Naturalizer Womens Joslin

Naturalizer Womens Joslin

Early Breast cancer detection at mass level; what can be done in developing countries?

Breast cancer is the most common cancer and second leading cause of cancer death in women around the world[1]. In Indian women, breast cancer is the second most common cancer, next only to carcinoma cervix. But in many urban areas in India, the breast cancer has recently emerged as the leading cancer in women [2].Breast cancer constitutes about 19-34% of all cancer cases among women in India [3,4,5]. Age adjusted incidence of breast cancer in India varies from 16 to 25 per lac population and approximately 80,000 new cases of breast cancer are diagnosed every year.[6]. With the rapid urbanization and changing lifestyle, the numbers are likely to increase further.

Early diagnosis and prompt treatment are paramount to improving the outcome of breast cancer. In India, early breast cancer constitutes about 30% [7] and locally advanced breast cancer constitutes about 50-70% of the breast cancer load. [8]. Accordingly, the proportional mortality rates in our country are much higher compared to North America where majority of cases present in early stages. The incidence to mortality ratio in North America is 0.25 compared to 0.48 in India [9]. Similarly, 5-year survival of over 70% in North America and western Europe is much higher than less than 48 % in India [10,11] and less than 10% in other developing countries [12]. 

There are many barriers to early diagnosis and treatment in India and other developing countries. First, women are not able to detect a lump in their breast early. Second, even after discovering a painless lump, they fail to understand its cancerous nature or prevalent notion of incurable nature of cancer prevents them from reporting to a healthcare facility early. This fact is supported by various studies in India and other developing countries which show that 79-98% of the women surveyed don't know that a painless lump in a breast can be cancer [14,15]and more than 75% of women link painful lumps and pain in the breast to cancer.[13]. Third, access to healthcare facility is limited in rural areas where majority of population lives. Last, conservative socio-cultural milieu prevents a woman from approaching male health care personnel for early check-up. The relative contribution of each of these factors is a matter of speculation.

 To facilitate early identification of  a lump in the breast, there are 3 available modalities; BSE(breast self examination), CBE (clinical breast Examination) and mammography. Both Mammography and CBE are effective in decreasing mortality due to breast cancer[16-21] Recommending mammography as a regular screening test on mass scale in India is impractical because of the astronomical costs involved in developing the requisite infrastructure and manpower. Moreover, the burden of breast cancer in developing countries is more in younger age group[3] in which the efficacy of mammography to detect breast cancer is questionable[22]. Similarly regular CBE on mass scale is logistically difficult due to scarcity of trained health personnel and socio-religious taboos regarding clinical breast examination [23,24].

BSE is a simple and inexpensive tool and can be performed by women themselves. Some studies have shown that practicing BSE helps to detect breast cancer lumps of smaller sizes [25-29] and leads to early diagnosis of breast cancer [25-34]but this does not translate in to reduction in mortality from breast cancer[35-37]. Presently, there is insufficient evidence to recommend for or against the teaching of BSE [38]. Conversely, BSE increases the number of physician visits for the evaluation of benign breast lesions and leads to higher rates of benign breast biopsies[35-37]. Also, proper technique of BSE is expensive to teach and difficult to perform[39-43]. Hence, the status of BSE as a screening modality on mass scale is debatable [35,44,45]. Furthermore, even in women performing BSE regularly, many early detected tumors are found incidentally and not during self examination[46-49]. Thus conventional screening tools are impracticable in developing countries highlighting the need for novel approaches.

 Prevalent misconceptions of pain associated with any cancerous breast lump and incurability of cancer are unaddressed issues in developing countries. Creating awareness on mass scale about these facts that any lump in the breast even a painless one can be cancer as well as curability of early diagnosed breast cancer is the need of the hour.  This strategy is relatively easy, inexpensive and practicable in resource restricted countries till standard screening tools are universally available, affordable  and accessible to masses.

