The importance of getting screened for common cancers.

An owl in the Dubai desert. (Dr. Noorali Bharwani)
An owl in the Dubai desert. (Dr. Noorali Bharwani)

“Facts do not cease to exist because they are ignored,” says Aldous Huxley.
Aldous Leonard Huxley was an English writer. By the end of his life, Huxley was widely acknowledged as one of the pre-eminent intellectuals of his time.

Generally speaking, many people ignore going through screening tests. They believe “no news is good news.” That is not good.

The fact remains early detection of cancer increases the chances for successful treatment and improves cure rate and prognosis. With this in mind the Government of Alberta has set up Alberta Cancer Screening Programs called Screeningforlife.

The Alberta program offers cancer screening to people who have no symptoms to get checked for breast, cervical and colorectal cancer.

Breast Cancer Screening

Just because no one in your family has had breast cancer does not mean you are not at risk. In fact, 80 per cent of women who develop breast cancer have no family history at all.

Having routine mammograms is the best way to find breast cancer early.

If you are between the ages of 50 and 74, you are at an age when it is important to consider having mammograms regularly. This is because the risk of breast cancer increases, as women get older.

Women who are under the age of 50 and over the age of 74 may need a screening mammogram on a regular basis if there are strong indications such as family history of breast cancer. These women should discuss their individual situation with their family doctor.

Cervical Cancer Screening

Screening is recommended for all average-risk females 25 to 69 years.

It is important to know cervical cancer can almost always be avoided with screening and vaccination. In fact, 90 per cent of cervical cancer can be prevented with regular Pap tests (the main screening test for cervical cancer) and following up on any abnormal results.

Georgios Nikolaou Papanikolaou (1883 – 1962) was a Greek pioneer in cytopathology and early cancer detection, and inventor of the “Pap smear”.

The single most important reason to have regular Pap tests is that they can save your life. About 75 per cent of sexually active Albertans will get HPV(human papillomavirus) in their lifetime. It is the main cause of cervical cancer. Good news is nine in 10 cases of cervical cancer can be prevented with regular Pap tests.

Colon and Rectal Cancer Screening

It is possible you may have colon cancer but have no symptoms. Speak to your doctor about colorectal cancer screening after you turn 50. Commonly used tests are:

Fecal Immunochemical Test (FIT) – This is a home stool test for people who have no symptoms and no family history of colon and rectal cancer.It is safe, easy to do and can be done right at home. Should be done once a year.

Colonoscopy – If your FIT is positive then you need a colonoscopy.A colonoscopy can also be recommended as your screening test instead of a FIT if you have any history that puts you at an increased risk.

Do not ignore the facts. Get yourself screened. If Albertans follow these guidelines then we can reduce the risk of cancer in Alberta by about 50 per cent. That would be wonderful!

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Exposure to Asbestos Leads to Many Health Problems

A beautiful view of the Canadian Rockies. (Dr. Noorali Bharwani)
A beautiful view of the Canadian Rockies. (Dr. Noorali Bharwani)

This is my 600th column and 19th year of writing What’s up doc? How time flies when you are having fun. So, here we are in 2015. Let me wish you a Happy New Year. It is never too late to wish happiness to anybody at any time of the year.

We will start the year discussing a condition that is not so common now. But there are people who are suffering and if we are not careful then more people will be affected. People who are working in old buildings and construction sites.

I am talking about the risks of exposure to asbestos. Exposure to asbestos leads to many health problems including cancer called mesothelioma. Mesothelioma (also called malignant mesothelioma) is cancer that affects the protective lining that covers many of the internal organs of the body.

Most people who develop mesothelioma have worked in jobs such as miners where they inhaled or ingested asbestos fibers, or were exposed to airborne asbestos dust and fibers in other ways.

Asbestos fibres are strong, durable and non-combustible. They were widely used by industry, mainly in construction and friction materials.

How much asbestos is in a product does not indicate its health risk. If the asbestos fibres are enclosed or tightly bound in a compound, there is no significant health risk. Asbestos poses health risks only when fibres are present in the air that people breathe.

One of the main problems with asbestos came from easily broken up asbestos used in buildings until the 1970s. People working in construction, maintenance or in the renovation of older buildings should be particularly careful.

Mesothelioma commonly affects the outer lining of the lungs and internal chest wall, but it can also arise in the lining of the abdominal cavity, the sac that surrounds the heart, or the sac that surrounds the testis.

The symptoms of asbestos exposer or mesothelioma are shortness of breath due to fluid between the lung and the chest wall, chest wall pain and unexplained weight loss.

The diagnosis may be suspected based on chest X-ray and CT scan findings, but must be confirmed either by chest fluid examination and biopsy. Mesothelioma carries a poor prognosis. Treatment with chemotherapy, radiation therapy or surgery is not very effective.

Health Canada has encouraged provincial occupational health authorities to adopt stringent workplace exposure limits for asbestos. Use of asbestos is strictly regulated under the Hazardous Products Act.

