Breast cancer accounts for 27% of all newly occurring Screening for Breast cancer
cancers worldwide and approximately 15% of all cancer
deaths. Breast cancer screening is based on the concept that early
detection of the disease often makes it possible to abort the
India is experiencing an unprecendented rise in the natural progression to death, while a late diagnosis has a
number of breast cancer cases across all sections of society. more ominous outcome. Thus goal of the breast screening
More than 1 lakh women are diagnosed with breast cancer is to gain lead time.
every year (as per National Cancer Registry).
There is no way we can prevent breast cancer, but we can
definitely detect it early and treat adequately.
Only and only with early detection, we can achieve The breast screening tools involves Self breast
longer survival. examination (SBE), Clinical breast examination (CBE) and
To make people aware of early detection it is going to Screening Mammography. Breast ultrasonography and MR
need lots of efforts since Indian society is so deep rooted mammmography are optional studies done as and when
in myths and alternative treatments and unusual illogical indicated.
beliefs.
Presently, India already has one of the worst survivals Recommendations for Breast MRI
from breast cancer in the world and India ranks number screening as an adjunct to Mammography:
one in the numbers of healthy life years lost (DALY – Recommended Annual MRI screening (based on evidence)
Disability Adjusted Life Years) due to breast cancer. • BRCA mutation
Healthcare is low on priority and even in major cities • First degree relative of BRCA carrier but untested
Screening guidelines
Age group (yrs) American cancer American College National cancer US Preventive Service
society (ACS) 2003- of Radiology (ACR) Institute (NCI) Task Force(USPSTF)
2007 2004 1997 2002
20 - 39 BSE – monthly No No No recommendation
CBE – 3 yearly recommendation recommendation
40+ CBE – yearly CBE – yearly Mammography – Mammography –
Mammography - yearly Mammography - 1-2yearly 1-2yearly with or
yearly without CBE
Age to stop No upper age limit No upper age limit No upper age limit Against screening
after 70 yrs
BSE – Breast self examination ; CBE – Clinical breast examination
11• Lifetime risk of 20% - 25% as defined by BRACAPRO or Recommended against MRI screening(based
other models that are largely dependent on family history on expert consensus opinion)
Recommended Annual MRI screening (based • Women at less than 15% lifetime risk
on expert consensus opinion)
• Radiation to chest between ages 10 and 30 Ultrasound Screening
• Li Fraumeni syndrome and first degree relatives Ultrasonic Imaging has been used as an adjunct to
• Cowden and Bannayan-Riley-Ruvalcaba syndromes and mammography in women with a suspicous abnormality
first degree relatives that is not easily or fully seen on mammogram or to image
an area of the breast that has such dense fibroglandular
Insufficient evidence to recommend For or tissue that the ability of mammography to provide a clear
Against MRI screening image is limited.
• Lifetime risk of 15%-25% as defined by BRACAPRO or
other models that are largely dependent on family history Conclusion
• Lobular Carcinoma in situ (LCIS) or Atypical lobular Screening enables us to detect a cancer much before it
hyperplasia produces symptoms. As early detection of breast cancer is a
• Atypical Ductal hyperplasia key to survive breast cancer , we should promote screening.
• Heterogenously or extremely dense breast on
mammography
• Women with personal history of breast cancer including
Ductal carcinoma in situ
Dear FOGSIans, thundering sound of rain, and wind in my hair. I just love
Greetings from the beautiful rains and I hope all of you are taking small breaks to enjoy
city of Taj (Agra). the monsoon with “Chai and Pakoras”.
Yes I am back from our We are now off to Indore this week to our focused
second “Super Duper” Yuva conference on “Breast”.
FOGSI in Udaipur. Udaipur is
Stay tuned.
a beautiful city and this Yuva
was a combination of fun with
academics.
Dr Neharika Malhotra Bora
So it’s the month of sweet Joint Secretary
earthy smell, tiny droplets hanging on the leaves, FOGSI
Disclaimer: This is private Newsletter Published by Jaypee Brothers Medical Publishers for circulation among FOGSI Members
12FOGSI LONDON FOGSI INDIA MEET
Dr Kanthi Bansal
The memorable meet between that FOGSI London Chapter is growing and showing huge
Federation of Obstetricians and promises.
Gynecologists Society of India Dr Jaideep Malhotra had brought souvenir for the
(FOGSI) London & FOGSI India members of FOGSI London Chapter. She brought scarf
was held on 5th July 2018 at the for ladies and ties for gentlemen which were distributed by
Great Hall, St Bartholomew Dr Neelanjna and Dr Kanthi Bansal.
Hospital, Church House, London.
Dr Narendra and Jaideep Malhotra also brought famous
Around 70 members from
sweets from Agra, India for the meet.
London & India had attended the
meet. There were ten roundtable discussions, each with
The program started with the welcome speech by different topics. The topics includes:
Dr Dib Dutta. There was a formal introduction by the 1. Intrapartum Care basic and advanced; Maternal-fetal
stalwarts of the London Chapter FOGSI with FOGSI Medicine; Maternal Mental Health
Chapter India members. To name few members from 2. Collaborative Research and Joint publications
London Chapter FOGSI. Dr Deb Dutta, Dr Gautam 3. Uro-gynaecology, Ambulatory Gynaecology, Scanning
Mehra, Dr Jyotsana, Dr Sheela Swamy, Dr Neelanjana, 4. Joint examination courses (MRCOG, DNB, and MICOG)
Dr Reena Agarwal, Dr Manju, Dr Sameer Umerinkar, 5. Reproductive Medicine
and Dr Anu Chawla were present. From FOGSI India, 6. Conferences, Seminars, and Workshops
Dr C N Purandare, Dr Jaideep Malhotra, Dr Narendra 7. Medical Education and Training
Malhotra, Dr Rishma Pai, Dr Hrishikesh Pai, Dr Shyam 8. Simulation training, MAS, Robotics
Desai, Dr Kanthi Bansal, Dr Ameet Patki, Dr Krishnendu 9. Contraception, Sexual health, Menopause, and Oncology
Gupta, Dr Mukesh Bansal, Dr Mriganka Saha, and 10. Joint working with NGO’s and global bodies.
