A pap smear is now a widely recognized and medically accepted diagnostic procedure to find out whether women of every age may have been afflicted with a disorder that they otherwise cannot see because of the virtue that it is “down there”.

“Pap” smear is short for “Papanicolaou” test, because… well, the former is just way too easy to pronounce and at least it will not give you the feeling that you are practicing in a tongue-twisting triathlon. A pap smear is a simple smear method of examining stained exfoliative cells. It has found its current and most common functions as a diagnostic tool for the detection of cancer of the cervix. However, it may also be used for tissue specimens from any organ. A smear is usually obtained during a routine pelvic examination annually beginning at eighteen years of age, which should be the ideal starting point for women everywhere to have themselves checked. This pap smear technique permits earlier diagnosis of cancer and, as of now, still contributes to a lower mortality rate from cervical cancer. The findings are then usually reported descriptively to the client or to the attending gynaecologist.

Of course, one of the most dreaded days in a woman’s health life is when her pap test results returns to her as “abnormal”. So does that mean that you—as a woman—really have something wrong with you? While pap smears are used primarily to detect human papillomavirus (HPV) and—more importantly—cervical cancer, there are still cases where “false positives” (yes, the term that is also used in pregnancies) can occur in procedure that is exact as a pap smear test.

There really are several factors on why you may have gotten an abnormal result that is not specifically caused by HPV or cervical cancer. What you can remember in these instances is that most abnormal pap smear tests do not necessarily indicate that you are already a candidate for cervical cancer. For one, you have to consider whether the medical technician who has interpreted the results of the test for you may have been really unsure of what he or she is looking at through the microscope. So, instead of “raising your hopes” up, some of them would rather make sure that you are available for a second pap smear test; thus, they will instead put a big fat “abnormal” on your result and urge you to take a second screening. At this junction, most women who usually test “positive” at the first testing have later found out that they do not harbour cancer cells at all.

Another common reason why you may have an abnormal pap smear is because you may have an infection of your cervix or your vagina, which is what the pap smear test had been sent out to do, in the first place. The most common cases of infection which have been documented for the women who tested abnormal for pap smear have more to do with an HPV infection. In that case, you can be just treated for that infection, even on an outpatient basis.

So there is a silver lining in the clouds after all. If you have been tested positive for a pap smear, you can still ask for a “second” testing, just to make sure.

Author Bio:
Dr.Alapati, the author, is a blogger who is a doctor by education. He helps people to reduce extra fat via “side effects free Liposuction” and He writes at ehealthwall.com and healthchrome.com.

It is 21st century when people in this world have brought many dreams become the reality. We all demand for an improved quality of life. As a woman you have the right to preserve your fertility before you loose it. A woman needs to know available options are there for them, they just need to find it.

Cancer is not rare in younger women now-a-days. The necessary treatment for most of the common cancer types occurring in younger women implies either removal of the reproductive organs or cytotoxic treatment. Therefore, they will be loosing their capability to procreate partially or definitively.

Educated working women have been delaying initiation of childbearing to later in life; therefore they may need to seek help in preserving their fertility. Indeed, because of proliferation of techniques to preserve fertility the number of options is increasing day by day. Some established procedures include embryo freezing and oocyte freezing. Some are still experimental, such as ovarian cortex freezing, ovarian slice freezing, whole ovary freezing.

Egg freezing also called vitrification and embryo freezing are rapidly advancing, breakthrough technology useful to preserve fertility in certain circumstances causing infertility.

Because of variations in types of cancer, dose of chemotherapy, time available before the onset of treatment, patient’s age and the partner’s status, each case is unique and requires a

different strategy of fertility preservation. Furthermore, embryo freezing is impossible to an unmarried woman in Bangladesh, so egg freezing could be an option. Worldwide egg freezing has been revolutionised by the method of vitrification in which a woman’s eggs are extracted, frozen and stored. Later, when she wishes to become pregnant, the eggs can be thawed, fertilized, and transferred to the uterus as embryos. So you can restore personal autonomy before you loose your chance.

Dr Fatima Momtaz

Paget’s disease of nipple is a special type of breast cancer, which is not very common. However, it is the one which can be misdiagnosed easily. It is frequently thought to be a skin inflammation or infection, leading to unfortunate delays in detection and care.

