REASON FOR HIGHER INCIDENCE OF BREAST CANCER IN SRI LANKA CHAPTER ONE
1. Cancer is the Latin word for crab. The ancients used the word to mean a malignancy, doubtless because of the crab-like tenacity a malignant tumor sometimes seems to show in grasping tissues it invades. Cancer may also be called malignancy, a malignant tumor, or a neoplasm (literally, a new growth).
2. Now a day’s Brest Cancer is the leading cancer type among the Sri Lankan women and women in the world  .This dangerous disease is one of the challenging diseases for the modern Biological Technology. Though the human beings are trying to go beyond the nature and disturbing the ecological harmony, nature is the supreme power and is well ahead of mankind. As per the most recent statistics, incidence of breast cancer in Sri Lanka has increased among the female population and it is the leading cause of death amongst the women in Sri Lanka  .
3. The age group commonly affected is age of 45 to 55 years and investigators prooved that the more number of affected women were within the above age group. There are many factors which are causing this deadly and dreadful disease, such as Environmental Pollution, Hormonal causes, dermatological diseases, changes in life styles, generic factors and factors which are not fully understood yet. Most of the patients are detected at an advance stage of the breast cancer. The best way to cure is try to prevent it. Early detection and treatments are solution to preventing breast cancer from spreading.
4. If a person gets to know that she has a breast cancer, it is natural to surprise what may have caused the disease. No one knows the exact causes of breast cancer. At present it is proved that bumping, bruising or touching the breast does not reason for cancer and breast cancer is not contagious. The breast cancer does not transmit from one person to another person.
5. Having risk factor does not mean that each and every woman will get breast cancer. Most women who have some risk factors never develop breast cancer. Self breast exam is the powerful weapon to detect the disease at the early stage.
6. The Rose Ribbon is the symbol of breast cancer was declared worldwide and 25th October is the a breast cancer awareness day and the month of October is named as breast cancer awareness month. 
3. The aim of this paper is to find out the reason for higher incidence of breast cancer in Sri Lanka.
4. To study and investigate what factors in the Sri Lankan woman’s life style that encourages the incidence Breast Cancer.
5. The specific objectives are as follows
To study the general symptoms of breast Cancer.
To study the most risk factors for breast cancers relative to the Sri Lanka.
To study the rate of growth of breast cancer among the Sri Lankan women.
To identify the preventive methods and treatments which are available at present.
To find out the reason for higher incidence of breast cancer in Sri Lanka.
To propose recommendations to reduce the growth of breast cancer among the Sri Lankan women.
1. Breast Cancer become more common decease among the Sri Lankan women due to less health-conscious.
STATEMENT OF THE PROBLEM
2. At present, the life style of Sri Lankan women makes them less prone to diseases such as Breast Cancer. However, presently, Breast Cancer is the No 01 type of cancer common among the women in Sri Lanka
SCOPE OF THE STUDY
3. The research is focused to find out the reasons for higher incidence of breast cancer in Sri Lanka by consulting the Consultant Oncologist at Maharagama Cancer Hospital and Doctors at National Cancer Control Programme (NCCP) and the breast cancer patients at Cancer Hospital Maharagama. Further, data was gathered by a questionnaire, from women of various social states who are residing in Kalutara district at the age between 40 to 50 years who are not affected breast cancer are yet to extract their awareness and health conscious. Also the research will analyze the data and recommendation will be made to avoid the higher incidence of breast cancer in Sri Lanka.
DATA COLLECTION METHODS
4. The collection of data for the research will be drawn from the following sources
For the primary data collections, the selected Brest cancer patients (Age group 45 to 55) at Maharagama Cancer Hospital will be issued with questionnaires and answers will be obtained according to the questionnaires.
Another Questionnaire will be issued to various social states of (Age group 45 to 55) women who are not affected breast cancer yet.
(2) Interviews The doctors at Cancer instituted Maharagama and as well as the diseases affected patients will be interviewed.
(1) Official statistics Statistics will be collected from National Cancer Preventing Programme Centre at Narahenpita and Cancer Institute at Maharagama
(2) Other Relevant data and information from Internet.