 

References

1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics,202. CA Cancer J Clin 2005,55(2): 74-108
2. Indian Council of Medical Research. National Cancer Registry Programme of India - an Overview. NCRP: Bangalore; 2002
3. National Cancer Registry Programme. Consolidated report of the population based cancer registries1990-1996. New Delhi: Indian Council of Medical Research; 2001
4. National Cancer Registry Programme. Ten year consolidated report of the hospital based cancer registries 1984-1993. An assessment of the burden and care of cancer patients. New Delhi: Indian Council of Medical Research; 2001
5. National Cancer Registry Programme. Consolidated report of the population based cancer registries1990-1996. Supplement: Year-wise tabulation of incident cancers and rates by site and gender. New Delhi: Indian Council of Medical Research; 2001
6. Nair MK, Sankaranarayanan R, Nair KS, Amma NS, Varghese C, Padmakumari G, et al. Overall survival from breast cancer in Kerala, India, in relation to Menstrual, Reproductive, and Clinical factors. Cancer 1993;71:1791-6
7. Nandakumar A, Anantha N, Venugopal TC, Sankaranarayanan R, Thimmasetty K, Dhar M. Survival in breast cancer: A population-based study in Bangalore, India. Int J Cancer 1995;60:593-6.
8. Chopra R. The Indian scene. J Clin Oncol 2001;19:106S-11S
9. Parkin DM, Pisani P, Ferlay J. Global cancer statistics. CA Cancer J Clin 1999;49:33-64
10. Goel AK, Seenu V, Shukla NK, Raina V. Breast cancer presentation at a regional cancer center. Natl Med J India 1995;8:6-9
11. Gajalakshmi CK, Shanta V, Swaminathan R, Sankaranarayanan R, Black RJ. A population-based survival study on female breast cancer in Madras, India. Br J Cancer 1997;75:771-5
12. Okobia MN, Osime U.Clinicopathological study of carcinoma of breast in Benin city. Afr J Reprod Health 2001;5(2)56-62
13. Odusanya OO, Tayo OO. Breast cancer knowledge, attitudes and practice among nurses in Lagos, Nigeria. Acta Oncol 2001;40(7):844-848
14. Okabia MN, Bunker CH, Okonofua FE, Osime U. Knowledge, attitude and practice of Nigerian women towards breast cancer: A cross sectional study. Wor J Surg Onco 2006;4:11-20
15. Oluwatosin   OA, Oladepo O.Knowledge of breast cancer and its early detection measures among rural women in Akinyele local government area, Ibadan, Nigeria. BMC Cancer 2006; 6: 271
16. Kerlikowske K, Grady D, Rubin SM, Sandrock C, Ernster VL. Efficacy of screening mammography. A meta-analysis. JAMA 1995;273:149–54
17. Wells MJ. Mammography and the politics of randomized controlled trials. Br Med J 1998;317:1224-1230
18. Smart CR, Hendrick RE, Rutledge JH 3d, Smith RA. Benefit of mammography screening in women ages 40 to 49 years. Current evidence from randomized controlled trials. Cancer 1995;75:1619-26 (published erratum appears in Cancer 1995;75).
19. Tabar L, Fagerberg G, Chen HH, Duffy SW, Smart CR, Gad A, et al. Efficacy of breast cancer screening by age. New results from the Swedish Two-county Trial. Cancer 1995;75:2507-17
20. Miller AB, To T, Baines CJ, Wall C. Canadian National Breast Screening Study-2: 13-year results of a randomized trial in women aged 50–59 years. J Natl Cancer Inst 2000;92:1490–9
21. Maxwell AE, Bastani R, Warda US. Demographic predictors of cancer screening among Filipino and Korean immigrants in the United States. Amer J Prev Med 2000;18:62–68.
22. Maxwell AE, Bastani R, Warda US. Misconceptions and mammography use among Filipino-and Korean-American women. Ethnc and Dis. 1998;8:377–384
23. Owen WL, Hoge AG, Asal NR, Anderson PL Jr, Cucchiara AJ. Self-examination of the breast: use and effectiveness. South Med J 1985;78:1170–3.
24. Smith EM, Francis AM, Polissar L. The effect of breast self-exam practices and physician examinations on extent of disease at diagnosis. Prev Med 1980;9:409–17