I have seen few patients who had their treatment as nipple eczema for certain length of time and eventually searched for help, as the treatment for eczema did not help at all, instead got worse. After doing punch biopsy of nipple, diagnosis was confirmed as Paget’s disease of nipple with underlying invasive breast cancer and had mastectomy(removal of whole breast)!

What is it?
It is an eczema-like change in the skin of the nipple, and 9 out of 10 women who have it have an underlying breast cancer. The underlying breast cancer may be an invasive breast cancer or ductal carcinoma in situ (DCIS). In DCIS, the cancer cells are completely contained within the milk ducts. It is seen in 1-4% of cases of female breast cancer.

How does it present?
* Presents as chronic eczematous change of the nipple with iItching, erythema, scale formation, erosions, nipple discharge including bleeding

* Underlying palpable breast lump (usually indicates an invasive nature).

Investigations
* Punch Biopsy of nipple with immuno-histochemistry and special stains

* Investigation of breast lump if palpable

* Investigations looking for underlying malignancy if no lump palpable, e.g. mammography or MRI (may be more useful) and core biopsy.

Management
The treatment of Paget’s disease of the breast will depend on:

* whether or not there is an underlying breast cancer

* whether it is DCIS or an invasive tumour

* how much of the breast is affected.

Surgery
Surgery is the main treatment for Paget’s disease. This may involve an operation to remove all of the breast (a mastectomy) or an operation to remove the affected area of breast, including the nipple and areola, and some surrounding normal breast tissue (breast-conserving surgery). Some of the lymph nodes in the underarm may also be removed.

A mastectomy may be recommended if the cancer is affecting a wide area. It may be possible to have breast reconstruction at the same time as a mastectomy or as a second operation some months later.

Some people don’t need any further treatment after surgery. Others may need radiotherapy, hormonal therapy or chemotherapy and or immuno-therapy. These treatments may be given separately or together.

Prognosis
Paget’s disease of the breast is associated with a poor prognosis, which is worse if the lesion is associated with an underlying palpable mass.

Dr Tasmia Tahmid

Breast cancer is the 2nd most cause of cancer death in women. Most of the deaths from the disease are due to late diagnosis, lack of screening and self examination.

The news of being diagnosed with cancer is not all bad. Most women who diagnosed at early stage are living like normal after surgical resection of breast tumor and other interventions to completely eradicate cancer cells from body.

In the month of October, which is observed as breast cancer awareness month, we need to tie up to spread the message that early diagnosis is the key to survival. Here are the key messages that need to be disseminated among mass population for early diagnosis, prevention and reduces large death toll.

Warning signs of breast cancer:

* New lump/swelling in the breast or underarm.

* Thickening or swelling of part of the breast

* Irritation or dimpling of breast skin.

* Redness or flaky skin in the nipple area or the breast

* Pulling in of the nipple or pain in the nipple area

* Nipple discharge (e.g. bloody) other than breast milk

* Any change in the size or the shape of the breast

* Pain in any area of the breast

Breast self-examination
Breast self-examination (BSE) is a method that involves the woman herself looking at and feeling each breast for possible lumps, distortions or swelling in front of a mirror. It should be done at regular interval.

So all women should check themselves or go to nearby centres for a screening examination in this month and should keep continue checking at regular interval.

The writer is Prof Dr Md Mizanur Rahman

Breast lump or swelling in the breast is a complaint frequently encountered by general surgeons. It is a common reason for the female patients to seek surgical consultation.

In my surgical practice the most common question that I face from the patient — “Is it cancer?” Breast lump has become synonymous with breast cancer. The fact is only 20 percent of breast tumours turn out to be malignant or cancerous!

Commonest benign (non-cancerous) breast lump is called fibroadenoma which is typically found in young women. It is generally smooth, spherical, painless and very mobile without any attachment to skin or surrounding breast tissue. More than one lump may be present. It gradually increases in size and may eventually fill the whole. During pregnancy fibroadenoma may increase in size, but returns to the original size after delivery of the baby.

Fibroadenoma is usually treated by surgical removal. It is a minor operation commonly done under short general anaesthesia. It is possible to plan the cut in the breast skin in such a way that there is almost no post-operative scar marks. In case of unavoidable large cuts, it is placed in such a way that the scar is hidden under the clothing.

