Genetic Testing for Breast Cancer

Genetic Testing for Breast Cancer: How it Helps

Thanks to Angelina Jolie, there has been much talk in recent years about the possibility of genetic testing to check an individual’s risk of developing breast cancer. Ever since the actor underwent preventable double mastectomy after discovering that she carried gene mutations, more people are interested in understanding the concept and whether risk reduction is actually possible.

Do I have a genetically higher risk of suffering from breast cancer? Are most breast cancers attributable to gene mutation? Will all people with mutation in BRCA-(cancer causing genes) go on to develop breast cancer? When it comes to genetic testing for cancers, a lot of questions abound in the minds of common people. While the “Angelina Jolie Effect” raised much awareness about the hereditary breast and ovarian cancer syndrome (HBOC), there are a lot of prevalent myths and misconceptions that need to be cleared.

What is genetic testing?

Simply, put, genetic testing searches for specific changes in a person’s DNA .Genetic changes can have harmful, beneficial, neutral (no effect). Mutations that are harmful may increase a person’s chance, or risk, of developing a disease such as cancer. Overall, inherited mutations are thought to play a role in about 5 to 10 per cent of all cancers.

Breast Cancer: The problem

Breast cancer is today the leading cause of cancer related deaths in women in India, surpassing cervical cancer. According to estimates of World Health Organization (WHO), roughly 144,937 women in India were detected with breast cancer in 2012 and 70,218 died of it, making it one death for every two new diagnoses. With the incidence of the disease rising by more than 20% since 2008, India is expected to have a whopping 200,000 new cases of breast cancer per year by 2030.

Age, sex, ethnicity and genetic predisposition are main risk factors for breast cancer. However, today there has also been a rise in risk factors propelled by lifestyle. Like diabetes, hypertension and cardiovascular disease, rise in breast cancer incidence in India can also be attributed to the increase in urbanization, rapid adoption of westernized lifestyles, and shift in reproductive behavior, with increasing number of younger women reporting the disease.

Women who are diagnosed at a younger age also are more likely to have a mutated BRCA1 or BRCA2 genes which present poor prognosis. Doctors are also reporting the prevalence of more aggressive cancers in younger women. Hence, it becomes important to educate and create awareness about the need of genetic counseling and genetic testing for breast cancer.

What is Genetic Mutation?

Some women have a genetic mutation in the tumor-suppressing BRCA1 and BRCA2 genes. These genes, in normal cells, help prevent cancer by making proteins that keep the cells from growing abnormally. However, in case there is a genetic mutation in these genes, the risk of cancer is high for both breast as well as ovaries.

In people with normal genes, the risk of breast cancer is 12 per cent. Yet, in a person with mutation in BRCA 1 genes, the risk stands at 50-80 per cent and in a person with mutation in BRCA 2 genes, the risk is 40-70 per cent.

Similar is the case with ovarian cancer. While an individual with normal genes stands a 1-2 per cent risk of developing ovarian cancer, a person with BRCA 1 mutation has her risk amplified to 24-40 per cent and 11-18 per cent in case of BRCA mutation.

The cancer risk is amplified by mutation in both genes or one. We need to bust the prevailing myth that one of the BRCA genes is responsible for breast cancer, while the other for ovarian cancer.

Benefits of testing for BRCA1/2: Is Genetic testing a foolproof solution?

A lot of concerned women ask whether undergoing genetic testing and having its results in hand will help them prevent breast and ovarian cancer with utmost certainty. Or whether having a gene mutation means they will certainly develop the disease at some point of time in life. The answer to both questions is no.

Although they are at increased risk, not all people with BRCA1/2 mutations go on to develop cancer. Among those who do develop cancer, the age of onset and type of cancer varies. The BRCA1/2 mutations run in families. They may be inherited from a person’s mother or father. There is a 50 per cent (or one in two) chance that a child born to a parent who carries a mutation in one of these genes shall inherit the mutation.

The test cannot predict ‘if’ or ‘when’ the person will develop breast or ovarian cancer; it can only determine if he or she is at risk because of the faulty gene(s). However, a negative test result affords freedom from anxiety about either your/your progeny’s risk for inheriting the family’s cancer susceptibility. At the same time, an early diagnosis of a positive result could mean better overall prognosis or outlook.

·  If you test positive, you can consult your genetic counselor and decide on taking a preventive action such as a preventive removal of the ovaries and breasts.

·  If you test positive, you would also know the need to be additionally alert against these diseases; so that you will make sure you undergo regular screenings and mammography. Early diagnosis of breast cancer makes  a big difference to life and death, and also ensures you have to undergo less aggressive treatments as compared to people diagnosed in later stages.