25. McPherson CP, Swenson KK, Jolitz G, Murray CL Survival of women ages 40–49 years with breast carcinoma according to method of detection. Cancer 1997;79:1923–32
26. Smith EM, Burns TL. The effects of breast self-examination in a population-based cancer registry. Cancer 1985;55:432–7
27. Koibuchi Y, Iino Y, Takei H, Maemura M, Horiguchi J, Yokoe T, et al. The effect of mass screening by physical examination combined with regular breast self-examination on clinical stage and course of Japanese women with breast cancer. Oncol Rep 1998;5:151–5
28. Gould-Martin K, Paganini-Hill A, Casagrande C, Mack T, Ross RK. Behavioral and biological determinants of surgical stage of breast cancer. Prev Med 1982;11:429–40
29. Greenwald P, Nasca PC, Lawrence CE, Horton J, McGarrah RP, Gabriele T, et al. Estimated effect of breast self-examination and routine physician examinations on breast-cancer mortality. N Engl J Med 1978;299:271–3.
30. Kuroishi T, Tominaga S, Ota J, Horino T, Taguchi T, Ishida T, et al. The effect of breast self-examination on early detection and survival. Jpn J Cancer Res 1992;83:344–50
31. Philip J, Harris WG, Flaherty C, Joslin CA, Rustage JH, Wijesinghe DP. Breast self-examination: clinical results from a population-based prospective study. Br J Cancer 1984;50:7–12
32. Auvinen A, Elovainio L, Hakama M. Breast self-examination and survival from breast cancer: a prospective follow-up study. Breast Cancer Res Treat 1996;38:161–8.
33. Thomas DB, Gao DL, Ray RM, Wang WW, Allison CJ, Chen FL, et al. Randomized trial of breast self-examination in Shanghai: final results. J Natl Cancer Inst 2002;94:1445–57
34. Semiglazov VF, Moiseyenko VM, Manikhas AG, Protsenko SA, Kharikova RS, Ivanov VG, et al. Role of breast self-examination in early detection of breast cancer: Russia/WHO prospective randomized trial in St. Petersburg. Cancer Strategy 1999;1:145–51
35. Semiglazov VF, Moiseyenko VM, Bavli JL, Migmanova NS, Seleznyov NK, Popova RT, et al. The role of breast self-examination in early breast cancer detection (results of the 5-years USSR/WHO randomized study in Leningrad). Eur J Epidemiol 1992;8:498–502
36. U.S. Preventive Services Task Force. Screening for breast cancer: recommendations and rationale. Ann Intern Med 2002;137:344–6
37. O'Malley MS. Cost-effectiveness of two nurse-led programs to teach breast self-examination. Am J Prev Med 1993;9:139–45
38. Campbell HS, McBean M, Mandin H, Bryant H. Teaching medical students how to perform a clinical breast examination. Acad Med 1994;69:993–5
39. Fletcher SW, O'Malley MS, Earp JL, Morgan TM, Lin S, Degnan D. How best to teach women breast self-examination. A randomized controlled trial. Ann Intern Med 1990;112:772–9
40. Campbell HS, Fletcher SW, Pilgrim CA, Morgan TM, Lin S. Improving physicians' and nurses' clinical breast examination: a randomized controlled trial. Am J Prev Med 1991;7:1–8
41. Pilgrim C, Lannon C, Harris RP, Cogburn W, Fletcher SW. Improving clinical breast examination training in a medical school: a randomized controlled trial. J Gen Intern Med 1993;8:685–8
42. Harris R, Kinsinger LS. Routinely Teaching Breast Self-Examination is Dead. What Does This Mean? J Nat Can Inst 2002; 94(19): 1420-1421
43.  World Health Organisation- Guidelines 2007. Screening for Breast Cancer
44.  Auvinen A, Elovainio L, Hakama M. Breast self-examination and survival from breast cancer: a prospective follow up study. Breast Cancer Res Treat 1996;38(2):161-8
45.  Miller AB, Baines CJ, To T, Wall C. Canadian National Breast Screening Study: 2. Breast cancer detection and death rates among women aged 50–59 years. CMAJ 1992;147:1477-88
46. McPherson CP, Swenson KK, Jolitz G, Murray CL. Survival of women ages 40–49 years with breast carcinoma according to method of detection. Cancer 1997;79:1923-32
47.  Huguley CM, Brown RL, Greenberg RS, Clark WS. Breast self-examination and survival from breast cancer. Cancer 1988;62:1389-96