The other common breast lump is due to an abnormality in female hormone level. In this condition, multiple lumps of various sizes are found in the breast. Typically both breasts are involved, although patients may complain about one breast only. Lump size maybe somewhere between a size of grain to 3-4 cm. The breasts are painful and tender. The pain may become intense at or near the time of menstruation. The pain may radiate to the arm or back, and may be so severe to interfere normal life.

In most patients it is the pain that brings them to a surgeon and not the lump. There may be nipple discharge in the form of clear sticky fluid.

The disease called Fibroadenosis is a disease of the reproductive age. It may be self-limiting, usually disappearing after the first pregnancy. In most patients the disease is of mild form and simple painkiller with adequate explanation usually brings about a relief.

More resistant cases are treated with hormone therapy. Surgery is reserved for extreme cases. A particularly painful cyst or lump is removed under general anaesthesia. As in fibroadenoma, it is possible to plan the skin cut to provide best cosmetic results. The most important point to remember from the patient’s point of view is the possibility of recurrence, and more than one operation may be required.

A breast lump is particularly a concern in women with risk factors. Risk factors include age, family history, early onset of menstruation, late menopause, late first pregnancy, obesity, hormone replacement therapy etc. More than 66 percent of women with breast cancer are above the age of 50 years and 80 percent are at least 40 years old. The chances of developing cancer are two to three times higher in case of women with a close female relative (mother, sister) who had breast cancer.

Early diagnosis is the key to effective treatment for breast cancer. Most breast cancers are detected by the patient herself. This is why, self-examination by the patient is important.

Very often, women in Bangladesh present to a doctor’s room when their diseases have already progressed to a grave condition and need aggressive treatment. Sometimes, physicians have very little to do with a woman when she comes at the end stage of a fatal disease like cancer. With simple and inexpensive screening tests, women can prevent a range of deadly diseases like cancer, glaucoma, complications of diabetes etc. and help remain heal and hearty.

1. Breast cancer
Diagnosis in the early stages is crucial for breast cancer like other cancers. Mammograms are used as an ideal screening tool to detect early breast cancer in women experiencing no symptoms and to detect and diagnose breast disease in women experiencing symptoms such as a lump, pain or nipple discharge. A woman should have a mammogram done within 40s. Onwards, they should get an annual screening for early detection, experts recommended. Any discomfort or pain in the breast should be investigated throughly and must not be neglected. Any unusual discharge should be checked out right away. Sometimes doctors recommend ultrasonography and low-dose x-ray can also detect disease at early stage and used as screening tools.

2. Cervical cancer
Cervical cancer is top ranked killer cancer in Bangladesh. It occurs in the cervix, a part of the uterus that extends into the vaginal cavity. Routine screening can find it early, when it is highly curable. It can also find abnormal precancerous cells on the surface of the cervix so they can be removed before they turn into cancer. Doctors recommend VIA (Visual Inspection of Cervix using Acetic Acid) which is given free of cost in the government settings and Pap test to screen for cancer of the cervix. The screening test should start as early as women enter in reproductive age. For better protection FDA approved vaccine cervical cancer vaccine is available in our country; it confers immunity against HPV virus that causes cancer.

3. Osteoporosis and fractured bones
Osteoporosis is a condition in which bones become weak and fragile. It is caused by bone loss, which accelerates in women after menopause. A test called Dual Energy X-ray Absorptiometry (DXA) can measure bone mineral density and detect osteoporosis before fractures occur. It can also help predict the risk of future bone fractures. Bone density testing is recommended for all women 65 years of age and older. It is also recommended for middle-aged women younger than 65 who have risk factors for osteoporosis.

4. Cholesterol levels
A high level of LDL cholesterol (bad cholesterol) is a major factor that increases the risk of developing heart diseases. Doctors screen for problems with cholesterol by using a fasting blood lipid profile. Management decisions are based on the results.

5. Type 2 Diabetes
Measuring the fasting blood glucose and two hours after breakfast are used to screen for diabetes. Experts also recommend another tests called HbA1C. If a woman is healthy and have a normal risk of diabetes, she should have the test done every two years starting at age 45; with higher risk, one should start testing earlier and more frequently.

