HEALTH TRIBUNE Wednesday, July 25, 2001, Chandigarh, India

Advice to a young woman
Dr J.D. Wig
ANY women are concerned because they have a family history of breast cancer. The fear may hamper their prospects of a long and full life.

How to breastfeed with an anaemic body
Dr Jagjit Singh and Tameem Hashmi
OR the past several years, the country has been witnessing a vigorous, high-profile and expensive campaign advocating mother’s milk for infants. 

Haldi: a versatile medicine
Dr R. Vatsyayan
N the event of a small emergency arising due to a knife cut in the kitchen, guess what will an average Indian housewife do. No prize for answering. She will find the closest and the safest household remedy at hand — turmeric or haldi.

Questions & Answers
Is cancer a definite killer?
Dr S.M. Bose



Advice to a young woman
Dr J.D. Wig

MANY women are concerned because they have a family history of breast cancer. The fear may hamper their prospects of a long and full life.

Does breast cancer run in families?: If you have a close relative — your mother, sister, or daughter, who developed breast cancer before the age of 50 —, you are at a moderately increased risk of developing cancer yourself. If your mother had breast cancer at 40 years of age, you should go for regular check-ups starting at 30 years. If your relative was more distant or elderly when she developed breast cancer, you are not considered at greater risk.

Is there any risk assessment index?

Yes. The Gail Risk Assessment Index is used to estimate an individual’s risk of breast cancer. Various factors taken into consideration are age, age at the first period, age at the first live birth, the number of breast biopsies, family history and race. The assessment index in high-risk individuals can help in deciding about chemoprevention. Chemoprevention is not recommended for women at low risk.

What advice would you give regarding mammography?: Screening young woman with a family history will detect cancers at an early stage, and a survival benefit may be expected. However, several studies have shown that the sensitivity and specificity of mammography are lower for women with a family history of breast cancer. The patients should be made aware of the limited evidence and the potential disadvantages of mammography, especially the radiation risk. Early results with magnetic resonance imaging have shown higher sensitivity and specificity than mammography. After holding discussions with women, mammography screening becomes appropriate and beneficial. The women concerned should be involved in the decision-making process.

What is the role of genetic mutation testing?: Genetic testing in higher risk patients to target mutation carriers is possible for increased surveillance. Such surveillance will enhance early detection of breast cancer. The ultimate goal is the ability to manipulate the mutations and prevent breast cancer in these high-risk patients.

The discovery of genes has led to the identification of women who carry a mutation and are at a very high risk of the disease. However, this facility is only available as a research tool.

What is screen-detected cancer?

There is an abnormality on the x-ray of breast which cannot be felt. The only way to accurately define its nature is to insert a guide wire under x-ray control into this abnormality. This is not painful but is a little uncomfortable. Whether or not further surgery is required depends upon the results of the microscopic examination.

What is chemoprevention?: Chemoprevention refers to the use of medications to reduce a person’s chance of developing cancer. Oestrogen plays an important role in the development of breast cancer. Drugs that can block the action of oestrogens have been studied to see if they can prevent breast cancer.

What is Tamoxifen?: Tamoxifen can affect the growth of cancer cells by blocking oestrogen. Women with early breast cancer who take Tamoxifen have a reduced risk of recurrent breast cancer. Women treated with Tamoxifen have a reduced risk of cancer in the opposite breast. Those with a higher risk of breast cancer who take Tamoxifen had a significant reduction in breast cancer events.

What are the risks of Tamoxifen therapy?: Tamoxifen is a well tried and effective drug that has a very low incidence of side effects. Women taking Tamoxifen are more likely to experience problems with stroke and blood clots in the lungs or leg veins, an increase in cases of uterine cancer, hot flushes and vaginal dryness. These occur predominantly in women older than 50 years. Overall, the beneficial effects outweigh the adverse effects.

What is the role of prophylactic mastectomy?: Bilateral prophylactic mastectomy (removal of breasts) greatly reduces the risk of breast cancer, and prophylactic mastectomy is predicted to increase the life expectancy of carriers of genetic mutations. Techniques of mastectomy are now available which improve the aesthetic result without compromising the principles of cancer surgery.

The fear of cancer should not stand in the way of your dreams. Recent advances and newer technologies offer a better chance by substantially reducing the risk of death. Newer drugs are being tested. These can be more effective and less toxic.

Dr Wig is a renowned surgeon who gives advice to The Tribune readers regularly.



How to breastfeed with an anaemic body
Dr Jagjit Singh and Tameem Hashmi

FOR the past several years, the country has been witnessing a vigorous, high-profile and expensive campaign advocating mother’s milk for infants. In the ritualistic observance of "days" and "weeks" to awaken and educate women about the advantages of breastfeeding to babies through poster-advertisements in the media, conferences, seminars and ministerial messages, lactating mothers are exhorted to shun artificial, packed baby foods and suckle their babies in order to ensure their healthy growth.