More information can be obtained from various sources like Wikipedia, Canadian Centre for Occupational Health and Safety, Health Canada and mesothelioma.net. The mesothelioma.net support group provides patients with free resources, support, education, and referrals to experienced mesothelioma doctors. For more information contact: sharon@mesotheliomahope.net

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Cancer Drugs are Being Abused by Bodybuilders

Kin Coulee Park, Medicine Hat: A beautiful mild evening look in January. (Dr. Noorali Bharwani)
Kin Coulee Park, Medicine Hat: A beautiful mild evening look in January. (Dr. Noorali Bharwani)

I was surprised when my attention was drawn to an article in MedPage Today titled “Bodybuilders Bulk Up Using… Cancer Drugs.” Should I be surprised?

“The only thing that should surprise us is that there are still some things that can surprise us,” said Francois de La Rochefoucauld (1613 – 1680). He was a noted French author with a clear-eyed, worldly view of human conduct that indulges in neither condemnation nor sentimentality.

Abusing cancer drugs to muscle up your body does call for condemnation. As we know, performance-enhancing drugs are substances used by athletes to improve their performances.

The phrase has been used to refer to several distinct classes of drugs: steroids, human growth hormone, stimulants (caffeine, amphetamine, methamphetamine), painkillers (simple analgesics to narcotics), sedatives, diuretics, blood boosters and others.

What about abuse of cancer drugs?

“Arimidex, also known by its chemical name anastrozole, is an aromatase inhibitor – a breast cancer drug. While steroids and growth hormone make headlines when athletes abuse them, breast cancer drugs are a lesser-known staple of doping regimens, for athletes and ‘weekend warriors’ alike,” says the article. Even common anti-estrogen breast cancer drugs like tamoxifen and exemestane are abused.

The article says these breast cancer drugs are on the prohibited performance-enhancing drugs lists from the U.S. Anti-Doping Agency and the World Anti-Doping Agency. But somehow some athletes manage to find them. How can this be stopped? A difficult question to answer.

Those athletes who abuse performance-enhancing drugs do eventually suffer from side effects. Hopefully, they will learn early in their lives that the best way to improve your health is by exercising regularly, eating healthy and not abusing performance-enhancing drugs. I hope somebody is listening.

Talk to you again soon. Keep smiling.

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Significance of BRCA genes in ovarian cancer.

International symbol of breast cancer awareness. (iStockphoto)
International symbol of breast cancer awareness. (iStockphoto)

First, it was Angelina Jolie, who had a double mastectomy because of increased genetic risk of breast cancer due to the presence of BRCA gene. The presence of BRCA gene also increases the risk of ovarian cancer. We know that if you have a family history of ovarian cancer then the risk of ovarian cancer increases amongst women in that family.

Take for example the recent announcement that Pierce Brosnan’s daughter Charlotte Emily died of ovarian cancer at age 42. Brosnan is a former James Bond star whose first wife, Cassandra (Charlotte’s mother), was also killed by the same disease in 1991 when she was 43. I am not sure if Charlotte Emily’s BRCA status is known.

There are two types of BRCA genes known as BRCA1 and BRCA2. BRCA is an abbreviation for breast cancer. These genes are tumour suppressor genes and once they undergo changes (mutation), their capacity to normally prevent cancer from developing is lost. It is now known that women found to have mutations in the genes have a very high risk of developing breast and ovarian cancers.

The genetic mutations are not common. About one in 500 to one in 1,000 individuals will carry a mutation or a gene change in one or another of these genes. It generally occurs amongst people who tend to stay together and don’t have offspring with people from other types of ethnicities. Experts say these mutations tend to stay within one group of individuals.

What distinguishes BRCA1 and BRCA2 genes is where they’re located in the chromosomes. There are also slight differences in terms of the types of cancers associated with the two genes.

The main difference in the two genes is that carriers of the BRCA1 gene mutation have a slightly increased risk of ovarian cancer compared to those with BRCA2. It is also known that carriers of BRCA2 genes have risks of different types of cancers, including pancreatic cancer and melanoma.

For ovarian cancer, women with a mutated BRCA1 gene have a 25 to 65 per cent lifetime risk of developing the disease. Those with a mutated BRCA2 gene have a 15 to 20 per cent chance of developing ovarian cancer.

For men, it is little different. For men with the BRCA2 mutation, there’s an increased risk of both prostate and breast cancers.

Who can ask for BRCA genetic testing?

There has to be a strong family history of cancer. The cancer must have occurred in young ages within the family and if you are a member of ethnic groups known to be affected then you would be eligible. If you don’t meet the criteria but still want to be tested then you can go south of the border and get yourself tested for about $3,000.

Early detection of breast cancer has dramatically changed the prognosis of the disease. We cannot say the same thing about ovarian cancer because we do not have any tests for early detection.

Each year, about 2400 Canadian women are diagnosed with ovarian cancer. Sadly, 1700 women with the disease die each year. In North America, ovarian cancer is the second most common gynecologic malignant disease and is the leading cause of death among women with gynecologic cancer.

More than 60 per cent of the women are in advanced stage when first diagnosed. Their five year survival rate is less than 30 per cent. Their prognosis is poor and they have very few treatment options. Some studies have reported higher survival rates of greater than 90 per cent in women with stage one disease. Only 25 per cent of the women are diagnosed early.

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