Information for doctors, medical students, other health practitioners and patients.

Sunday, July 30, 2006

Issue #2: Smoking

Statistics:

Current statistics say that about 60% of Filipino men smoke and more than half of Filipino households are not smoke-free. As many as 40% of Filipino adolescent boys smoke and mostly began in their teens. Every year, there are about 20,000 smoking-related deaths in the country. Many vendors of cigarettes are children. Sadly, there are no laws prohibiting minors from buying or selling cigarettes.

Effects of Smoking:

Cardiovascular Diseases: Recent statistical studies say that smoking is the most prevalent risk factor of cardiovascular diseases including heart attack and stroke among Filipinos.

Cancer: Tobacco contains nicotine, carcinogens, and other toxins capable of causing gum disease and oral cancer. It has also been shown that incidences of cancers of the lung, larynx, esophagus, pancreas, kidney and urinary bladder are increased in smokers.

Respiratory Disease: Cigarette smoking is responsible for >90% of chronic obstructive pulmonary disease. Smoking induces inflammatory changes in the small airways at the early stage but after more than 20 years, pathophysiologic changes in the lungs develop and progress proportional to smoking intensity and duration.

Pregnancy: Smoking is associated with several maternal complications of pregnancy including premature rupture of membranes, placental abruption, placenta previa and several others, which all lead to fetal and maternal morbidity and mortality.

Other effects: Smoking delays healing of peptic ulcers, increases the risk of osteoporosis, results in premature menopause, wrinkling of the skin gallstone and inflammation of the gallbladder in women and male impotence.

"Quit!" or "Don’t try smoking!"


These phrases are the best ways to lessen or avoid the adverse effects of smoking. Some smokers find it harder to stop smoking because of a failure of previous attempt, concern about “withdrawal” symptoms and lack of information about the possible adverse effects of smoking. Only a third of smokers think that smoking is a risk of developing cardiovascular diseases.

"Okay I will quit, but what do I get?"

Cessation of cigarette smoking reduces the risk of a second coronary event within 6-12 months after quitting, and rates of first myocardial infarction (heart attack) or death from coronary disease. After 15 years of cessation, the risk of a new myocardial infarction or death from coronary heart disease in former smokers is similar to that in those who have never smoked.

Cessation of cigarette smoking reduces the risk of developing cancer relative to continuing smoking, but even 20 years after cessation there is a modest persistent increased risk of developing lung cancer.

Changes in the small airways of young smokers will reverse after 1 to 2 years of cessation. There is a slowing of the rate of decline in lung function with advancing age rather than a return of lung function toward normal.

"I am a non-smoker; does this mean I will not be affected?"

Long-term exposure to environmental tobacco smoke increases the risk of lung cancer and coronary heart disease among nonsmokers. It also increases the incidence of respiratory infection and asthma in children. But at least your risk of developing these diseases is lower compared to smokers.

This means that the drive for cessation of smoking should be everybody’s concern. Awareness to the several adverse effects of smoking must begin in as early as the elementary school years.

Simple coping-after-quitting tips:

1. Exercise: It will serve as an outlet and can drive you away from temptations. Further, it can make you feel better about yourself.
2. Chewing gums: Use it as an alternative to put into your mouth.
3. Avoidance: Avoid smoking areas and smokers. If it is impossible to do so, just think of the reasons why you should stop smoking. At least, it will strengthen your resistance against temptation.
4. Always brush your teeth after every meal. Use mouthwash often to keep your mouth fresh.
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Saturday, July 29, 2006

Issue #1: Breast Cancer

Overview:

Breast cancer is a malignant proliferation of epithelial cells linking the ducts or lobules of the breast. It is the most common cause of cancer in women, excluding skin cancer. It is a hormone-dependent disease so that women without functiong ovaries who never receive estrogen replacement do not develop breast cancer.

