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Dr Arvind Lal
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Women in India belong to various socio-economic backgrounds and are sometimes marginalised or neglected when it comes to basic healthcare. Women however are the backbone of our society and if one needs a healthy society, then it is essential to have healthy women.
The status of women in India has been subject to many great changes over the past few millennia. From equal status with men in ancient times through the low points of the medieval period, to the promotion of equal rights by many reformers, the history of women in India has been eventful. In modern India, women have adorned high offices including that of the President, Prime Minister, Speaker of the Lok Sabha and Leader of the Opposition.
Contrary to common perception, a large percentage of Indian women are working. In urban India, women comprise an impressive number of the workforce. For example, in the software industry, females comprise 30 per cent of the workforce. They are at par with their male counterparts in terms of wages and position.
According to a World Bank report published in 2012 – females constitute 48.37 per cent of the population in India. This means that women constitute nearly half of the population- they are not called the better half without reason.
In the current environment, it is pertinent to focus on women’s health. This involves acknowledging the differences between men and women, without overshadowing the commonalities. Women and men have many of the same health problems, but they affect women differently. Some diseases such as osteoarthritis, obesity, anaemia and depression are conditions more commonly found in women while some conditions, such as menopause and pregnancy are unique to women.
Today, several young women experience the early onset of hormone imbalance and associated symptoms such as depression, extreme fatigue, allergies, endometriosis, hair loss, facial hair growth, pre-menopausal symptoms (PMS), and osteoporosis. If the symptoms are ignored in the early stages, they worsen as time goes by.
Incidence of cancer in women is also on the rise. In India, breast and cervical cancers are still the most prominent, primarily due to lack of preventive screening (pap smears and mammography) unlike in the West. Indian Council of Medical Research’s (ICMR) National Cancer Registry Programme predicts a rise of cancer in females by 24 per cent (75,289 in 2010 to 93,563 in 2020).
Other cancers that are on the increase are carcinomas of the colorectum, thyroid and lung, together adding upto nine per cent of all cancers in Indian women.
Scientists claim to have identified a genetic variation that makes some women seven times more vulnerable to cervical cancer. The concerned gene known as p53, normally defends the body against tumours. But its variant form, p53Arg, is more easily blocked by HPV, the virus which doctors blame for almost all cervical cancers. Most cases of cervical cancer are easily preventable with regular screening tests and follow-up. They are also highly curable when detected and treated early. Now vaccines are available to protect against the commonest cause of cervical cancer.
An estimated five to ten per cent of all breast cancers are hereditary. Variations of the BRCA1, BRCA2, CDH1, STK11, and TP53 genes increase the risk of developing breast cancer.
Role of a pathologist
In no area of diagnostics does the pathologist play a more important and crucial role than in the diagnosis of tumours as in histopathology (tissue diagnosis). Patients and lay men are often entirely ignorant of this role and imagine that their surgeon or oncologist is the true diagnostician. The reality is that in any patient found to have a tumorous swelling, the histology report is the principal determinant of diagnosis, probable clinical course and therapy. Tumour pathology is expanding at an unprecedented rate. Skilled morphologic examination by an expert pathologist remains the gold standard in anatomic pathology for – ‘the final diagnosis’.
Immunohistochemistry (IHC) i.e. specialised chemical staining of the tumour tissue on a slide, is a vital and useful adjunct to morphologic diagnosis of cancer. Use of IHC for identification of potential therapeutic targets (e.g. c-kit, EGFR, CD-20, HER-2 –NEU etc) is of considerable importance in cancer treatment. Molecular genetic techniques are emerging as valuable tools in tumour pathology and are a vital adjunct to surgical pathology.
More often than not, women neglect their own health and focus instead on their partner’s and their children’s. It is important that they take care of their health and keep in mind the following –
- Plan for pregnancies and see the doctor regularly
- Have regular mammograms
- Get regular health checkups and screenings for breast, cervical, uterine and ovarian cancer
Comprehensive and advanced testing techniques can help the treating doctor in determining the choice of cancer treatment. HER2 is a protein found on the surface of certain cancer cells. Some breast cancers have a lot more HER2 receptors than others. Tumours that are HER2-positive tend to grow more quickly than other types of breast cancer. Knowing if a cancer is HER2-positive can sometimes affect the choice of treatment. As expected, most of these are rare mutations and may be found in one to two per cent of the population. Some of these mutations are found only in five per cent of cells. Using comprehensive genomic analysis we can now find out how every patient is different and we can actually tailor therapy based on each tumor’s molecular subtype. Many good old techniques like FISH, IHC and PCR need to be supplemented with genetic level testing.
Human carcinogenesis is a multi step process involving complicated genetic events in which several oncogenes and onco-supressor genes are involved. Current trends are now shifting towards testing a patient for multiple genes and not a single gene related to cancer. Today, we know of many genes like APC, PIK3CA, CCL2, FOXQ1 and around 200 other genes that play a role in either causing cancer or could potentially aid treatment decisions.
We, at Lal Path Labs are striving to provide a comprehensive and complete profile for cancer diagnostics at the state-of-the art surgical and anatomic pathology unit at NRL, Rohini. A panel of 12 skilled surgical pathologists provide complete and detailed cancer pathology reporting in accordance with international guidelines with a large panel of IHC antibodies for diagnosis, prognosis and therapeutic purposes. Molecular and cytogenetic techniques for gene expression and determining karyotyping abnormalities and mutation analysis are well established diagnostic tools in the fight against cancer.
The annual number of biopsy (histopathology) samples at Dr Lal Pathlabs has increased enormously in the last two years i.e. from 74,349 in 2010 to 99,512 in 2011 and 1,18,496 in 2012, nearly 400 biopsies a day. Of these nearly 30 per cent i.e. approximately 120/day represent cancer related workloads every year – including biopsy diagnosis, reporting of large cancer surgical specimens and IHC.