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Prevention of Breast Cancer

I write with reference to an article titled ‘Prevention of Breast Cancer’ published on the Daily News on Feb. 23 by Dr. D.P. Athukorale. Cancer prevention is not that easy or as straight-forward as preventing Polio by immunisation or for that matter preventing HIV infection and AIDS and some measures can be very expensive.

Breast cancer (BC) is probably the most common and second deadliest cancer in women. Major risk factors for breast cancer in women are advancing age, genetic predisposition and oestrogen exposure. Approximately 85 per cent of breast cancers occur after women reach 50 years of age. Even in older age groups, many women must be screened in order to identify a single cancer.

With regard to genetic risk, it is important for the readers to know that even though a family history of breast cancer is common in women who develop breast cancer, only 5 to 6 per cent of all breast cancers are associated with germline (inherited) genetic mutations.

The majority of these involve two genes, BRCA1 and BRCA2, and testing for mutations in these genes while commercially available is prohibitively expensive. Women with multiple first-degree relatives with premenopausal breast cancer are the ones most at risk and likely to carry the genes.

For women over 50 years of age with average risk, Breast Self Examination (BSE) has been suggested as a simple screening procedure. However, the efficacy of Breast Self-Examination (BSE) is unproven.

The consensus in the developed countries (as stated in a subscriber web site of clinical updates) is that BSE not be performed except by women who express a desire to do so and who have received careful instruction to differentiate normal tissue from suspicious lumps.

Clinical Breast Examination (CBE) is a better alternative. Available indirect evidence supports the effectiveness of CBE for breast cancer screening. However, CBE is difficult to standardize and takes around 10 minutes given the workload of our doctors this may be asking a lot! The authors of the update (last in October 2008) concluded that women between the ages of 50 and 70 be screened with mammography.

For women between the ages of 40 and 50, the risks and benefits of mammography should be discussed with their clinician and the decision to perform mammography should be determined by individual patient values.

Given the high cost of mammography and limited facilities for the test, in our context one wonders whether the cut off age could be 60 and not 50 years especially for those with no family history and even then whether CBE alone would suffice?

What about the changes in lifestyle factors that may reduce risk of breast cancer? They can be adopted very widely and at no significant cost to the individual.

Among the dietary factors, animal and ecologic (international) studies show a positive correlation between fat consumption and increased breast cancer risk. The greatest benefit is in women who have a high fat intake prior to commencing a low fat diet. A high intake of soy has been shown to reduce BC in Asian women.

Increased flavonoids found in tomatoes, green peppers, berries, and citrus fruits have been associated with a modest decrease in breast cancer risk in Western populations. While one study seemed to suggest that BC was associated with a high intake of refined carbohydrates, large cohort studies have not confirmed this finding. Neither vitamin C nor vitamin E supplementation was beneficial for prevention of the cancers.

Alcohol consumption increases the risk of cancers of the colon, breast, oropharynx, and esophagus. While moderate alcohol use has some beneficial effects on cardiovascular health, consumption of as little as one drink per day has been associated with an increased cancer risk.

Physical activity is associated with a decreased risk of colon and breast cancer. The association between physical activity and decreased risk for breast and colon cancer has been demonstrated across levels of obesity, suggesting that the protective effect of activity goes beyond its impact on body weight. The optimal duration, intensity, and frequency of physical activity that may afford cancer protection is unknown.

For women who have a genetic mutation that predisposes them to breast and ovarian cancer, the authors concluded that the available options of prophylactic surgery, intensified surveillance, and chemoprevention should be explained in detail, and the comparative benefits of each of these strategies discussed with each patient and her family.

Although the strategy of bilateral oophorectomy (removal of ovaries) and mastectomy may provide the greatest degree of risk reduction, the impact on quality of life cannot be trivialized, and residual risks for malignancies remain. Tamoxifen is an anti-oestrogen drug. It is beneficial for both primary and secondary prevention in high-risk women.