Undoubtedly and undeniably, mother’s milk is the safest food for infants, which not only builds strong resistance against deadly diseases of childhood but also protects women from unwanted pregnancies. Hence it genuinely deserves to be publicised and promoted. But while clamourously advocating and exhorting women to breastfeed their infants, is not necessary to consider whether women in India have really adequate nutrition to be able to feed their babes without inviting any risk to themselves or to the babies?

While India has made excellent strides in health sector in recent decades, health needs of a vast majority of the women in the country, however, continue to remain unmet, thus making them susceptible to a series of diseases, particularly anaemia. A sufficient level of blood in the body is essentially vital for proper milk-yielding. But the reality is just opposite. A study conducted by the Indian Council of Medical Research (ICMR) indicates that one third of women in India have haemoglobin levels below a gm/dl, causing two to three fold increase in the prenatal mortality rate.

Even the most prosperous state of Punjab, always termed as the breadbasket of the country, is not free from this malaise where severe anaemia contributed, directly or indirectly to 35 per cent of all in-hospital maternal deaths. Similarly in Maharashtra, according to the official figures, 19 per cent women die of anaemia, the second largest killer of females in the state. All the slogans and exhortations to mothers to breastfeed their children appear hollow and a cruel joke when a World Bank publication apprises us with the stunning fact that between 50 and 90 per cent of the pregnant women in India suffer from anemia, the second largest killer of women accounting for 20 per cent of the maternal deaths.

One tends to ask: how will milk be produced in a woman’s body without sufficient blood? With dry breasts and skeletal body how will a poor mother will feed her hungry children and save them from diseases? The questions still remain unanswered.

Exacerbated by widespread malnutrition maternal mortality in India has assumed alarming heights. While the country has only 15 per cent of the world’s population, it accounts for over 20 per cent of the world’s 585,000 maternal deaths reported annually.

The Washington-based Worldwatch Institute’s shocking revelation that in an Indian village as many as 16 pregnancy-related illnesses were found to be responsible for every maternal death, is indicative of the gross insensitivity to the women’s health.

While women work from first light until dark and labour twice as many hours a day as men to meet their family needs, they generally get a lesser share of food and have virtually no health care. "Many more boys become literate than girls. Twice as many boys as girls are brought to health centres for treatment. Employment rights, social security rights, legal rights, property rights, even civil and political liberties, are likely to depend upon one cruel chromosome", observes UNICEF in one of its publications. Though said in general, these remarks reflect the true pathetic state of Indian women, a majority of whom remain deprived and denied of the fundamental right to live a healthy life today.

It is generally believed that women, compared to men, require less nutrition as they spend fewer calories. But the reality is just opposite. A field study conducted by UNICEF in an Indian village found women spending 52 calories against 31 by men. Poor nutrition among women becomes evident during infancy, persists through childhood and tends to increase with age.

With the onset of menarche, women’s needs for iron increase. In adulthood, the daily iron requirements of women are twice those of men. Aaemia can heave several causes. The diet itself may lack enough iron, or the iron content, which it contains, may not be effectively absorbed. For example, iron in meat is absorbed well, but only a low proportion of it in cereals and vegetables, which are more common in the country’s household diet, is absorbed. Malaria, infestation by intestinal parasites and as hookworm and reproductive loss of blood, for example, through menstruation contribute to the loss of iron, thus pushing women to the greater risk of dying prematurely.

In 1970, the country launched with much fanfare an ambitious programme to provide iron and folic and tablets to pregnant women. However, the programme miserably failed to yield the desired results. And this is evident from the fact that only 51 per cent of the women had been receiving the tablets, according to the data available till 1992-93. The wide gap prevailing in the coverage of women between the states can be seen from the fact that while Kerala’s achievement of distribution of anaemia prophylaxis tablet was 91.2 per cent, the relative figure of Bihar was a poor 21.4 per cent, according to the World Bank.

Even with this low coverage supplies of the tablets have been erratic forcing a number of women either to refuse or discontinue their use. Moreover, the quality of the tablets has been said to be poor and their effectiveness questionable. The malnutritional status of women is a part of a vicious circle that has particularly dangerous portents for pregnant and lactating women and their infants. Underfed and malnourished women are more likely to give birth to low birth weight babies, and if the underweight baby is a female who survives, she in turn is likely to continue to be undernourished throughout her childhood, adolescence and adult life. India’s bitter truth in this regard is that even now between seven and 10 million, which constitute one third of the total number of children taking birth in this country, are borne with low birth weight, out of which nearly one third die before completing their fifth year.

The nation’s health is closely linked to the women’s health. No policy or programme of health can succeed without taking into consideration the women’s health needs. Would the advocates of breastfeeding, therefore, address the real issue of women’s poor health first upon which subsists the very process of suckling?

Dr Jagjit Singh can be contacted at 59, Kailash Hills, New Delhi - 110 065.



Haldi: a versatile medicine
Dr R. Vatsyayan

IN the event of a small emergency arising due to a knife cut in the kitchen, guess what will an average Indian housewife do. No prize for answering. She will find the closest and the safest household remedy at hand — turmeric or haldi.