THE STRUCTURE OF THE PAPER
5. The paper will be structured as follows:
Chapter I The first chapter will contain the introduction to the paper
b. Chapter II The second chapter will contain the Methodology of the study and will comprise of the following
Statement of the problem
Scope of the study
Method of data collection
Structure of the paper
Chapter III The third chapter will describe about breast cancer with following areas.
What is breast cancer
Symptoms of breast cancer
What are the risk factors for breast cancer
Treatment methods for breast cancer
How to carried out proper self breast exam
Chapter IV The fourth chapter will display the data which were collected during the research.
Chapter V The fifth chapter contains the analysis of data.
Chapter VI The sixth chapter will be the conclusion and recommendations
WHAT IS BREAST CANCER
1. Breast cancer is fateful tumors that create from cells of the breast. This fateful tumor is a group of cancer cell that may attack in to surrounding tissues or spread to isolated areas of the body. These cancers cells can spread very quickly even than the blood stream. Cancer is simply a group of abnormal cell with unusual growth patterns.
2. Cancer develops when the cells in a part of the breast start growing and growing. Breast cancer is the result of abnormal cells that grow out of the control and produce extra tissues in the breast. It is being either in the cells of the lobules, which are the milk producing glands or the ducts or the passages that drain milk from the lobules to the nipple.
3. There are many type of cancer all start due to uncontrollable growth of abnormal cells. The normal cells grow, divide and die in an orderly fashion. Cancer cells continue to grow and divide. They are deferent from normal cells. Instead of dying it survive normal cell and it will continue to form new abnormal cells.
4. The main controlling part in a cell is called as the nucleus, which contains DNA. Cancer cells starts to reproduce as a result of a mutation in a DNA. The DNA is in every cell and directs all its activities. Most of the time when DNA is damaged or cell dies or able to repair the DNA, but in cancer cell, the damaged DNA is not repaired.
SYMPTOMS OF BREAST CANCER
1. In the first stage breast cancer will not show any symptoms. Even though there were no any usual pains. Most of the breast cancer is in progress inside the breast before the presence of symptoms. Here are the woman feels the symptoms of the breast cancer.
2. A Change in the size or shape of the breast: If a mature breast changes in size or shape and chiefly it only one breast is changing very abnormally, it may be an alarm that milk ducts or the lobes deeper within the breast are swelling. These changes of breast can be appear because of the fibrocystic or ordinary monthly hormonal cycles. So woman must be aware if the changes of ordinary periodical changes are not in step. If so, consult a health professional and face to an examination immediately.
3. A lump or a thickening in the in the breast or in the armpit: Due to hormonal changes, some lump or swelling in the breast tissue may occur. But, if a lump of thickening persists in the breast area or in the armpit area, it may be an important cause to worry and the body is fighting from an invasion it can be shown by the swelling in the armpit, where the lymph nodes are positioned. A cyst or a problem in the ducts or the lobes appear because of a lump in the breast tissue.
4. Fluid leaking from the nipple (not milk): All the woman, who are in the age between 40 to 50 there may be a little bit of non – bloody leakage from the nipples of both breasts. But those women no need to be in a trouble as if the leakage happens normally, because of the hormonal changes. If the leakage happens just only from a nipple or if it’s bloody, those women must take an action as far as possible to find out and treat the problems.
5. Unusual pain in the breast or in the armpit: If an pain occurs with the monthly period in both breasts, it is not a troublesome thing to be concern as the pain is usual to you. But instead of that usual pain, if there is an unusual pain, which occurs only in one breast or armpit area, it should be check out by a doctor. All in all, the hormonal changes in both of your breasts can see by keeping a very good reward of the cycles.
6. Changers in size or shape of the nipple: The size or shape of the nipples can change with the weight of body. If nipple not returned to normal shape or pulls in you must do a manual exam by telling to a doctor and also woman who got a problem in the milk ducts, must be in a great concern to do a diagnostic mammogram test. Changers of the colour and form of the nipple or the areola like dimples, puckers or a rash on the skin of the nipple can be a alarm to an unusual sign of your health. A small rash in the nipple can turn in to a horrible breast cancer.