About the Author

Senior Surgeon & Internationally renowned Doctor

Department of Surgery, Fortis Super-specialty Hospital

Mohali (Chandigarh), Punjab

India

Naturalizer Women's Joslin Strappy Sandal $54.99 Naturalizer was one of the first shoe brands that women could turn to for the feminine style they coveted and the comfort they thought was impossible to attain. Naturalizer's fresh, unpretentious designs are a smooth fit with your wardrobe, your life and your own unique style. Naturalizer promises style that makes you look good and feel good - always.

Naturalizer - Joslin (White Soft Nappa Leather) - Footwear $31.99 6pm.com is proud to offer the Naturalizer - Joslin (White Soft Nappa Leather) - Footwear: Complete your ensemble with the fashionable Joslin slip-on from Naturalizer®. ; Leather upper with elastic goring and hook-and-loop strap for a personalized fit. ; N5 comfort system footbed provides the ultimate in comfort and support all day long. ; Synthetic outsole maintains traction on a variety of surfaces. ; to learn more about the N5 Comfort features. ; Heel Height: 3 4 in ; Weight: 6 oz ; Product measurements were taken using size 7. Please note that measurements may vary by size.

Naturalizer - Joslin (Moon Stone Soft Nappy Leather) - Footwear $31.99 6pm.com is proud to offer the Naturalizer - Joslin (Moon Stone Soft Nappy Leather) - Footwear: Complete your ensemble with the fashionable Joslin slip-on from Naturalizer®. ; Leather upper with elastic goring and hook-and-loop strap for a personalized fit. ; N5 comfort system footbed provides the ultimate in comfort and support all day long. ; Synthetic outsole maintains traction on a variety of surfaces. ; to learn more about the N5 Comfort features. ; Heel Height: 3 4 in ; Weight: 6 oz ; Product measurements were taken using size 7. Please note that measurements may vary by size.

Naturalizer Womens Capri Dress Flat $31.5 Naturalizer was one of the first shoe brands that women could turn to for the feminine style they coveted and the comfort they thought was impossible to attain. Naturalizer's fresh, unpretentious designs are a smooth fit with your wardrobe, your life and your own unique style. Naturalizer promises style that makes you look good and feel good - always.

Naturalizer Glimpse Loafers and Slip Ons Women Black Leather $59 Catch a glimpse of high fashion in this womens wedge heel! The Naturalizer Glimpse is a sleek slip-on shoe with double sided goring for an easy fit. Perfect for the boardroom or a dinner out, this Naturalizer womens shoe is set in a leather upper and features N5 Comfort Elements to keep you feeling great. The wedge heel provides a flattering lift to this clean style. Get a second look in the Naturalizer Glimpse.

Naturalizer Glimpse Loafers and Slip Ons Women Oxford Brown Leather $59 Catch a glimpse of high fashion in this womens wedge heel! The Naturalizer Glimpse is a sleek slip-on shoe with double sided goring for an easy fit. Perfect for the boardroom or a dinner out, this Naturalizer womens shoe is set in a leather upper and features N5 Comfort Elements to keep you feeling great. The wedge heel provides a flattering lift to this clean style. Get a second look in the Naturalizer Glimpse.

ECCO Women's Joslin Slip-On $129.95 Wear it to work and all weekend long, the Joslin slip-on won't steer you wrong. Select hardware dresses up the vamp lending a classic touch, while the moccasin toe and slim wedge heel are all about foot-coddling comfort.

Naturalizer Glimpse Loafers and Slip Ons Women Black Leather, Oxford Brown Leather $59 Catch a glimpse of high fashion in this womens wedge heel! The Naturalizer Glimpse is a sleek slip-on shoe with double sided goring for an easy fit. Perfect for the boardroom or a dinner out, this Naturalizer womens shoe is set in a leather upper and features N5 Comfort Elements to keep you feeling great. The wedge heel provides a flattering lift to this clean style. Get a second look in the Naturalizer Glimpse.

Derek Joslin Autographed Puck - LOGO COA $17.95 Derek Joslin Autographed Puck - LOGO COA DEREK JOSLIN signed SAN JOSE SHARKS LOGO PUCK with COAEvery signed item comes fully certified with a tamper proof hologram certificate of authenticity and is backed by the SportsMemorabilia.com Authenticity Guarantee.