6. Colorectal cancer
The majority of colon cancers develop from colon polyps that are growths on the inner surface of the colon. A colonoscopy is a common screening test for colorectal cancer. A doctor views the entire colon using a flexible tube and a camera. Polyps can be removed at the time of the test. A similar alternative is a flexible sigmoidoscopy that examines only the lower part of the colon. If a woman is at average risk, screening usually starts at age 50.

7. Glaucoma
Glaucoma is a condition that can result in blindness due to damage to the optic nerve. People older than age 50, family history of glaucoma, personal history of eye injury and steroid use are risk factors for glaucoma. For healthy individuals without increased risk, routine screening every two years is recommended for people under age 40. For those between 40 to 54 years, testing should be done every one to three years. From age 55 to 64, testing should be done every one year, and for those over 65, every six to 12 months.

Despite significant improvement in medical science in recent decades, mothers and their babies in the third world countries like Bangladesh are still at risk during the perinatal period, which covers pregnancy, delivery and the postpartum.

Babies born too early are more likely to die than that of born at term. They are also more likely to have neurological and developmental disorders that carry long-term consequences for their quality of life, their families and for health and social services.

Perinatal health includes care for both mother and their new born babies. But we often forget about the care of the mothers during and after delivery. However, maternal deaths are less than babies. This is a tragic event as a significant proportion of these deaths are associated with substandard care.

When we talk about paediatrics (child care), it only deals with children. And the obstetricians deal with mothers only. But we need to set up a sturdy bridge in between these two separate entities. It is impossible to think about healthy child without healthy mother. In fact, perinatal science deals with a unique two in one health delivery system.

Bangladesh has made a significant progress in reducing maternal and infant death in recent years. This has been possible because of strong leadership of the Ministry of Health and Family Welfare (MOHFW) in creating a supportive policy environment, technical and financial commitment of donors and UN agencies, active engagement of professional bodies and academic institutions. National Neonatal Health Strategy has already been prepared by the MOHFW. Now we need to operationalise the recommendations outlined in the strategy and begin to roll out the crucial interventions needed to prevent unnecessary deaths.

Immediate and early postnatal care for mothers and newborns is one such crucial intervention. Most of maternal and newborn deaths occur within the first three days of childbirth. Therefore we need to deliver the services to them in those crucial days.

Neonatal sepsis (infection of the newborn) is the single largest contributor to neonatal mortality. We need to ensure that the health service providers at community level can prevent, detect and manage sepsis when it occurs. Now operation research is underway to see the feasibility of different approaches in order to determine the best way to deliver this service to the majority of the newborns who are born at home.

We need to strengthen the policies, guidelines and service providers’ capacity to ensure that the neonates and the mothers are not left without care. Unless we can scale up these services to reach the primary level of health system, we will not be able to attain the Millennium Development Goals by 2015. We need to create additional posts of neonatologists and obstetricians at the district hospital level as a starting point.

Prof M Shahidullah.

Cervical cancer is cancer of the cervix — the lower part of the uterus, which opens into the vagina. Cervical cancer is the second-most-common type of cancer that strikes women worldwide after breast cancer.

It is estimated that nearly 250,000 deaths are associated with cervical cancer globally every year. According to the World Health Organisation, there were 500,000 new cases of cervical cancer in 2005.

The tragedy of cervical cancer is that it often strikes when a woman is still young. It tends to happen in women between the age of 35 and 55 years. She may be trying to raise her family or may be she has not had children yet.

A population-based survey reported that the coverage of cervical cancer screening in Bangladesh is less than 1%. Older and poor women are at the highest risk of developing cervical cancer in Bangladesh.

Cause of cervical cancer
99% of cervical cancers are caused by Human Papillomavirus (HPV), which spreads through sexual contact. There are over 100 different types of HPV. The majorities of viruses are considered Low Risk and do not cause cervical cancer. However, HPV-16 and HPV-18 often referred to as High Risk HPV types are associated with more than 70% of cervical cancer cases.

The body’s immune system usually fights off the infection as a result most women never suffer from HPV infection. However, in some women the infection does not go away. When the virus remains active in the body for a long period of time, cervical cells begin to change and the risk of cervical cancer increases.