·  The Food and Drug Administration (FDA), U.S.A., has approved several drugs, and drug combinations for breast cancer prevention, and treatment. Tamoxifen and Raloxifene reduce the risk of developing breast cancer, and are used for risk management among women who carryBRCA1/2 mutations.

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Who should undergo genetic testing?

Individuals with family history of any of these conditions should undergo testing:

·  Cancer in both breasts in the same woman.

·  Breast cancer diagnosed  before  50 years of age.

·  Breast and ovarian cancers in either the same woman, or in the same family.

·  Multiple tumors found in the same breast.

·  Two or more primary types of BRCA1- or BRCA2-related cancers in a single family member.

·  Case of male breast cancer.

·  Certain ethnicities, such as the Ashkenazi Jews.

What are the tests available in India?

A battery of genetic tests is available in India: Hotspot testing, Carrier testing, Full gene sequencing, Deletion/duplication analysis, and Breast Ovarian Cancer Panel (Massive Parallel Sequencing analysis of multiple genes including BRCA1/2).

CORE Diagnostics offers the entire range of testing, along with free genetic counseling for guiding medical follow-up.

Ms. Anika Parashar, COO, Fortis La Femme and a globally renowned counsellor believes that it’s not only the severity of the disease but also the stigma around it that is to be dealt with it. 

What are the common stigmas and how can they be tackled?

 The foremost stigma about Breast Cancer is that it changes your life forever. It leaves you with physical and emotional devastation, wounded in both body and spirit. And while you mostly recover, you can never return to your life like before. Plucked from the healthy herd, you are branded a “survivor” – and nothing will ever be the same. You are confirmed to be completely cured of it only if you die of something else.”

But all of this can be tackled by positive counselling of the patient and  the family. Counselling can help you to cope better with the many difficulties you face, during and after your cancer diagnosis and treatment. It can help reduce the stress you face and improve your quality of life.It has also been scientifically proven that women experienced a boost in their immunty. A counsellor may help you to find different ways of coping that had not occurred to you before. And because counselling is confidential, you can be honest about what is bothering you. 

 Breast cancer & related issues

There are a few things about breastcancer which, if taken care off can keep you away from it! First and foremost, know your breasts, the feel and lookof your breasts and hence a monthly self-examination is key. Breast self-examination should be done immediately after your periods and if you notice any mass, lump, retraction or discharge from nipples or an uneven size of the breasts you must consult a physician.  The risk factor increases when you have a family history of a breast carcinoma.

Apart from the family history there are other factors like aging, benign breast problems, early exposure to ionizing radiation, having children later in life or not at all, lack of exercise and drinking alcohol. All women above the age of 40 should have an annual mammography. Early breast cancer is completely treatable .All breast cancers are not the same! Some grow early, some grow fast and hence the prognosis for all is not the same. Breast awareness can help reduce the deaths from breast cancer, so be Breast Aware! 

There are a few concerns which often come handy with Breast Cancer. Nutritional status and dietary intake play a significant role in the prognosis of breast cancer patients and may modify the progression of disease, as well as influence risk for comorbid conditions, such as osteoporosis and cardiovascular disease. Some other common late effects include an early menopause, emotional distress and depression, fatigue or insomnia (trouble sleeping), fear of recurrence, sexuality and intimacy issues. 

Enterprise Digital Summit 2016

India Must Bridge Digital & Capability Gap

India, which has led other developing nations as being the largest exporter of information technology services and skilled manpower among developing countries, is trailing China in digitally transforming its economy? Is there a resurgence now?  The World Development Report (WDR) , recently  released by the World Bank sheds light on  reaping the benefits of digital transformation.

As far as the Internet is concerned China has stolen the march---of the top 20 internet companies, 5 are Chinese. It’s largest e-commerce company Taobao, a website for online shopping similar to eBay and Amazon, operated by Alibaba Group. has a market capitalisation that is 25 times higher than that of Flipkart, the largest e-commerce company in India.

Another major factor—as of  2014 India had 227 million Internet users, compared to 665 million in China; barely two out of every five Indian businesses had an online presence compared to almost two-thirds of firms in China. India needs to bridge the digital access and capability gap.

There is also an urgent need to improve quality of basic infrastructure — expressways, logistics, storage, postal delivery system and reliable supply of electricity — and adopt a more open  mind  towards innovations like mobile money or even ride-sharing services—in  order to facilitate easy entry of start-ups. Indian  IT professionals excel in  Silicon Valley yet the average Indian worker falls short of  his Chinese counterpart. The key is improving overall business climate and  the quality of human capital--around 25 per cent of India’s adult population cannot read and write compared to less than 5 per cent in China.