Of Dooms and Death (The Joslin De Lay Mysteries ) $4.99 The year is 1368. England is a dark and brutal place. It is also where Joslin de Lay's quest begins . . . His father murdered, Joslin has no friends in this land. He must make his way to Wales, for the answers to his father's death lie there. But tread carefully, Joslin - the road westwards holds many dangers. Dangers for which a young Frenchman is ill-prepared. Because Death walks that way, too.

The Joslin Guide to Diabetes $5.82 An indispensable, up-to-date resource for managing your diabetes from the global leader in diabetes research, care, and education Finding out that you have diabetes immediately raises questions about the condition, its treatment, and its impact on your future. Why did I get diabetes? What will I have to do to treat it? How will my future health be affected by having diabetes? What will my life be like? Getting accurate answers to these and many other questions will determine how well you are able to live with diabetes. This completely updated edition of The Joslin Guide to Diabetes will help provide the answers you need. It's an easy-to-understand resource that explains not only the types of diabetes treatment but also every aspect of diabetes self-management, including: • Meal planning and carbohydrate counting • Monitoring blood glucose • Administering insulin and taking oral medications • Treating high and low blood glucose • Using physical activity to help control diabetes, maintain good health, and reduce the chances of future problems • Successfully fitting diabetes into your lifestyle Based upon research and the clinical experience of the world-renowned Joslin Diabetes Center and written by physician and diabetes expert Richard S. Beaser, M.D., and nutritionist and diabetes educator Amy Campbell, R.D., M.S., C.D.E., this book will help those with diabetes integrate the medical treatments and lifestyle changes necessary to learn how to live healthfully with this condition.

Naturalizer Womens 'Heaven' Burgundy Wine Loafer Shoes (Size 6) $62.35 Brand: MINNETONKAColor options: BlackHeel height: Flat (0 to 1/2")Measurement was taken from a size 6Upper: Genuine Suede UpperSole: Man-Made SoleFootbed: noneModel: HeavenWomen's Naturalizer *Heaven* man-made loafers. Silver-tone buckle. Contrast stitch detailing. Decorative cutout and decorative strap and raw seam detail. Rounded toe design. Crocodile embossed design. Glossy finish. Stacked heel. Cushioned insole. Non-slip, man-made sole.

My Whole Big Family by Joslin, Shastina [Paperback] $39.6 Author: Joslin, Shastina Binding Type: Paperback Number of Pages: 32 Publication Date: 2010/11/26 Language: English Dimensions: 8.50 x 8.50 x 0.08 inches

The Joslin Diabetes Healthy Carbohydrate Cookbook $3.95 In response to a major movement in diabetes treatment, recipes low in animal protein and saturated fat that give you the nutrition you need to stay healthy and energetic During the last decade, major changes in the approach to dietary treatment of diabetes have occurred. Today it is widely recognized that people with diabetes can enjoy a high-carbohydrate meal plan low in animal proteins and saturated fat and get the nutrition they need to stay healthy and energetic. Now The Joslin Diabetes Healthy Carbohydrate Cookbook offers tasty and easy-to-prepare recipes that provide necessary protein in the form of beans, lentils, and tofu and take full advantage of the bounty of vegetables, fruits, herbs, and spices available year-round. Dishes such as Vietnamese Imperial Rolls with Peanut Dipping Sauce, Belgian Endive and Watercress Salad with Blue Cheese Toasts, Pumpkin Ravioli with Mushroom Ragout, and Star Fruit Upside-Down Cake prove that living with diabetes does not mean eating bland, tasteless foods. The Joslin Diabetes Healthy Carbohydrate Cookbook features: * 175 delicious and healthful recipes for appetizers; soups and stews; salads; sandwiches and pizzas; pasta, grains, and tofu; and desserts * A complete guide to stocking your healthy pantry * Informative sidebars on a variety of topics, including tips for perfect risotto, how to buy and prepare tofu, a primer on lettuce and greens, and cooking with artificial sweeteners * Nutritional analysis and Joslin Choice information for every recipe * A three-week menu plan that takes the guesswork out of preparing meals Whether you are living with diabetes or are simply in search of flavorsome, nourishing food for yourself and your family, the creative and fresh-tasting recipes and helpful information in this book will make The Joslin Diabetes Healthy Carbohydrate Cookbook an invaluable companion in your kitchen.