WHAT ARE THE RISK FACTORS FOR BREAST CANCER
7. Though breast cancer takes the first place in modern generation. Doctors or scientists still do not find and understand what precisely cause the breast cancer. But there are many reasons for breast cancer. Among of all reasons personal health history, family health history and age are the major causes. As a woman must have a healthy and vigorous personal history of her body. And woman must have the regular menstrual periods, which started before age 12 and ended after age 50 in a correct way. If a woman suffered from breast cancer in history of the family, it will also be an important point to be noticed. Because it will also help to affect from breast cancer in future to any member of the family.
8. Family History Of Breast Cancer: Women who have breast cancer among her close blood relatives, may in a direct risk. Of them, this risk can be double, if her first –degree relative ( mother, sister or daughter ) suffers from this breast cancer. And also there will be another risk, if woman’s father or brother suffers from breast cancer in her whole family history.
9. Personal History Of Breast Cancer: There will be an amplified risk of growing a breast cancer, if she is already suffering from Cancer in one breast. And this new cancer cells are little bit differ from the early cancer.
10. Race and Ethnicity: African- American women mostly die from breast cancer, instead of White women. The reason for this situation is, less concern among the African- American women. Though the White women worry so much to follow treatments, African- American women not try to do so as they are in a lower position of the society. Instead of them Asian, Hispanic and Native- American women have a minor risk of increasing and dying from breast cancer.
11. Menstrual Periods: If a woman has started her menstrual cycles at an early age like before 12 and keep it up to 55 Years of age, they have a lower threat of breast cancer.
12. Previous Chest Radiation: Women like children and younger adults sometimes do radiation therapies to the chest area, in order to prevent from another cancers ( Hodgkin disease or Non- Hodgkin lymphoma ), will be in a considerably risk of breast cancer in future. If a woman doing radiation therapy during adolescence, the risk will be in the highest point. And if a woman get radiation treatments after age 40, the risk will be in a lower point.
LIFESTYLE- RELATED FACTORS AND BREAST CANCER RISK.
13. Having children: Women have a little danger of breast cancer, if they become pregnant after 30 years of age or not having children for the whole life time. So that, become pregnant at a young age or give birth to many babies at a young age will decrease this threat somehow.
14. Breast- feeding: The risk of breast cancer will be in a lower place, if women do breast-feeding for 1 ½ to 2 years after the birth of baby.
15. Alcohol: Using alcohol is a bigger risk for having breast cancer. The risk will increase with the amount of alcohol, that one person used. As the American Cancer Society recommends, the women who take a single alcoholic drink a day have a very little risk of having breast cancer by comparing with non-drinkers. Those who take 2 to 5 drinks day by day have about 1 ½ times of threat with the women, who drink no alcohol. Extreme use of alcohol, also help to grow cancers of the mouth, throat, esophagus and liver.
16. Being Overweight or Obese: For the growth of breast cancer, there is another important fact with full of risk. Being overweight or obese after menopause is a major problem in these days among the women. Before menopause, the ovaries of woman’s body produce most of the hormone, estrogen while fat tissues produce a little. And after menopause, fat tissues take the full responsibility to produce estrogen. So that by the increasing of estrogen level, that produce from fat tissues can raise the chance of getting breast cancer. And also with the higher level of blood insulin inside the body of stout women, can link to breast cancer. The risk of breast cancer will change more, if overload fat in waist area than in hips and thighs.
17. Physical Activity: The physical activities of a woman can low the risk of having breast cancer. If a woman takes walk about 10 hours per week, it will help to decrease the risk.
18. Chemicals In The Environment: Some environmental properties have the ability to cause breast cancer throughout the society. Of them, there are things such as estrogen-like properties, that can affect someone’s body inside and die. Some plastics, certain cosmetics, personal care products, pesticides ( DDE ) and PCB’s can named as estrogen-like properties. Though these things are in the environment, nobody still can not find the exact way, how they cause breast cancer, as they are so complex.