Understanding that digital transformation is at the fore of every industry and segment, was the theme of the  Enterprise Digital Transformation (EDT) Summit 2016, which concluded in Mumbai recently? The summit was aimed at looking at business through the lens of technical capabilities and how they could impact operations and revenues.  The summit was hosted by HP and the Economic Times.

Panel discussions focused on systematic planning for consistent revenue generation from digital businesses, .Only 27 per cent of the enterprises today have a logical and consistent digital strategy that sets out how the firm will create further digital business. Experts emphasised the need for concerted efforts to take the various digital initiatives across businesses to account and create a clear digital vision that maps the delivery of the revenue-generating digital experience.

It is expected that by 2018, 67 per cent of the 2000 global enterprises will have digital transformation at the centre of their corporate strategy. In other words digital transformation  is the final of 3 steps; the first being digital competence,and the second digital literacy. To put it in layman terms it simply means ‘going paperless’. This will affect not just businesses but other areas too such science, art, government, education and mass communication.

The summit offered a diverse mix of engaging keynotes, panel discussions, where leaders of the industry and noted public figures PP Choudhary (minister for Information & Technology and filmmaker Karan Johar among others, came together to discuss the journey of digital transformation.

The government also strongly believes in the need of digitization of commercial services.  “For the policy maker, digital readiness means the ability to use digital technologies to reach out to citizens and involve citizens in the process of growth, separating the gap between the haves and have- nots. We should think not only of Digital India today, but think of the opportunities presented by the Digital India of tomorrow. Not being digitally ready is not an option; Digital India is an imperative for our nation to be ready to face tomorrow,"he commented.

Karan Johar provided insights on the role of technology in digitizing the world of cinema. He added, "I'm one of the rare few people from the current lot of filmmakers who made the shift to digital editing, along with Aditya Chopra. There's been a sea change within the film fraternity when it comes to using technology. I actually edited all my films using literally a scissor in hand, snipping and slicing film together. Technology means you can try fade-ins and blurs and after the initial excitement died down, we understood how to make the most of the technology that was here to stay. The whole change has been completely, diametrically phenomenal."

The event not only consisted of the policy makers, but also the policy executors. Various sectors converged at the event, namely banking, power, trading, consumer technology, etc.

Ashish Kumar Chauhan (MD & CEO, Bombay Stock Exchange), sharing his expertise in trading and dependence of technology and IT in their daily business awed  the audience with insights into the functioning of the  the BSE. He divulged that BSE requires only 60 micro seconds for a trade transaction to be completed.

In the coming years, Bombay Stock Exchange intends to reduce this time to nanoseconds, all with the help of enterprise technology. He explained, "Technology comes in waves, and over time those waves have become shorter. Now, those waves are hitting us virtually every day. Over the last 30 years, digital technologies have changed the world fundamentally. “IT to me, is binding glue for the organization. Only the IT head knows everything about the entire organization since they work closely with each division, he added.

India has been one of the early successes in digital revolution leading in software development and information services. A case in point is the Aadhaar digital ID  which has now become a model  for other countries too. Whether the new initiatives will generate even greater and more widely shared digital dividends — faster growth, more jobs, and better services — depends not only on expanding affordable access to all, but also on making long overdue progress on the analogue complements of digital investments .

The WDR argues that digital dividends are not spreading rapidly enough? This is because of 2 major reasons--nearly 60 per cent of the world's people are still offline and,, some of the perceived benefits of the internet are being neutralized by new risks. So how can we alleviate the risks? While the World Bank has stressed the need for increased connectivity it has also emphasized the need for better regulations so that companies can innovate and compete, improve skills, make institutions more accountable so that the needs and demands of the citizens are addressed by the government.

The Key Elements of Digital Transformation

There is a total of three core or key elements that contribute towards successful starting and development of the process of digital transformation, and they are given below.

·         By 2015, about 90% of jobs will need information and communication technology-related skills

·         A whopping 93% of marketers are now making use of social media for enhancing their image, selling products and getting in touch with customers.

2016 charmed Mumbai with its exuberant list of the industry’s best speakers from various sectors talking about the role of technology in developing and identifying new business strategies to make the most of future growth. The summit offered a diverse mix of engaging keynotes, panel discussions, where leaders of the industry and noted public figures like Karan Johar (film-maker), PP Choudhary (H'ble Minister for Information & Technology, Government of India) among others, came together to discuss the journey of digital transformation.