Recent studies show that a newer anti-oestrogen Raloxifene when approved may be better as it has less of the side effects mentioned by Dr. A. There is no clear “best” choice among these alternatives; it is highly dependent upon the patient’s own set of values. The clinician’s job is to make the information about each option as clear as possible and to support the patient in the decision-making process.


Why are schoolchildren so indisciplined?

It is obvious that the world is making great strides with knowledge. People are said to be living in knowledge societies. Education which is the basis of knowledge, is imparted by schools for the creation of law-abiding and disciplined citizens. However, it is ironical that the problem of indiscipline has snowballed into alarming proportions in the field of education.

There are various factors that have led to this indiscipline. The parents who compell their children to learn certain subjects according to their choice, are influenced by the diverse needs in this modern complex society.

They do not seem to consider the children’s abilities or talents in this regard. The children may have some other capabilities but the choice is in the hands of the parents.

The urbanisation of society has created an environment where the children do not have any leisure time activity. Some are deprived of sports activities due to lack of space in these urban areas, in spite of the fact that sports is a must for their personality formation.

Television also has contributed much to the unrest among children who watch dramas and other programs with the adults disregarding the adverse effects made on the children.

The impact made in this way by TV, is so great that they have come up to the extent of being aggressive on many occasions. Some children do not show any interest in studies due to the background where they are born and bred.

The parents should set an example for their children’s behaviour also. It is a matter for regret that many parents do not look into the performance of their children whether they are good or bad, because the parents are

caught in the treadmill of making money.

Some parents are neither interested nor encourage their children to go on picnics or excursions organised by the schools to create an awareness among them about the natural environment and the society where they live in.

It is true that the international schools are rendering a great service by imparting education because it is impossible for the Government to absorb all the children of school going age into Government schools.

However, the parents’ interest shown in the studies of their children in international schools does not seem to be satisfactory compared to those of Government schools.

When taking about the indiscipline of the children one teacher told me that children in a certain interventional school, have used to run away from the school during the last

Period.

When complained about this situation to the authorities the irate principal has instructed the teachers “to break their legs”. This goes to prove the extent of decline in discipline.

I have observed on many occasions that the schoolchildren travelling by train, kept on standing on the foot-board ignoring the risky situation where they were in.

Against the above backdrop the children are compelled to bottle up their feelings and try to release them in schools treating them as ideal and enjoyable places.

It is the bounden duty of all adults concerned to think in terms of finding a solution to this grave social problem.


When bullets flew

When bullets flew, and people cried and hope lay on the ground

A prayer was whispered to the Saints through the resounding sound

“Oh, God, please protect us, please do not turn away”

And at that moment, a bullet went astray.

The valiant cry of soldiers, barricaded the door

While all the frightened players, lay face down to the floor

“We thank you all for coming” “please don’t misunderstand”

Shouted the Police Force outside the bus, who formed a human band

We will not let this happen; as the driver rammed into gear,

Shouting; “This won’t happen to cricket, not now, not here!”

In the horrific chaos, sacrificial declarations rang out;

“We will protect you to the end”,

And so proved that Pakistan was truly Sri Lanka’s friend.

Eight soldiers died in battle, but surely not in vain,

For the pride of one Nation lived due to the sacrifice and pain

Of all the courageous soldiers, God’s will and His Rein.

(May God forever bless the lives of the soldiers who died saving the lives of our Beloved Sri Lankan Cricket Team).


Lincoln and President

Today the President is confronted with challenges from all corners of the country. The on-going war, suppression of media freedom, the escalating Cost of Living and many more.

During the American civil war Abraham Lincoln was faced with a similar situation. He was criticised by a deputation sent to call on him. This is what he said, “Gentlemen, suppose all the property you were worth was in gold, and you had put it in the hands of Blondin famous for crossing the Niagara river on a rope.

Would you shake the rope and keep shouting ‘Blondin stoop a little more go a little faster, lean a little more to the North, lean a little more to the South. No, you would hold your breath, as well as your tongue, and keep your hands off, until he was safe over.” The Government is carrying an immense weight. Untold treasures are in our hands. We are doing the very best we can. Don’t badger us. Keep quiet and we will get your safe across.