19. Tobacco Smoke: Though there is no connection between cigarettes and breast cancer, the smoke of cigarettes take an upper position of affecting by breast cancer. By the smoke of tobacco, the breast milk will be filled with chemicals through breast tissues. And later on, this will also turn into a cancer unexpectedly.
20. Night Shifts: Women who work usually night shifts or who study at night may also at a risk of having breast cancer. This happens because of a hormone called Melatonin, that affected by body’s exposure to light to it’s production.
TREATMENT METHODS FOR BREAST CANCER
21. Patients of breast cancer have many and different treatments to do. Of them some treatments are named as Standard and some are named as Clinical Trials. Clinical Trial help to develop the current treatments and also to gain information about new treatments for breast cancer patients. So patients, who have still not started at least any treatment, they can try with Clinical Trials. Because of that, these Clinical Trials later on become as the Standard treatment. There are five types of Standard treatments to follow by breast cancer patients.
22. Surgery: By doing a surgery, surgeons try so hard to take out the lymph nodes, under the arm, that are covered with cancer cells. Surgeons normally, do this after confirming that there are cancer cells in lymph nodes, by looking from a microscope.
23. These surgeries can do in many ways to remove all the places, where the cancer cells covered. And this will however help to relive from the spreading of cancer cells. If not some patients will have to face Radiation Therapy, Chemotherapy, Hormone Therapy or Targeted Therapy under the prescriptions of doctors. These treatments directly support to low the risk of getting again with cancer by taking out all the cells in the breast.
24. Radiation Therapy: Radiation Therapy stops the growth or development of cancer cells by killing the cells with the use of high- energy X-rays or other types of radiation. There are two types of Radiation Therapy as External Radiation and Internal Radiation. To send radiation towards the cancer, doctors use the External Radiation. Internal Radiation uses to place radioactive substance sealed in seeds, wires, needles or catheters in or near to the breast.
25. Chemotherapy Chemotherapy is another cancer treatment, that kill cancer cells or stop them from dividing by injecting drugs to the body. After inserting the drugs from mouth , vein or muscle to the body, it reaches straight away to the cancer cells throughout the body and act as soon against the cancer cells.
26. Hormone Therapy To remove hormones or block the action of cancer cells, doctors use Hormone Therapy as another important cancer treatment. Normally, hormones are produce by the glands and they circulate in the bloodstream. So of them, some hormones help to grow the cancer cells. If the tests of a patient’s show an unexpected growing of cancer cells, this therapy uses to block the growth of cells.
27. Targeted Therapy: Targeted Therapy is another treatment to recognize and attack only the specific cancer cells by the aid of drugs and other substances without harming the normal cells in the body. There are two types of Targeted Therapies as Monoclonal Antibodies and Tyrosine Kinase Inhibitors.
28. Monoclonal Antibodies use antibodies, that made from the cells in immune system to treat cancer patients. By inserting antibodies to the body, they can stop the spreading of cancer cells, block the growth and even kill the cells. These antibodies help to carry many things like toxins, drugs and some radioactive substances straight away to the cancer cells.
29. Tyrosine Kinase Inhibitors, uses with the amalgamation of other anticancer drugs in order to obstruct the necessary signals for tumor, that need to grow cancer cells.
HOW TO CARRY OUT PROPER SELF BREAST EXAM
28. All women should know how to perform breast self examination and how to identify any abnormalities in your breast. Normally during menstrual periods breasts undergo various changes due to the effect of hormones. It is common for the breasts to feel tender, lump or swollen especially before periods. However after the menopause, it is common for breasts to become a soft. Therefore women with menstrual periods should do the examination one week after the monthly periods.
29. Self examination of breast: Before carried out self exam should select an enclosed location and should remove all clothing from the upper part of your body. After that stand in front of a mirror and observe both breasts in the positions indicated below.