The Government also strongly believes in the need of digitization of commercial services. PP Choudhary (Honourable Minister for Information & Technology, Government of India) being realistic about the current scenario commented “For the policy maker, digital readiness means the ability to use digital technologies to reach out to citizens and involve citizens in the process of growth, separating the gap between the haves and have nots. We should think not only of Digital India today, but think of the opportunities presented by the Digital India of tomorrow. Not being digitally ready is not an option; Digital India is an imperative for our nation to be ready to face tomorrow."

Also present at the event was eminent film-maker, Karan Johar who provided insights on the role of technology in digitizing the world of cinema. He added, "I'm one of the rare few people from the current lot of filmmakers who made the shift to digital editing, along with Aditya Chopra. There's been a sea change within the film fraternity when it comes to using technology. I actually edited all my films using literally a scissor in hand, snipping and slicing film together. Technology means you can try fade-ins and blurs and after the initial excitement died down, we understood how to make the most of the technology that was here to stay. The whole change has been completely, diametrically phenomenal."

The event not only consisted of the policy makers, but also the policy executors. Various sectors converged at the event, namely banking, power, trading, consumer technology, etc.

Ashish Kumar Chauhan (Managing Director & CEO, Bombay Stock Exchange), sharing his expertise in trading & dependence of technology & IT on their daily business kept the audience in awe of the art the BSE uses for its functioning. He divulged that BSE requires only 60 micro seconds for a trade transaction to be completed. In the coming years, Bombay Stock Exchange intends to reduce this time to nanoseconds, all with the help of enterprise technology. He explained, "Technology comes in waves, and over time those waves have become shorter. Now, those waves are hitting us virtually every day. Over the last 30 years, digital technologies have changed the world fundamentally. IT to me, is binding glue for the organization. Only the IT head knows everything about the entire organization since they work closely with each division.”

The Economic Times Enterprise Digital Transformation 2016 closed with felicitations to the key players of the industry, followed by a networking session among the speakers and delegates present at the event.

The event will be attended by top bureaucrats and industry leaders, which includes Uday Ghare (Vice President, Digital Services, Communications, Media and Entertainment at Tech Mahindra), Golok Kumar Simli (Principal Consultant & Head Technology, Passport Seva, Ministry of External Affairs, Government of India), Deepak Sharma (CDO, Kotak Mahindra Bank) and others will engage in panels and chats on the pertinent topics in the segment.

C

HamarastationHamarishaan

Colorful Commute

Colourful  Commute

Termed as one of the biggest beautification drives, over 5,000 volunteers symbolically launched Hamara Station Hamari Shaan , a citizen-driven initiative to beautify 36 railway stations of Mumbai. Mumbai First and Making A Difference Foundation (M.A.D) have partnered with the Central and Western Railway for this project. From Churchgate to Dahisar and from Masjid Bunder to Thane, all stations would be beautified during this initiative. On western line there are 21 stations which would be beautified. On the Central line there would be 15 stations taking the total to 36..

Chief Minister Devendra Fadnavis, Suresh Prabhu ( minister of railways) and actor Anil Kapoor along with MP Poonam Mahajan picked up the paint brush  and symbolically launched the campaign.

The visual theme of each station between Thane and CST on the Central Line and Dahisar and Churchgate on the Western Line, has been designed to suit the character of the place. While heritage station buildings like Bandra and CST will not be painted, stations like Marine Lines and Charni Road station, owing to their proximity to the sea, will be painted in aqua blue. The murals, vinyl sheet decorations, and the paintings will cover the walls on the platforms, the panels alongside the staircases, ticket windows and the walls on the foot over bridge. Each station has been allocated a budget of between Rs 2-5 lakh, entirely funded by corporate sponsors and volunteers.

Interestingly several other measures were announced ahead of the civic polls to be held in Februray 2017.Fadnavis  announced PM Narendra Modi will launch the elevated corridor between Chhatrapati Shivaji Terminus (CST) and Panvel and Bandra-Virar fast corridor during his visit to the city next month.

He also announced a single electronic mobile ticket for all public transport, offering respite to Mumbaiites, who spend at least an hour commuting to work.

 “We will launch the construction of CST-Panvel and Bandra-Virar elevated corridor at the hands of PM Modi. Currently, the suburban railway carries 70 lakh passengers. With the elevated corridor and metro network spanning over 117km, we would be able to mobilise another 80 lakh passengers daily,” said Fadnavis.

“The electronic ticketing app will help commuters access all kinds of public transport.