No more deputations were sent.


Use of Sinhala and Tamil in Government Departments

It is quite surprising to find that the Government Departments still limit their official correspondence with the people only in Sinhalese. Though Tamil has been granted the official recognition in the General Administration, it is sad to observe that this bilingual administration is not implemented without any valid reason.

Recently, a Tamil writer and poet has received a circular in Sinhalese from the Cultural Section of the Regional Secretariat informing the writers, poets and other artists of a cultural competition in writing poems, short stories etc., in the three languages - Sinhalese, Tamil and English. But, the Tamil and Muslim writers have not been clearly given a Tamil translation or an English translation to understand the contents and instructions of the contests.

In fact, this is an unreasonable way of administration and denial of the rights to Tamils and Muslims to participate in the contests organised by the Cultural Department.

The taxes to the Government are paid by Tamils and Muslims too. In that case, the Government is compelled to spend money for employing a Tamil translator. Then how can the Government deny the right of winning prizes in the contests by them?

The only solution of this problem is to appoint a translator of these three languages in each Department to facilitate the communication between the officers and the people. It is also advisable for the Government to appoint a Cultural officer who is proficient in the three languages.

May I appeal to the President to give his kind consideration to reorganise the administration using Tamil language too as already emphasised in the Mahinda Chinthana.


No Ceasefire at this final hour

Every time the Tigers are on the verge of defeat militarily, they beg for a ceasefire and once declared by the Government, they continue their routine work plan to redevelop their gunnery. They do not honour the terms and conditions of the Agreement. Prabhakaran had violated the CFA and withdrew from Peace Talks in June 1990, April 1995 and April 2003.

The ceasefire has been a ploy used by the LTTE during the last two decades. Even at the final phase of the ongoing humanitarian operations, TNA Parliamentarian R. Sampanthan and the political leader of the LTTE Nadesan want the Government to declare a ceasefire to re-generate and strengthen the war machinery and bring the Terror Leader Prabhakaran from deathbed to the easy chair.

Almost all uncleared areas in the Northern Province have now been liberated by the brave Security Forces through the humanitarian war operations maintaining the Zero Civilian Casualty Policy and the Tigers are confined to a small area in the Mullativu jungle, where Prabhakaran is lying on Deathbed gasping for breath. The Tiger leadership has not yet realised the value of human life.

He is holding thousands of innocent Tamil civilians including pregnant women and infants forcibly as human shields without allowing them to move in to safe areas controlled by the Government with all necessary facilities.

UN Under Secretary General on Humanitarian Affairs Sir John Holmes who arrived on February 19 and the other visiting representatives of various welfare organisations have expressed their satisfaction over the facilities provided by the Government.

Tamil civilians who crossed over to the safe zone are very happy and grateful for the kind and generous entertainment including special medical care. R. Sampanthan who introduced Prabhakaran as the National Leader of the Tamils and their freedom fighter is the only sympathiser who sheds crocodile tears and criticises the Government and the Armed Forces making false allegations in favour of the LTTE.

He has no habit of expressing disapproval of the barbaric act of Prabhakaran’s terror due to the fear of death.

When the Marvil Aru anicut was closed by the Tigers leaving more than 70,000 Tamils to suffer immense hardships without a drop of water, the bomb explosion that took place at the IDPs checkpoint killing Tamil refugees and the heinous killing of 15 unarmed civilians including four women and a child in Inginiyagala, the TNA Member of Parliament elected by the Tamil voters did not utter a single word of sympathy and condemn the brutal act of terror.

The proxy MP has an inalienable right to appeal to the LTTE leadership to disperse the human shield, lay down arms and surrender to the Government Forces or commit suicide permitting the innocent Tamils to live in peace and harmony.

R. Sampanthan and LTTE Political Leader Nadesan should understand that the Government will not belittle the victorious war heroes and concede a ceasefire at any cost on the verge of the gallant victory of the whole nation.


