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Sunday, August 1, 2010

Why do you need a second opinion on cancer?

The need for a second opinion on cancer
The topic of getting a second opinion on cancer is controversial. Why do we have to get a second opinion? Let me put this in simple words. Cancer is a disease with enormous physical, mental, emotional, psychological and social impact on the patient and his family members. Such are the ramifications of all these aspects after the diagnosis that it can leave an individual and a family devastated. Added to this is the cost of the treatment, which can be enormous. When a particular cancer patient is treated, the family wants the best for him, be it the doctor, be it the medicines and the methods and schedule of treatment. Getting a second opinion can solve many of the doubts in the patient's and his family members' minds provided they approach the right person at the right time. It has its down side also and a biased and unscientific second opinion is sure to ruin the chances of a cure in cancer patients. 
Where to get a second opinion on cancer
How to get and where to get a second opinion? Oh, there is no dearth of options. Oncologists of all disciplines - Medical, Radiation, Surgical are there to give their opinion(s) against payment of their fees and sometimes as a social responsibility. Most of them, I presume, will be guiding you to the right path but some  will obviously be guided themselves by the market forces and they will give and have their own reasons for such an opinion. By the time you visit the oncologist for a second opinion, you yourself would have read a lot about the cancer from the internet and correlating the information gathered from the internet and the first and the second oncologists' opinion will leave you more confused. What is the solution then? There are two solutions which come to my mind regarding getting a second opinion on cancer. First is to pick and choose the right information from the net and second is to approach a professional body/organization for an opinion. Picking and choosing the correct information from the net is difficult and tedious for a layman because everybody may not have that scientific bend of mind to comprehend the information and you have the know the right website for the correct information. Professional organizations dealing only with second opinion without any binding on the patient for treatment are not many and even if you find one, it may not be in your immediate vicinity. 
Reason for designing a site on information and second opinion on cancer
Keeping this lacuna in the demand versus availability of a second opinion on cancer, I along with some of my colleagues from all the disciplines of oncology, thought about having a blog site which will deal only with information and second opinion on cancer. I have decided to keep it a free service and also give the opinions based on evidence based medicine and the latest recommended treatment based on international consensus. The beauty of this blog will be that it will give out all the references from medical journals based on which the second opinion is being given to you which I don't think anybody else is doing till date. I will also give you clarifications on complex medical terms thus making it easy for you to understand.I have also devised a simple referral form which will contain all the basic information about the patient before we form an opinion. I will post the form in my next blog post and will keep on posting it from time to time for your benefit. It may take a few days before I am able to post a reply to you depending on the complexity of the situation. However my motto will be fast, efficient and reliable information and second opinion on cancer.

My contact e mails
partha65@gmail.com
partha.oncologist@hotmail.com
partha_oncologist@yahoo.com