Turmeric has been used as a herb and a spice in India for thousands of years. This yellow-coloured rhizome became the focus of world attention when an American pharmaceutical company moved to get a patent on it. Turmeric grows all over India and is cultivated as a commercial crop. Known by many names as haridra, nisha and kanchani in Sanskrit (and haldi in Hindi), its scientific name is Curcuma longa.

Turmeric finds mention in almost every ayurvedic treatise — ancient, medieval or modern. It has been described as tikta and katu (bitter and pungent), laghu, rooksha and ushna (light, dry and hot). Turmeric alleviates kapha and vata. Sages supporting Ayurveda have extolled it as digestive, astringent, anti-diabetic, and helpful in blood formation. It has also been described as varnya (good for skin).

Turmeric contains volatile oils, vitamin A, protein, minerals and an overwhelming amount of carbohydrates. Its main active constituent is a substance called curcumin, which has been shown to have a wide range of therapeutic effects. It is a known anti-bacterial, anti-allergic, carminative, diuretic and anti-oxidant herb. It is used in a number of diseases like acne, blemishes, burns, autoimmune disorders and liver diseases. Turmeric is currently being evaluated for its anti-cancer properties as curcumin has been shown to inhibit tumours of the skin and the colon when it is administered in the early stages of carcinogenesis.

Used both externally and internally, some of the common household prescriptions of turmeric are as under :-

* As household first aid, the turmeric powder is applied on cuts and bruises. It works as an excellent antibiotic.

* Apply a poultice of the turmeric paste with ghee or sesame oil, when bearably hot. It is an effective remedy for sprains, wounds and inflammed joints.

* Turmeric is an important ingredient in herbal cosmetics. Used in ubtans or face packs, it helps improve the complexion. Its powder with an equal quantity of powders of white sandal, orange peel, majeeth and rose leaves is an effective paste to cure blemishes and pimples.

* Make a powder of equal amounts of turmeric, amla and sugar. Take one gram of it twice a day for a couple of weeks. It is a tried medicine in conditions involving chronic pruritis and urticaria.

* Persons responding to seasonal changes with flu, coughs and running nose are administered honey mixed with turmeric or milk boiled with a little of turmeric.

Although turmeric is used in a number of classic ayurvedic medicines, Haridrakhand is the most famous. It is known as a good blood purifier, an anti-allergic medicine and a systemic corrector. For therapeutic use, turmeric can be given up to 2 gm in two or three divided doses in a day. Though its use is generally safe, an overdose can cause acidity and nausea. As turmeric can reduce blood clotting, it should be used with caution by people taking anti-coagulants.

Dr R. Vatsyayan is an Ayurvedic consultant based at the Sanjivani Ayurvedic Centre, Ludhiana. (Phone 0161-423500 ad 431500; 
Email -



Questions & Answers
Is cancer a definite killer?
Dr S.M. Bose

Q. It is said that cancer is a sure sign of death. Is it so?

A. No. This statement is misleading. In the USA, 40 per cent to 50 per cent of all cancerous diseases are completely cured and if only early-stage cancers are considered, almost 80 per cent are cured.

Q. Has it been proved that tobacco causes cancer?

A. Yes. It has been scientifically proved that tobacco-smoking causes cancer. Tobacco (smoking as well as chewing) is not only known to produce cancer of the lungs; its association has been shown with diseases of many other organs — the larynx (voice box), the oesophagus (food pipe), the stomach, the pancreas, the urinary bladder, the breast etc.

Q. What is passive smoking and how bad is it?

A. If a person is in an environment where tobacco smoke is present, he or she is also inhaling the tobacco smoke. This is known as passive smoking. It is apparent that the passive smoker will inhale very little as compared to the active smoker but then the inhaled tobacco smoke will definitely produce harmful effects in the passive smoker also.

Q. Is cigarette with filters safer?

A. No. Cigarette filters do not give any immunity against cancer although it is well known that cigarettes with filters produce less harm than the ordinary ones.

Q. My mother had a 3 cms-sized swelling in her breast. It was painless but it turned out to be cancerous.

A. The majority of cancer swellings are painless to start with . It is only when they develop complications or become very large in size that they give rise to pain.

Q. It is said that radiation can cause cancer and at the same time radiation is used to treat cancer. How can this be?

A. You are correct. Large doses of radiation can give rise to cancer and at the same time a rational use of radiation can suppress the growth of cancer.

Q. My father had the cancer of the large intestine. It is said that this is genetically linked. How can I protect myself from developing the cancer of the large intestine.

A. The cancer of the large intestine can be gene-linked but this is passed on to the offspring in only a small percentage of the cases. It is not possible yet to prevent the development of cancer although high-fibre and low-fat diets are supposed to be helpful in preventing the development of cancer of the large intestine. What is very important is the awareness of the problem leading to the early detection and management of cancer at an early stage.

Professor Bose is the Head of the Department of Surgery at the PGI.