Dengue outbreak in Talwatta, Kandy

An outbreak of dengue fever in Talwatta, Kandy in recent few weeks has underlined the urgent need of public health care and preventative measures to contain the disease. There has been a number of cases in this area for the last few weeks. In some cases the entire family has been affected.

Many families have one or two dengue patients, especially young ones. As we all know, Dengue fever is a debilitating mosquito-borne disease that is potentially fatal, particularly to young children and the elderly.

Apparently, during the last few years ‘Dengue control’ had become annual event for awareness rather than dealing with the underlying causes. Even such events took place mostly in and around the Colombo area.

Although people living in the Talwatta area have informed health officials and other relevant Government officials, no action has taken to remedy the situation. Therefore, I urgently request the concerned authorities to act fast to curb the situation.


Constructive and entertaining aspect of teledramas

This is in response to the article by R. Somasiri of Pannipitiya (28/2), under the heading ‘Destructive aspect of teledramas’.

The above subject no doubt provides a platform for differing views and opinions from disgruntled, perhaps malicious individuals.

Teledrama script writers in their wisdom, highlight the optimistic and aesthetic values of the young talented, enthusiastic actors and actresses which enhances their in-born talents.

The above mentioned teledramas are extremely popular, especially with the Sri Lankan expatriate community all over the world. These teledramas are considered manna from heaven for people who used to watch violent, sexually oriented corrupt films; that cannot be enjoyed as a family unite.

In contrast the Sri Lankan teledramas portray simple village life with humour and sparkling wit, presented by script writers and directors with careful propriety and decency.

Watching these teledramas one could sense the feeling of latching on to something that is part and parcel of ones’ heritage, culture, and religion and bring back nostalgic memories of Sri Lanka.

These teledramas could be enjoyed by the whole family, including children without any embarrassment or discomfort. Most of these teledramas centre on young lovers. They express their extreme love and affection in the most decent manner. A slight tap on the shoulder or holding hands would suffice to make the audience understand their deep feelings of their love.

In contrast Western films cannot be enjoyed as a family unite without deep embarrassment and discomfort. They go into lip kissing, prolong body touching, exhibiting strong sexuality. These types of episodes are taboo in our teledramas, much to the credit of producers and directors.

Some critics insist that these teledramas distort the minds of children.

This is mere foolish belligerency, with a view to discredit the teledrama industry, which earns much needed foreign exchange, and at the same time offer immense pleasure for local communities...

Perhaps these critics are motivated by personal vendettas, envy or edged on by vested interests. If these people are so worried about distorting, the minds of children watching teledramas, perhaps they should focus their benevolent minds and energies towards young innocent school children, who play truant to creep into dingy video parlours to watch pornographic films.

These illegal video parlours are mushrooming all over the island. Most of these children who frequent these parlours we are informed are as young as 12 years. Why cannot these critics shedding copious tears understand that children watching teledramas with the

family, is much better than watching pornographic films. If they are so concerned about these children they should do something to stem the tide of these illegal parlours.

Much could be said about how popular these teledramas are. I have seen Sri Lankan ladies in Australia, Sinhalese, Burgher and even Tamils impatiently waiting to purchase the next teledrama episode No need to say more about the extreme popularity of these teledramas.

Much could be also said about the actors and actresses. The girls are extremely pretty and the men handsome. They are talented, motivated and enthusiastic. Added to this lot one could observe old actors like the award winning actress, Irangani Serasinghe and some veteran actors like Wijaratne Warakagoda, joining the bandwagon.

They bring with them much needed experience, character, shine and polish into the teledrama series.

It is absolute hogwash to say that, children are angry and husbands seek divorce, due to housewives watching teledramas.

How could anybody begrudge the poor housewife and mother toiling from dawn to dusk, when she is about to relax and watch her favourite teledrama for a mere half hour in the evening. In conclusion, whatever said and done, against the teledrama industry, is well defended. Tens of thousands of teledrama enthusiasts cannot be wrong.

Anything said and done against the above subject will simmer down to a damp squib.

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