Saturday, July 31, 2010

Basics of Breast Cancer

Important Information about Breast Cancer
• Breast cancer (cancer of the breast) is one of the most common cancers in women.
• Most cases occur in women over the age of 50.
• If you notice any lump or change to your normal breast then you should see a doctor promptly.
• If breast cancer is diagnosed at an early stage, there is a good chance of a cure.
• In general, the more advanced the cancer (the more it has grown and spread), the less chance that treatment will be curative. However, treatment can often slow the progress of the cancer.
What is important is that you get to know your own breasts – how they look and feel – and report any changes promptly to a doctor.
What is Breast Cancer
• Breast cancer is one of the most common cancers in females
• Around one in eight women develop breast cancer at some stage in their life.
• Most develop in women over the age of 50 but younger women are sometimes affected.
• Breast cancer can also develop in men, although this is rare.
• Breast cancer develops from a cancerous cell which develops in the lining of a milk duct or milk gland (lobule) in one of the breasts.
• There are some ‘sub-types’ of breast cancer which are important to know as the treatment and prognosis (outlook) vary depending on the exact type of the cancer.
Types of Breast Cancer
Broadly it is divided into
Non-invasive and Carcinoma in situ
Some people are diagnosed when the cancerous cells are still totally within a duct or lobule. These are called ‘carcinoma in situ’ as no cancer cells have grown out from their original site.
Ductal carcinoma in situ (DCIS) is the most common type of non-invasive breast cancer
Invasive cancer
Most breast cancers are diagnosed when a tumor has grown from within a duct or lobule into the surrounding breast tissue. These are called ‘invasive’ breast cancers.
Invasive breast cancers are also divided into those where cancer cells have invaded into local blood or lymphatic vessels and those that have not.
A carcinoma in situ is easier to treat and has a better outlook than an invasive cancer.
Grade of the cancerous cells
A sample of breast cancer tissue can be looked at under the microscope. As a rough guide, the lower the grade, the better the cancer is likely to respond to treatments such as chemotherapy and radiotherapy.
• Grade 1 – the cancer cells tend to be slow growing and less ‘aggressive’.
• Grade 2 – is a middle grade.
• Grade 3 – the cancer cells tend to be fast growing and more ‘aggressive’.
Presence of receptors
Some breast cancer cells have receptors, which allow certain types of hormones or proteins to attach to the cancer cell. The types of receptor tested for are:
• Hormones
Tests on a sample of breast cancer cells can show if they contain estrogen receptors or progesterone receptors. (Estrogen and Progesterone are female hormones.)
Treatment can block the hormone receptors in these cancers
• Her2
Some breast cancer cells have receptors for a protein known as HER2.
Cancers having high levels of these receptors are called Her2 positive.
Stage of the cancer
• This does not describe a type of cancer, but describes how much the cancer has grown and whether it has spread.
• As a general rule, the earlier the stage, the greater the chance of a cure
Causes of Breast Cancer
• A cancerous tumor starts from one abnormal cell.
• The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell.
• This makes the cell abnormal and multiplies ‘out of control’
Risk factors
Although breast cancer can develop for no apparent reason, there are certain ‘risk factors’ which increase the chance that breast cancer will develop.
• Ageing – The risk of developing breast cancer roughly doubles for every 10 years of age. Most cases develop in women over the age of 50.
• Where you live – The rate of breast cancer varies between countries. This may reflect genetic or environmental factors.
• Family history – This means if you have close relatives who have or have had breast cancer. In particular, if they were aged under 50 when diagnosed.
• If you have had a previous breast cancer.
• Being childless, or if you had your first child after the age of thirty.
• Early age of starting periods.
• Having a menopause over the age of 55.
• Taking HRT (hormone replacement therapy) for several years (in women over 50 years) leads to a slightly increased risk.
• Having dense breasts.
• A past history of some benign breast diseases.
• Lifestyle factors – little exercise; obesity after the menopause; excess alcohol.
Family history and genetic testing
• About 1-2 in 20 cases of breast cancer are caused by a ‘faulty gene’ which can be inherited.
• Breast cancer which is linked to a faulty gene most commonly affects women in their 30s and 40s.
• The genes BRCA1 and BRCA2 are the commonest faulty genes.
• If you have any of the following in your family, you might want to see to your doctor.
Three close blood relatives (from the same side of the family) who developed breast or ovarian cancer at any age.
Two close relatives (from the same side of the family) who developed breast or ovarian cancer under the age of 60.
One close relative who developed breast cancer under the age of 40.
A case of breast cancer in a male relative.
A relative with cancer in both breasts.
Note: most cases of breast cancer are not due to an inherited faulty gene.
Symptoms of breast cancer
• A breast lump
The usual first symptom is a painless lump in the breast.
Note:
Most breast lumps are not cancerous.
Most breast lumps are fluid filled cysts or fibroadenomas (a clumping of glandular tissue) which are benign.
However, you should always see a doctor if a lump develops as the breast lump may be cancerous.
• Other symptoms
Other symptoms which may be noticed in the affected breast include:
Changes in the size or shape of a breast.
Dimpling or thickening of some of the skin on a part of a breast.
The nipple becomes inverted (turns in).
Rarely, a discharge from a nipple occurs (which may be bloodstained).
A rare type of breast cancer causes a rash around the nipple which can look similar to a small patch of eczema.
Rarely, pain in a breast.
Note: pain is not a usual early symptom. Many women develop painful breasts and this is not usually caused by cancer.
The first place that breast cancer usually spreads to is the lymph nodes (glands) in the armpit. If this occurs you may develop a swelling or lump in an armpit. If the cancer spreads to other parts of the body then various other symptoms can develop.
Diagnosis of breast cancer
• Initial assessment
If you develop a lump or symptoms which may be breast cancer, a doctor will usually examine your breasts and armpits to look for any lumps or other changes.