Dr Monica were present. The round table discussions were very fruitful. At the
Dr C N Purandare was invited to give his view on end of the roundtable discussion, two or three members
the meet. The speech by FIGO President was indeed from each table gave a brief summary about the discussion.
very supportive and gave positive message for the future Dr Jyotsana had conducted the roundtables in an excellent
development of the London Chapter FOGSI. manner. Summarized notes from each discussion were
collected by Dr Jyotsana, so that it could be implemented.
The next speech was by none other than Dr Jaideep
The ultimate outcome of these interactions was that they
Malhotra, FOGSI President. She was extremely happy to see
were new initiatives, with fruitful discussion and everyone
the Chapter grow so well within a short span of 1 year. She
looked forward to work in collaboration.
also expressed that this group meet has many purposes and
she also felt that each one in the group wanted to do much There was photo session and after the dinner, the meet
more and so the outcomes were phenomenal. According completed with closing remarks and FOGSI anthem.
to her she said plans are only good intentions unless they It was indeed a super evening with excellent
immediately degenerate to hard work. arrangements and great food. Special thanks to the loving
Dr Rishma Pai who was instrumental in starting this hosts from London Chapter FOGSI, Dr Neelanjana,
chapter said that it’s a truly special evening and appreciate Dr Sheela, Dr Jyoti, and others. Special thanks to Dr Dib
the efforts made by UK and also all the other who have Dutta for having left no stone unturned for making this
travelled from so far. meet highly successful. All the participants felt very proud
to be a part of FOGSI & FOGSI London family.
She expressed her feelings, that she felt like a mother-
watching proudly as her child grows and blossom. She said Complied by Dr Kanthi Bansal
13The Greener Doctrine
PAC—Menstrual Hygiene Awareness
May 1– May 28, 2018
Dr Archana Verma
It is a just around 28 days since Varanasi, Vijayawada, Vizag, Vadodara, and Yavatmal.
the Green the Red campaign Apart from doctors, these sessions were attended by
was launched to spread General Medical Fraternity viz Nurses, Hospital staff,
awareness about sustainable Nursing students, and Medical students also.
alternatives to disposable There has been a wave of enthusiasm among the
sanitary pads and tampons. medical fraternity - doctors are spinning off whatsapp
The campaign, has caught
groups, reaching out to different communities, writing
on in many different cities
creative slogans in regional languages, making videos
across India and has received extensive coverage in
of their views, spreading the message through local
newspapers and local radio channels.
radio channels, print media and social media and
Taking into mind the international menstrual above all trying these options for themselves.
hygiene day in mind, “The Greener Doctrine” was
Some of them have decided to stock reusable
launched on 28 April 2018, targeting 100 sessions for
menstrual hygiene products in their hospitals and
doctors by doctors in the 1 month as a run up to World
clinics to make these products more accessible to
Menstrual Hygiene Day – 28 May 2018.
women.
Three gynecologists associated with green the red
A group of doctors in Ratlam, Madhya Pradesh,
NGO contacted by the Public Awareness Committee
celebrated the Menstrual Hygiene Day on 28th of May
of the Federation of Obstetricians and Gynecologists
by conducting a menstrual hygiene camp in a distant
Society of India (FOGSI), and Dr Jaideep Malholtra,
adivasi village called Bhakat. Commendable indeed
President FOGSI, and Dr Jayderp Tank welcomed
considering our doctors have to juggle these sessions
the idea of a PAN-India campaign to promote newer
with their professional work.
modalities in menstrual hygiene management.
This year promises to be a year of menstrual
We find the most efficient way to get the message
hygiene, with celebrities talking about it, FM radio
across was to request each of the 253 FOGSI affiliated
channels composing songs on it, several organisations
societies across the country to conduct a session during
running drives to donate menstrual hygiene products
their monthly society meetings.
to the under-privileged.
The method proved to be efficient and effective.
While it is great that menstruation is finally being
In just over 30 days, more than 100 sessions has been
talked about openly, the importance of advocating
conducted in more than 80 cities covering more than
reusable menstrual hygiene products cannot be
7,000 participants. The cities where sessions have
stressed more.
happened are: Mandya, Ahmedabad, Agra, Akluj,
Both from the perspectives of our health and the
Alwar, Aurangabad, Bengaluru, Bhopal, Bharuch,
future of our environment, reusable menstrual hygiene
Bhilai, Chennai, Cochin, Dehradun, Delhi, Dhule,
Ghaziabad, Gulbarga, Indore, Ichalkaranji (near products must come into the main stream narrative of
Kolhapur), Jammu, Jabalpur, Jodhpur, Kolkata, managing menstrual hygiene. We are hopeful that the
Kukatpally(Hyd), Mathura, Meerut, Nasik, Nagpur, “The Greener Doctrine” has ensured just that!
Noida, Nagercoil, Ooty, Patna, Ralegaon, Ratlam, Thankful to whole team including Dr Manisha
Solapur, Shillong, Salem, Surat, Trichy, Ujjain, Udaipur, Surat, Dr Sneha, Dr Varshar Shehla, and Dr Shraddha.
1415
16
You can also read
