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.
Dr. A. S. Dissanayake
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.
R. Somasiri Pannipitiya
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).
Dr. L. M. K. Tillekeratne
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.
D. M. Victor E. Pieris Kalamulla
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.
M. Y. M. Meeadhu Kandy
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.
Mahinda Nihal Perera Moratuwa
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.
Sarath Ekanayake Kandy
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.
F. S. R. Jayamanne Melbourne
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