 With more than 1 crore daily passengers (75 lakh on CR and WR, and 30 lakh on BEST buses), the city’s public transport is the biggest platform to reach out to people ahead of civic polls. Moreover, the Andheri-Ghatkopar Metro and Chembur to Bhakti-Park monorail cater to three lakh passengers daily.

Shishir Joshi, the CEO of Mumbai First, announced the ‘Hamara Station, Hamari Shaan,’ project and said the program was planned in such a manner that even the daily passengers would feel these stations belong to them, as they would also take part in these beautification project. He said, “Some stations have already been beautified, but this will be a massive programme to be completed in just six days.”

Anil Kapoor said he loved local train travel and recalled memories of train journeys from Chembur to Bandra. “Recently I travelled by a local train I found stations so clean and trains so efficient and on time.”

Entertainment network Viacom18 in collaboration with NGO Mumbai First has adopted three suburban railway stations for cleanliness and beautification as part of the Central Government’s ‘Swachh Bharat Abhiyan’. Under the Viacom18’s flagship CSR programme ‘Chakachak Mumbai’ (clean and shining Mumbai), the company will support beautification of Andheri, Vile Parle and Ghatkopar stations with the help of volunteers throughout the week.

The Middle Eastern Spread that Unites & Divides

The Middle Eastern Spread that Unites & Divides

The word hummus,is an Arabic word meaning “chickpea.” --a Arab dip or spread that is made from chickpeas (also known as garbanzo beans) that have been cooked and mashed, then blended with tahini (a paste made from sesame seeds), olive oil, lemon juice, garlic and salt. It is pronounced in different ways: the Americans say hum-mus,whereas those with roots in Israel pronounce it as "choo-moose", where "ch" is the gutteral  sound we do not  have in English.

Hummus is more than just a dish. When famous American chef, author and TV personality visited  Israel and Palestine it became very clear to him that the  ownership of hummus was vociferously disputed. But we know that chickpeas are known to man almost 10,000 years back, much before there were Israelis or Arabs. The Greeks loved it and the Romans made various dishes with it. .Greece, Israel, Jordan, Egypt, Palestine, Turkey, Syria and Lebanon  claim historical ownership to this delicious and nutritious spread. Of all the conficts that plague this region, the fight over hummus  is by far the most  harmless and  absolutely delicious.

Where it truly originated, , no one can say for sure, though the earliest mention of the spread dates back to Egypt during the 13th century. The beige spread stuffed into pitas, used as a  dip and served at every Middle Eastern eatery is also an appetizer.

 No matter where it originated or who makes the best hummus,the truth is it is now recognized as the super supplement for the 21 st Century woman. This ‘ancient meal’ with profuse health benefits, has become so popular that actresses such as Sonam Kapoor and  Natalie Portman today swear by it !

Here’s why:

The main ingredient of hummus, chickpea is admired and consumed all over the world attributing to its high nutritional quality which provides a range of health benefits.
While most women today are facing a number of health issues at an early age, Hummus for them is no less than a super food.

Ideal for Skin and Blood
Made up of large amount of protein, Hummus is essential as a building block of the skin, blood, muscles and bones. It’s an added benefit for vegetarians as they can make up for the proteins that people gain from meat. Being a rich source of protein it helps balance sugar levels in the blood stream and also fights against sugar cravings.
Hummus is also reported to contain iron which boosts the energy levels enabling one to be able to train in the gym therefore losing excess weight.

High in fibre content
Enriched with high content of fibre which helps keep the digestive tract regular having hummus regularly is one of the most effective ways to ensure that fibre is being included in the diet.  A recent study states, “Consumption of fibre-rich hummus has been proven beneficial in the regulation of bowel movements and brings relief from constipation.”

Fights cancer

Hummus has been found to work against the growth of various cancer cells owing to the presence of various healthful components such as phytic acid and saponins in chickpeas. Hummus being a resource of fibre keeps the harmful toxins from binding with the colon lining and flushes them from the body.
Also, beans contain folate (Folic acid, one of the B vitamins that is a key factor in the synthesis (the making) of nucleic acid-DNA and RNA) and this can help in reducing the risk of getting colorectal cancer. This is because folate helps with division and multiplication of healthy cells in the body.

Natural anti-oxidant resulting in leaner muscle and stronger bones

The ingredients of hummus-- tahini and chick peas-- contain calcium and amino acids which help in maintaining the health of bones and muscles. This is important especially for aged women as their bones are fragile and break easily. It also helps with prevention of osteoporosis in aged people by strengthening their bones.
Amino acids are the building blocks of proteins which are found in chickpeas and the body uses it for physiological processes such as muscular strength, repairing of tissues, functioning of brain and energy production.