Epidemiology:

Risk Factors
  1. Age - The risk of getting breast cancer increases with age but incidence begins to decline beginning at the age of menopause. The three dates in a woman's life that have a major impact on breast cancer are age at menarche, age at first full-term pregnancy and age at menopause. Women who experience menarche at age 16 have only 50-60% of the breast cancer risk of a woman having menarche (first menstruation) at age of 12; the lower risk persists throughout life. Similarly, menopause occuring 10 years before the median age of menopause (52 years), whether natural or surgically induced, reduces risk of breast cancer by about 35%. Women who have a first full-term pregnancy by age 18 have a reduced (30-40%) risk of breast cancer compared with nulliparous (or women who never experienced pregnancy) women
  2. Race - Asian women have a lower risk of developing breast cancer compared to Caucasians. It is said that Asian women have substantially lower concentrations of estrogens and progesterone.
  3. Diet - Its role to breast cancer etiology is still controversial. While there are associative links between total caloric and fat intake and breast cancer risk, the exact role of fat in the diet is uproven. Obesity and breast cancer have been closely linked with.
  4. Alcohol intake - There is a risk associated with alcohol intake but the mechanism is still unknown. Some studies say that "Two drinks daily increase the risk of getting breast cancer by about 25 percent."
  5. Radiation - It may increase the risk in younger women. Women who have been exposed to radiation before age 30 have an increased risk whereas exposure after age 30 appears to have a minimal carcinogenic effect on the breast.
  6. Heredity - It has been implied in many studies that genetics play an important role in breast cancer etiology.
Signs and Symptoms:

Early breast cancer causes no symptoms and is not painful. Usually breast cancer is discovered before any symptoms are present, either on mammography or by feeling a breast lump. A lump under the arm or above the collarbone that does not go away may be present. Other possible symptoms include breast discharge, nipple inversion and changes in the skin overlying the breast.

Screening for Breast Cancer:

Screening procedures have been recommended by doctors for early detection of breast cancer. This includes breast self exam and mammography.

Breast Self Exam:

Women are strongly encouraged to examine their breasts monthly.

  1. Timing: It is done monthly, 7 to 10 days after the first day of your menstrual period. If you are not menstruating, you perform it same day every month.
How to do it?

A multimedia presentation of performing breast self examination can be viewed in Komen.org.

Mammography:

Screening mammography has reduced the lethality of breast cancer by promoting detection at an earlier stage. The procedure is justified on an annual basis for women over age 40.

Treatment:

Surgical therapy: Depending on the staging and type of the tumor, just a lumpectomy (removal of the lump only) may be all that is necessary or removal of larger amounts of breast tissue may be necessary. Surgical removal of the entire breast is called mastectomy.

Chemotherapy: Unlike many other epithelial malignancies, breast cancer responds to several chemotherapeutic agents, including anthracyclines, alkylating agents, taxanes, and antimetabolites.

Systemic therapy: This is the use of medications to treat cancer cells throughout the body. It is used for metastatic breast cancer.

Radiation therapy: This is used after surgical removal of the breast tumor. This uses X-rays or gamma rays which are very effective in destroying the cancer cells that might recur where the tumor was removed.

Prognosis (Outcome):

The higher the stage at the time of diagnosis, the worse the prognosis of breast cancer is. This is where the importance of early screening for breast cancer comes important.

Breast Cancer in Males:

Yes, males can have breast cancers but of much lesser incidence than female breast cancer. The male to female ratio is 1:150. It usually presents as a unilateral lump in the breast and is frequently not diagnosed promptly. When male breast cancer is matched to female breast cancer by age and stage, its overall prognosis is identical.

Reference:

Braunwald, E., et al., Harrison's Principles of Internal Medicine. 2001. The McGraw-Hill Companies, Inc.

http://en.wikipedia.org/wiki/Breast_cancer

http://www.infobreastcancer.ca/bse2.htm

http://www.komen.org/bse/
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About this site

This website aims to provide simple explanations of the diseases commonly encountered by us, Filipinos. The etiology or causes, epidemiology, clinical manifestations, management, prevention, and prognosis will be discussed here.

Comments are welcomed.
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