Breast cancer is one of the top cancers among women. Most of us would know someone who has, or has had breast cancer, and with the ongoing media coverage of the condition, women are becoming increasingly aware of the condition. National breast screening programmes, dedicated breast clinics, advances in modern treatment methods together with ongoing research, all play their part in the early detection and successful treatment of breast cancer.

Screening For Breast Cancer Would Include:

1. Breast Self-Examination: Large scale studies have found that breast self-examination (BSE), when used for screening, did not reduce mortality rates from breast cancer. However, it is felt that BSE does improve women's awareness of their own breasts, thus allowing any changes to picked up earlier. BSE also helps improve women's awareness of breast cancer.

There are 2 parts to Breast Self-Examination:

(i) LOOK: Look at your breasts in the mirror to check for any changes. This should be done in various positions, such as leaning forward, holding your arms up in the air and with your hands pushing in on the hips. Compare both breasts.

Look for changes on the skin of the breasts (colour, dimpling, a lump or pulling in). The nipples should also be inspected for retraction, inversion, dryness or ulceration.

(ii) FEEL: Many women find it easier to do this while having a bath, because water and soap make it easier and may enhance detection of lumps. Feel all parts of your breasts with the flat of the palm and fingers, for areas that may be different from the rest (such as a lump, a band of hard tissue or a tender area). Remember to also check under the nipples and up into the armpits.

2. Clinical Breast Examination: Women who have found any change in their breast/breasts should consult their doctors for a clinical breast examination.

3. Mammography: The basic idea behind breast cancer screening, or any other screening for that matter, is that it allows for detection of the breast cancers before they become large enough to be felt. Early detection and treatment generally results in better treatment outcomes.

Mammography screening is widely accepted as appropriate and beneficial for women above the age of 50. In Singapore, the recommendations by the Ministry of Health for Breast Cancer Screening are as follows:

Asymptomatic women 50 - 69 years

All normal risk, asymptomatic women 50 - 69 years should have screening mammograms only every 2 years.

Asymptomatic women 40 - 49 years

Women aged 40 - 49 years with no significantly increased risk, should discuss the benefits, limitations and potential harms associated with screening with their doctors before making a decision on whether or not to have screening.

Asymptomatic women < 40 years

Normal risk, asymptomatic women under 40 years of age do not require breast screening.

Asymptomatic women > 70 years

Unlike in Western nations, where evidence supports mammographic screening every 2 years in women 70 - 75 years of age, the incidence of breast cancer in this age group among Singaporean women is significantly lower. As such, screening mammography may be less beneficial. Asymptomatic women in this age group should discuss the potential benefits and risks of screening with their doctor.

The following groups of women should consult their doctor about screening for breast cancer:

• Women who have increased genetic risk for cancers
• Women on hormone replacement therapy
• Women with prior breast cancer
• Women with premalignant breast conditions

Dr Ang C.D. has been in medical practice for over 12 years. He graduated with an M.B.B.S. degree from the National University of Singapore in 1997 and subsequently completed his post-graduate diploma in Family Medicine.

He has had training in Emergency Medicine, Internal Medicine, Geriatric Medicine, Orthopaedic Surgery, Obstetrics & Gynaecology, Neurosurgery, General Surgery, Colorectal Surgery and Urology.

Dr Ang currently practices in a family clinic in Singapore, seeing a good mix of paediatric, adult and geriatric patients.

With the goal of providing local and international patients with a resource for specialist care in Singapore, Dr Ang has founded SingaporeDoc.com, a Web Directory of Specialists in Private Practice in Singapore. http://www.singaporedoc.com

By Dr Ang C. D.

The AMC, a nonprofit research institute located in Lakewood, Colo., will continue as an independent foundation devoted to financial support for research in cancer causation, prevention and control at the University of Colorado.

The merger also is designed to help increase philanthropic community support for cancer research, according to Dr. Al Marcus, interim scientific director at AMC.

"Combining efforts with the university makes both organizations stronger," says Marcus. "Not only will this enhance our ability to share research approaches and resources, but it will increase grant funding and fundraising opportunities as well. The relocation will facilitate collaborations and provide access to the state-of-the-art facilities."

AMC was originally founded as the Jewish Consumptive Relief Society in 1904, a charitable hospital and research center that treated patients with tuberculosis. In the 1950s, when that disease was brought under control, the society changed its name to the American Medical Center and directed its sizable resources to the treatment and research of cancer.

Until 1989, AMC was a hospital as well as a research center, but then began focusing entirely on research and ways to control cancer, to help patients live longer and to prevent cancer before it starts.

Cancer Center in Pittsburgh Warns of Cell Phone Risks
The head of a prominent cancer research institute issued an unprecedented warning to his faculty and staff Wednesday: Limit cell phone use because of the possible risk of cancer.

The warning from Dr. Ronald B. Herberman, director of the University of Pittsburgh Cancer Institute, is contrary to numerous studies that don't find a link between cancer and cell phone use, and a public lack of worry by the U.S. Food and Drug Administration.

Herberman is basing his alarm on early unpublished data. He says it takes too long to get answers from science and he believes people should take action now especially when it comes to children.