You will normally be referred to a specialist.
Sometimes a biopsy of an obvious lump is arranged, but other tests may be done first such as:
Mammogram. This is a special X-ray of the breast tissue which can detect changes in the density of breast tissue which may indicate a tumors.
Ultrasound scan of the breast.
MRI scan of the breast. This is more commonly performed on younger women, especially those with a strong family history of breast cancer.
• Biopsy – to confirm the diagnosis
A biopsy is when a small sample of tissue is removed from a part of the body.
The sample is examined under the microscope to look for abnormal cells.
A specialist may take a biopsy with a needle which is inserted into the lump and some cells are withdrawn (FNAC –Fine Needle Aspiration Cytology).
Sometimes the doctor may be guided as to where to insert the needle with the help of a mammogram or ultrasound scan.
Sometimes a small operation is needed to obtain a biopsy sample.
The biopsy sample can confirm or rule out breast cancer. Also the cells from a tumor can be assessed and tested to determine their grade and receptor status.
• Assessing the extent and spread
If you are confirmed to have breast cancer, further tests may be needed to assess if it has spread.
For example, blood tests, an ultrasound scan of the liver, chest X-ray, a bone scan or other types of scan. This assessment is called ‘staging’ of the cancer.
The aim of staging is to find out:
  1. How large the tumor has grown.
  2. Whether the cancer has spread to local lymph nodes in the armpit.
  3. Whether the cancer has spread to other areas of the body.
Finding out the stage of the cancer, the grade of the cells and the receptor status of the cancer help doctors to advice on the best treatment options.
It also gives a reasonable indication of outlook.
The treatment for breast cancer
• Treatment options which may be considered include surgery, chemotherapy, radiotherapy and hormone treatment.
• Often a combination of two or more of these treatments is used.
• The treatments used depend on:
The cancer itself –
its size and stage (whether it has spread),
the grade of the cancer cells, and
whether it is hormone responsive or contains Her2 receptors, AND
The woman with the cancer –
age,
whether or not she has achieved menopause,
her general health and personal preferences for treatment.
Surgery
• The types of operation which may be considered are:
Breast-conserving surgery. This is often an option if the tumor is not too big.
A ‘lumpectomy’ (or wide local excision) is one type of operation where just the tumor and some surrounding breast tissue is removed.
It is usual to have radiotherapy following this operation.
This aims to kill any cancer cells which may have been left in the breast tissue.
Removal of the affected breast (mastectomy).
This may be necessary if there is a large tumor or a tumor in the middle of the breast.
It is often possible to have breast reconstruction surgery to create a new breast following a mastectomy.
This can often be done at the same time as the mastectomy, although it can also be done months or years later.
There now are many different types of reconstruction operations available.
Whatever operation is done it is also usual to remove one or more of the lymph nodes in the armpit. These lymph nodes are where breast cancer usually first spreads to.
The lymph nodes which are removed are examined under the microscope to see if they contain any cancer cells.
This helps to accurately stage the disease and helps to guide the specialist as to what treatment to advice following surgery.
Alternatively, a sentinel lymph node biopsy may be performed.
This is a way of assessing if the main lymph nodes draining the breast cancer contain cancer. If they are clear then the remaining lymph nodes in the armpit will not need to be removed.
Radiotherapy
• Radiotherapy is a treatment which uses high energy beams of radiation which are focused on cancerous tissue.
• This kills cancer cells, or stops cancer cells from multiplying.
For breast cancer, radiotherapy is mainly used in addition to surgery. When radiotherapy is used in addition to surgery it is called ‘adjuvant radiotherapy’.
• New techniques for radiotherapy are currently in use which reduce the toxicity and duration of treatment
Chemotherapy
• Chemotherapy is a treatment of cancer by using anti-cancer drugs which kill cancer cells, or stop them from multiplying.
• When chemotherapy is used in addition to surgery it is known as ‘adjuvant chemotherapy’.
• Chemotherapy is sometimes given before surgery to shrink a tumor so that surgery may have a better chance of success and also a smaller operation may be performed. This is known as ‘neoadjuvant chemotherapy’.
• The type of chemotherapy given may depend on the type of cancer.
• New gene tests are being developed to help doctors decide which women will benefit the most from chemotherapy.
• Chemotherapy may also be used for some women to treat breast cancer which has spread to other areas of the body.
Hormone treatments
• Some types of breast cancer are affected by the female hormone estrogen (and sometimes progesterone).
• These hormones stimulate the cancer cells to divide and multiply.
• Most estrogen and progesterone is made by the ovaries.
• Treatments which reduce the level of these hormones, or prevent them from working, are commonly used in people with breast cancer.
• This hormone treatment works best in women with ‘hormone responsive’ breast cancer, but they sometimes work in cancers classed as non-hormone responsive.
• Hormone treatments include:
Estrogen blockers.
Tamoxifen has been available for many years and is still widely used.
It works by blocking the estrogen from working on cells. It is usually taken for five years.
Aromatase inhibitors.
These are drugs which work by blocking the production of estrogen in body tissues.
They are used in women who have gone through the menopause.
GnRH (gonadotrophin releasing hormone) analogues.
These drugs work by greatly reducing the amount of oestrogen that you make in the ovaries.
They are usually given by injection and may be used for women who have not yet reached the menopause.
An alternative which may be considered for women before the menopause is to remove the ovaries (or to destroy them with radiotherapy). This stops estrogen from being made.
Trastuzumab
• Trastuzumab (also known as Herceptin) is a treatment that may be given to women who have a large number of HER2 receptors in their cancer.
• It is a type of drug called a monoclonal antibody.
• It works by attaching to HER2 receptors on the surface of breast cancer cells and thereby stopping the cancer cells from dividing and growing.


