Edith Wharton by Joslin, Katherine [Paperback] $73.96 This stimulating reassessment of Edith Wharton by a leading authority on her work, will help to place Whartons fiction against the nineteenthcentury gendered literary models. Like other American women writers, Wharton puts her protagonists within the social domestic world, but unlike them she emphasizes the restrictions imposed by the group on the individual. Author: Joslin, Katherine Series Title: Women Writers Binding Type: Paperback Number of Pages: 164 Publication Date: 1994/01/15 Language: English Dimensions: 7.32 x 4.85 x 0.43 inches

Property of Joslin Family Family Kids Hoodie by CafePress $26 Property of the Joslin Family t-shirts, stickers and gifts are great for anyone with the last name of Joslin. Family Kids Hoodie Stay warm while lookinrsquo; casual-cool in this kid version of an adult favorite - our ash grey Hanes Pullover Hooded Sweatshirt. Deep front pocket and hood for extra protection against getting slammed by bad weather. Made of cotton/polyester blend that

Property of Joslin Family Family Hooded Sweatshirt by CafePress $45 Property of the Joslin Family t-shirts, stickers and gifts are great for anyone with the last name of Joslin. Family Hooded Sweatshirt Tee, TShirt, Shirt The hoodie: the perfect utilitarian piece of clothing. Leave your hat and scarf at home Stay warm and comfy in your Pullover Hooded Sweatshirt. This hoodie is constructed with a cotton/polyester blend - both durable and comfortable.Heavyweight 90

Rainbow Over Crossroads by Joslin, Jay [Paperback] $29.54 Poet, wordsmith and storyteller Jay Joslin continues his journey of awe, passion and absurdity in this, his second collection. With a troubadours spirit and a daring verve, he makes metaphorical play with the quintessential signs and portents which remind us that we are indeed on a planet, and are very fortunate to exist at all, astronomically speaking. Author: Joslin, Jay Binding Type: Paperback Number of Pages: 324 Publication Date: 2005/01/01 Language: English Dimensions: 9.00 x 6.00 x 0.73 inches

What Do You Say, Dear? By Joslin, Sesyle $11.83 Explains the proper etiquette when one meets an elephant, is saved by a knight, encounters an outlaw, bumps into a crocodile, or finishes a royal banquet Author: Joslin, Sesyle Publication Date: 1986/08/01 Binding Type: Paperback Grade Level: 23 Language: English Depth: 0.25 Width: 8.25 Height: 6.75

Naturalizer Women's Lynx Thong $69 Naturalizer Women's Lynx Thong

Naturalizer Women's Wonda Sandal $45.5 Naturalizer Women's Wonda Sandal

Naturalizer Women's Miriam Flat $65.55 Naturalizer Women's Miriam Flat

Naturalizer Women's Carlene Flat $29.99 Naturalizer Women's Carlene Flat

Naturalizer Women's Sailor Espadrille $58.95 Naturalizer Women's Sailor Espadrille

Naturalizer Women's Ilaz Boot $129.99 Naturalizer Women's Ilaz Boot

Naturalizer Women's Kole Mule $64.31 Naturalizer Women's Kole Mule

Naturalizer Women's Jangle Strappy $69 Naturalizer Women's Jangle Strappy

Naturalizer Women's Glee Sandal $59.99 Naturalizer Women's Glee Sandal

Naturalizer Women's Diara Flat $69.19 Naturalizer Women's Diara Flat

Naturalizer Women's Torino Sandal $79 Naturalizer Women's Torino Sandal

Naturalizer Women's Judo Sandal $49.99 Naturalizer Women's Judo Sandal

Naturalizer Women's Faina Shoe $59.95 Naturalizer Women's Faina Shoe

Naturalizer Women's Beliz Bootie $63.2 Naturalizer Women's Beliz Bootie

Naturalizer Women's Indulge Flat $75 Naturalizer Women's Indulge Flat

Naturalizer Women's Clava Pump $65.95 Naturalizer Women's Clava Pump

Naturalizer Women's Polly Pump $82.72 Naturalizer Women's Polly Pump

Naturalizer Women's Daquiri Sandal $88.99 Naturalizer Women's Daquiri Sandal