Stand erect with arms by the side.(Figure- 3.1 )
Raise both hands over the head.(Figure- 3.1 )
Place both hands on hips and press down.(Figure- 3.1 )
Then lie down and put a towel under the shoulder of the examined breast. Examine the right breast with the left hand and left breast with the right hand. By using flat of the fingers gently fell each breast in one of three patterns. (Figure- 3.2 )
30. Every woman should have knowledge of how their breast look and feel. It is very important and by carrying out as a routine breast exam, women will familiarizing itself their breasts and will be able to get quickly notice if there are any changers like lump or variation in the breast.
Breast cancer is rising to be a major concern for the health and well being of the female population in Sri Lanka. Diagnosis and treatment would cost the government coffers invaluable money reducing the potential that could be yielded through the population. Moreover, the shock effect that one goes through when one is confronted with the news that one is diagnosed with breast cancer or any other cancer for that matter, catastrophically damages one’s will to survive and fight on. This demoralization contributes more significantly in magnifying the effect of breast cancer both in terms of health consciousness and the emotional well being of the patient.
Like any other cancer known throughout the medical world, breast cancer is widely prevalent and if detected too late would be unstoppable. However, as this paper goes on to elaborate, breast cancer, if detected with an adequate lead, could be prevented and thereby extending the hope for life in the patient as well as their loved ones. It is therefore important that a positive approach in a positive mind frame be taken by all concerned both affected and not affected for the appearance of cancer occurs mostly without warning.
Battling a cancer successfully and overcoming all odds gives a unexplainable sense of relief as well as sense of achievement to the patient and the circle of family friends and loved ones. Hence it is of prime importance that a national as well as social scale of interest be shown and integrated into the cancer prevention programme which should be conducted at national and all other sub divisional levels. The psychological advantages yielded through the alleviation or more practically the arrest of breast cancer would result in a more healthy population, better mortality rate as well as happier families resulting in a stable social and cultural life.
What is unsatisfactory in this respect is that the general interest in all scopes is still not up to the expected levels. This results in cancer awareness only when one contracts the disease or when a loved or known person contracts the disease. Hence the implementation of the recommendations would result in a better cancer free society yielding happiness, prosperity and peace.
RECOMMENDATION TO IMPROVE THE AWARENESS IN POPULATION IN GENERAL
1. As a whole the general population has no adequate knowledge in breast cancer. The services that is been already provided by the NCCP has to be further developed to enable the message to reach the society in depth.
2. The self examination for detecting of breast cancer to be made well aware to the women during the schooling period as well as during clinics and other awareness programmes conducted by midwifes and health services authorities.
3. The population is to be educated in the food habits and other habits that paves the way to initiate breast cancers and that accelerates the growth of the same.
RECOMMENDATIONS TO EDUCATE THE POPULATION ON THE STEPS TO BE TAKEN AFTER THE BREAST CANCER WAS DETECTED AT THE EARLY STAGE OF GROWTH AND THE AVAILABLE MEDICATION
4. The avenues available for the women who suspect of suffering from breast cancer to confirm or negate the presence of cancer are limited. The services that are been provided by NCCP does not meet the requirement. The services provided by the corporate sector are not accessible for the common citizen due to high costs. As such, the facilities available through state sector to be enhanced to meet the requirement.
RECOMMENDATIONS TO ADMINISTER A PATIENT WHO IS IN THE MATURED STAGES OF THE BREAST CANCER
5. The patient concerned is to be provided with all the possible care and treatments to ensure that she does not feel that the relatives have abandoned her. The presenting of the patient for the regular medical checks and keeping the patient occupied in some sought of an activity will help her to live at least a minute longer.
RECOMMENDATIONS TO ADMINSTER A PATIENT BY STRENGTHENING THE MENTAL STAMINA
6. Due to the previous experience or the stories heard, a patient who is confirmed to be suffering from a breast cancer will undergo a severe mental breakdown. Therefore the patient is to be provided with all the support required to uplift the mental draw backs and to grow the determination to fight the decease. The cardinal example is Lance Armstrong, the cycling champion of USA the 7 time winner of the tour de` France . Hence, the patient should;
a. 1st accept the fact that she is suffering from a breast cancer.
b. 2nd to accept the consequences of the ailment.
c. 3rd to strengthen the mental stamina by the means of meditation to face the reality.
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