There are other factors can increase the risk that an HPV infection develops into cervical cancer:

* Sexual intercourse at an early age

* Multiple sexual partners

* Multiple full-term pregnancies

* Chlamydia, gonorrhoea, syphilis, or herpes simplex virus type 2 infection

* Cigarette smoking

* Use of oral contraceptives for a long period of time

* Weakened immune system or HIV infection • Mother or sister with a history of cervical cancer

* Low levels of folic acid (a type of Vitamin B)

Symptoms
Cervical cancer is usually a slow-growing cancer, typically takes 10-15 years before invasive cancer develops. Once cervical cells begin to change, it first becomes “pre-cancerous” a condition also known as “dysplasia” or Cervical Intraepithelial Neoplasia (CIN).

In the early stages cervical cancer often causes no symptoms. However, when symptoms do occur, they may include:

* Bleeding between regular menstrual periods

* Bleeding after sexual intercourse

* Bleeding after douching

* Bleeding after a pelvic exam

* Pelvic pain not related to your menstrual cycle

* Heavy or unusual discharge that may be watery, thick, and possibly have a foul odor

* Increased urinary frequency

* Pain during urination

These symptoms can be caused by cervical cancer, or by a number of serious conditions, and should be evaluated promptly by a medical professional.

Diagnosis
Cervical cancer is diagnosed through a series of examinations. A Pap test is most commonly used to screen and detect the possibility of a cervical cancer or dysplasia.

An HPV DNA test is used to determine the high-risk strains of HPV infection, which is most likely to lead to cervical cancer. If an abnormality is found during a Pap and HPV DNA tests, a Colposcopy is performed.

Finally, a Cone biopsy is performed by removing a cone-shaped piece of tissue from the cervix for microscopic examination. A pathologist examines the sample for confirmation of precancer or cancer cells.

Treatment
Options for treating cervical cancer depend predominantly on the stage of disease — the size of the tumor, the depth of invasion, and whether the cancer has spread to other parts of the body.

Other factors that are considered are the patient’s age and if she wishes to have children. The primary forms of treatment are surgery or combined radiation therapy and chemotherapy.

* Surgery to remove the uterus

* Radiation therapy to kill the cancer cells

* Chemotherapy to stop the growth of cancer cells

Vaccine
The vaccine is now available for prevention of HPV infection. Studies show that women who receive cervical cancer vaccine between the ages of 15 and 25 have 100% protection against the HPV-16 and HPV-18.

The vaccine is given in three shots over six-months. Centers for Disease Control and Prevention (CDC) recommended this vaccine for girl’s ages 11 to 12, although it may be used in girls as young as age 9.

Ideally, females should get the vaccine before they are sexually active. The vaccine is also recommended for 13-26 year-old girls who have not yet received or completed the vaccine series. This allows a girls immune system to be activated before she encounters HPV. Vaccinating at this age also allows developing the highest antibody levels. The higher the antibody levels the greater the protection.

Abu Siddiqui…

Researchers who tracked breast cancer rates in Norwegian women proposed the controversial notion on Monday that some tumors found with mammograms might otherwise naturally disappear on their own if left undetected.

But leading cancer experts expressed doubt about the findings and urged women to continue to get regular mammograms, saying this screening technique unquestionably saves lives by finding breast cancer early on when it is most treatable.

Dr. Per-Henrik Zahl of the Norwegian Institute of Public Health in Oslo and Norwegian and U.S. colleagues examined invasive breast cancer rates among nearly 120,000 women age 50 to 64 who had a mammogram — an X-ray of the breast used to find evidence of cancer — every two years over a six-year period.

They compared the number of breast cancers detected with another group of about 110,000 Norwegian women of the same age and similar backgrounds who were screened just once at the end of the six-year period.

The researchers said they expected to find no differences in breast cancer rates but instead found 22 percent more invasive breast tumors in the group who had mammograms every two years.

Mammography and breast self-examination for tumors are standard methods used for early detection of breast cancer, the leading cause of cancer deaths among women worldwide.

The American Cancer Society estimated that about 465,000 women die of breast cancer globally each year, and 1.3 million new cases are diagnosed.

The researchers acknowledged many doctors might be skeptical of the idea but they cited 32 reported cases of a breast cancer regressing, a small number for such a common disease.