Why I felt the need to have a blog site dealing with cancer information and second opinion

During my career as a clinical oncologist for the past 15 years I have come across numerous patients and their family members, who when faced with the cruel fact that either he/she or a person very close to their heart has been diagnosed with cancer, are utterly confused and disoriented. They are at their wit's end about their next step.
The patient himself/herself goes through a series of psychological upheavals starting with the feeling that the diagnosis is incorrect and thereafter moving onto the feeling of hopelessness culminating into the feeling of "Why Me Of All Persons ?". In other words the state of mind of the patient does not allow him/her to think rationally about the further course of action. The patient's family, on the other hand, is devastated by the diagnosis and are running from pillar to post to find out the ways and means of treatment. Opinions start to flow in from every possible corner about the doctor to see, the drugs to use, the alternative medicine resources, anecdotes, how bleak is the future and what not leaving them utterly confused.
Navigating through all these when the patient and the family decide to see a doctor, an oncologist to be precise, the busy doctor, sitting in his office, takes a moment to glance through the papers pertaining to the diagnosis and starts prescribing the treatment. This may not happen in the developed countries but it certainly happens days in and days out in the developing and the underdeveloped countries where the doctor-patient ratio is appalling. The doctor does not have the time and more so does not have the inclination to listen to the patient's story and counsel the patient. The family and the patient had jotted down so many things that they wanted to ask the oncologist but could not gather the confidence and the courage to ask him. The patient is in no state of mind to cajole the doctor and even if somebody from the family gathers the courage to put up a question to the doctor, curt comes the reply,"It is beyond your comprehension" or "You could have become a doctor yourself to understand these intricacies of medicine and especially cancer". My decision is final and binding replies the doctor signals his assistant to send in the next patient.
You come out of the oncologist's office dazed and more confused and telephone one of your relatives about the appointment that you just had with the oncologist. He narrates a story to you and guides you to another oncologist who is supposed to be very good. When you visit him, he leaves you more confused about the management because what he tells does not tally with the previous oncologist's version. You don't know what to do and whom to approach with your dilemma. You decide to surf the internet to gather some information but that does not help either because the search engine returns results in millions in a fraction of a second. You don't know which information to assimilate. Finally you choose to toss a coin and select an oncologist and you do your best to stick on to him and follow his instructions though sometimes you have your own doubts.
This is not the way cancer should be treated. There are guidelines for everything starting from prevention to diagnosis and management. All these have been devised after years' of clinical research. Keeping these guidelines in the back of your mind while treating a patient or guiding him promises to deliver the best possible as per evidence based medicine.
Keeping this in mind I envisaged a site of my own which will help these cancer patients by guiding them properly and by being a friend in their days of need. I am not a rich doctor and therefore could not afford to build a fancy dedicated site of my own. I have decided to start small with a blog site therefore and provide my services through it only. Some years down the line I wish to upgrade this endeavor of mine to be upgraded to something like a "Wikioncologica" which will serve the mankind. If anybody reading this blog has any questions or comments, I would be more than happy to answer them either at my blog or by e mail.