"Really at the heart of my concern is that we shouldn't wait for a definitive study to come out, but err on the side of being safe rather than sorry later," Herberman said.

No other major academic cancer research institutions have sounded such an alarm about cell phone use. But Herberman's advice is sure to raise concern among many cell phone users and especially parents.

In the memo he sent to about 3,000 faculty and staff Wednesday, he says children should use cell phones only for emergencies because their brains are still developing.

Adults should keep the phone away from the head and use the speakerphone or a wireless headset, he says. He even warns against using cell phones in public places like a bus because it exposes others to the phone's electromagnetic fields.

The issue that concerns some scientists though nowhere near a consensus is electromagnetic radiation, especially its possible effects on children. It is not a major topic in conferences of brain specialists.

A 2008 University of Utah analysis looked at nine studies including some Herberman cites with thousands of brain tumor patients and concludes "we found no overall increased risk of brain tumors among cellular phone users. The potential elevated risk of brain tumors after long-term cellular phone use awaits confirmation by future studies."

Studies last year in France and Norway concluded the same thing.
"If there is a risk from these products and at this point we do not know that there is it is probably very small," the Food and Drug Administration says on an agency Web site.

Still, Herberman cites a "growing body of literature linking long-term cell phone use to possible adverse health effects including cancer."

"Although the evidence is still controversial, I am convinced that there are sufficient data to warrant issuing an advisory to share some precautionary advice on cell phone use," he wrote in his memo.

A driving force behind the memo was Devra Lee Davis, the director of the university's center for environmental oncology.

"The question is do you want to play Russian roulette with your brain," she said in an interview from her cell phone while using the hands-free speaker phone as recommended. "I don't know that cell phones are dangerous. Of concern are the still unknown effects of more than a decade of cell phone use, with some studies rising alarms, said Davis, a former health adviser in the Clinton Administration.

She said 20 different groups have endorsed the advice the Pittsburgh cancer institute gave, and authorities in England, France and India have cautioned children's use of cell phones.

Herberman and Davis point to a massive ongoing research project known as Interphone, involving scientists in 13 nations, mostly in Europe. Results already published in peer-reviewed journals from this project aren't so alarming, but Herberman is citing work not yet published.

The published research focuses on more than 5,000 cases of brain tumors. The National Research Council in the U.S., which isn't participating in the Interphone project, reported in January that the brain tumor research had "selection bias." That means it relied on people with cancer to remember how often they used cell phones. It is not considered the most accurate research approach.

The largest published study, which appeared in the Journal of the National Cancer Institute in 2006, tracked 420,000 Danish cell phone users, including thousands that had used the phones for more than 10 years. It found no increased risk of cancer among those using cell phones.

A French study based on Interphone research and published in 2007 concluded that regular cell phone users had "no significant increased risk" for three major types of nervous system tumors. It did note, however, that there was "the possibility of an increased risk among the heaviest users" for one type of brain tumor, but that needs to be verified in future research.

Earlier research also has found no connection.
Joshua E. Muscat of Penn State University, who has studied cancer and cell phones in other research projects partly funded by the cell phone industry, said there are at least a dozen studies that have found no cancer-cell phone link. He said a Swedish study cited by Herberman as support for his warning was biased and flawed.

"We certainly don't know of any mechanism by which radiofrequency exposure would cause a cancerous effect in cells. Cell phones emit radiofrequency energy, a type of radiation that is a form of electromagnetic radiation, according to the National Cancer Institute. Though studies are being done to see if there is a link between it and tumors of the brain and central nervous system, there is no definitive link between the two, the institute says on its Web site.

"By all means, if a person feels compelled that they should take precautions in reducing the amount of electromagnetic radio waves through their bodies, by all means they should do so," said Dan Catena, a spokesman for the American Cancer Society. "But at the same time, we have to remember there's no conclusive evidence that links cell phones to cancer, whether it's brain tumors or other forms of cancer."

Joe Farren, a spokesman for the CTIA-The Wireless Association, a trade group for the wireless industry, said the group believes there is a risk of misinforming the public if science isn't used as the ultimate guide on the issue.

"When you look at the overwhelming majority of studies that have been peer reviewed and published in scientific journals around the world, you'll find no relationship between wireless usage and adverse health affects," Farren said.

Frank Barnes, who chaired the January report from the National Research Council, said Wednesday that "the jury is out" on how hazardous long-term cell phone use might be.

Speaking from his cell phone, the professor of electrical and computer engineering at the University of Colorado at Boulder said he takes no special precautions in his own phone use. And he offered no specific advice to people worried about the matter.

If people use a cell phone instead of having a land line, "that may very well be reasonable for them," he said.

Susan Juffe, a 58-year-old Pittsburgh special education teacher, heard about Herberman's cell phone advice on the radio earlier in the day.

"Now, I'm worried. It's scary," she said.
She says she'll think twice about allowing her 10-year-old daughter Jayne to use the cell phone.

Sara Loughran, a 24-year-old doctoral student at the University of Pittsburgh, sat in a bus stop Wednesday chatting on her cell phone with her mother. "I think if they gave me specific numbers and specific information and it was scary enough, I would be concerned," Loughran said, planning to call her mother again in a matter of minutes. "Without specific numbers, it's too vague to get me worked up."