Friday, July 30, 2010

Autobiography

Hello friends of the cyberspace. I am Partha and this is my first official blog post. I loved biology during my school days and dreamt of becoming a doctor. I cherished that feeling all throughout my higher secondary days and ultimately qualified to join my alma mater - R G Kar Medical College, Kolkata in 1983. Like any new comer to the medical school, slogged Anatomy, mastered the technique of drawing a simple muscle curve with the twitch of the index finger and never understood the complex biochemical structures during the days of my first professional. Second professional was more easy going - bunked classes for reasons best known to me, overslept in the hostel, got interested in college politics and tried to make up for the bunked classes by arranging for extra classes before the exams were due as a part of my duty as the class representative. I felt like a hero! I fell in love with Internal Medicine during my final professional, tried to be a master of murmurs but in vain, never went to the ophthalmology OT but managed to pass out of Medical School. Compulsory Rotatory Internship and Housemanship in Internal Medicine and Cardiology was fun. After a brief stint with the West Bengal Health Services for about an year, I joined PGIMER, Chandigarh for my postgraduate training in oncology. I shifted base to AIIMS thereafter for my Diplomate of National Board and to gather larger experience. I did some basic and clinical research along with active patient management during my days in AIIMS. I decided to move out of AIIMS and joined Max Healthcare as a consultant oncologist in 2003. Now I am on the verge of joining as the Chief of South East Asia operations of Healthcare Global Enterprises from March 2010 onwards. It has not been a smooth sailing throughout but with God's grace and your blessings I have been able to make it this far. I seek all your best wishes and blessings to succeed in my new venture.

Thursday, June 19, 2008

Health Hazard and Mobile Phones

The Government of India in its recently circulated notification has warned about the health hazard from the indiscriminate use of mobile phones, with special precautions for children below 16 years of age, pregnant women and people with heart ailments. Mobile phone radiation and health concerns have been raised, especially following the enormous increase in the use of wireless mobile telephony throughout the world. This is because mobile phones use electromagnetic radiation in the microwave range. These concerns have induced a large body of research (both epidemiological and experimental, in animals as well as in humans).
The World Health Organization, based upon the consensus view of the scientific and medical communities, that health effects (e.g. headaches) are very unlikely to be caused by cellular phones or their base stations, and expects to make recommendations about mobile phones in 2009–10.

Electromagnetic radiation can be classified into ionizing radiation and non-ionizing radiation, based on whether it is capable of ionizing atoms and breaking chemical bonds. Ultraviolet and higher frequencies, such as X-rays or gamma rays are ionizing. These pose their own special hazards.

Non-ionizing radiation is associated with two major potential hazards: electrical and biological. Additionally, induced electric current caused by radiation can generate sparks and create a fire or explosive hazard.

Non-ionizing radiation refers to any type of electromagnetic radiation that does not carry enough energy per quantum to ionize atoms or molecules — that is, to completely remove an electron from an atom or molecule. Instead of producing charged ions when passing through matter, the electromagnetic radiation has sufficient energy only for excitation, the movement of an electron to a higher energy state. Nevertheless, different biological effects are observed for different types of non-ionizing radiation.

Near ultraviolet, visible light, infrared, microwave, radio waves, low frequency RF and static fields are all examples of non-ionizing radiation. Visible and near ultraviolet may induce photochemical reactions, ionize some molecules or accelerate radical reactions, such as photochemical aging of varnishes or the breakdown of flavoring compounds in beer to produce the 'lightstruck flavor'. The light from the Sun that reaches the earth is largely composed of non-ionizing radiation, with the notable exception of some ultraviolet rays.





Ultraviolet radiation
Ultraviolet light can cause burns to skin and cataracts to the eyes. Ultraviolet is classified into near, medium and far UV according to energy, where near ultraviolet is non-ionizing. Ultraviolet light produces free radicals that induce cellular damage, which can be carcinogenic. Ultraviolet light also induces melanin production from melanocyte cells to cause sun tanning of skin. Vitamin D is produced on the skin by a radical reaction initiated by UV radiation.


Health hazards of handsets

Part of the radio waves emitted by a mobile telephone handset are absorbed by the human head. The radio waves emitted by a GSM handset, can have a peak power of 2 watts, and a US analogue phone had a maximum transmit power of 3.6 watts. Other digital mobile technologies, such as CDMA and TDMA, use lower output power, typically below 1 watt. The maximum power output from a mobile phone is regulated by the mobile phone standard it is following and by the regulatory agencies in each country. In most systems the cellphone and the base station check reception quality and signal strength and the power level is increased or decreased automatically, within a certain span, to accommodate for different situations such as inside or outside of buildings and vehicles.

The rate at which radiation is absorbed by the human body is measured by the Specific Absorption Rate (SAR), and its maximum levels for modern handsets have been set by governmental regulating agencies in many countries. In the USA, the FCC has set a SAR limit of 1.6 W/kg, averaged over a volume of 1 gram of tissue, for the head. In Europe, the limit is 2 W/kg, averaged over a volume of 10 grams of tissue. SAR values are heavily dependent on the size of the averaging volume. Without information about the averaging volume used comparisons between different measurements can not be made. Thus, the European 10-gram ratings should be compared among themselves, and the American 1-gram ratings should only be compared among themselves.

Specific absorption rate (SAR) is a measure of the maximum rate at which radio frequency (RF) energy is absorbed by the body when exposed to radio-frequency electromagnetic field. It is used for exposure to fields between 100kHz and 10 GHz. The SAR value will depend heavily on the geometry of the part of the body that is exposed to the RF energy and on the exact location and geometry of the source of the RF energy. Thus tests must be made with each specific source, such as a mobile phone model, and at the intended position of use. The value cited for a specific model is then the maximum level measured in the body part studied. The most common use is in relation to mobile phones, and here the mobile phone is placed at the head in a talk position. The SAR value measured is then value measured in the place that has the highest absorption rate in the entire head, which for a mobile phone often is as close to the phone as possible. Various governments have defined safety limits for exposure to RF energy produced by mobile devices that mainly exposes the head or a limb for the RF energy:

Thermal effects

One well-understood and well known effect of microwave radiation is dielectric heating, in which any dielectric material (such as living tissue) is heated by rotations of polar molecules induced by the electromagnetic field. In the case of a person using a cell phone, most of the heating effect will occur at the surface of the head, causing its temperature to increase by a fraction of a degree which is less than that obtained during the exposure of the head to direct sunlight. The brain's blood circulation is capable of disposing of excess heat by increasing local blood flow. However, the cornea of the eye does not have this temperature regulation mechanism and exposure of 2-3 hours' duration has been reported to produce cataracts in rabbits' eyes at SAR values from 100-140W/kg, which produced lenticular temperatures of 41-41°C[12]. Premature cataracts have not been linked with cell phone use, possibly because of the lower power output of mobile phones. Thus we see that lens protein is far more sensitive to mobile phone radiation than the human head which is, in most of the cases, is directly exposed to the radiation.

Non-thermal effects
Some researchers have argued that so-called "non-thermal effects" could be reinterpreted as a normal cellular response to an increase in temperature. There may be several thermoreceptor molecules in cells, and that they activate a cascade of second and third messenger systems, gene expression mechanisms and production of heat shock proteins in order to defend the cell against metabolic cell stress caused by heat.
Proponents of another school of thought disagree with the thermal hypothesis, citing evidence of different pathways for the synthesis of stress proteins in cells subject to EMF radiation versus heat shock. These pathways involve different DNA segments of the same gene. They postulate instead a non-thermal mechanism whereby EMF rearranges the electron configuration on DNA molecules. This charge accumulation could overcome the hydrogen bonds joining the DNA strands.

Blood Brain Barrier effects
Swedish researchers have found a leakage of albumin into the brain via a permeated blood-brain barrier.

Electrical sensitivity
Some users of mobile handsets have reported feeling several unspecific symptoms during and after its use; ranging from burning and tingling sensations in the skin of the head and extremities, fatigue, sleep disturbances, dizziness, loss of mental attention, reaction times and memory retentiveness, headaches, malaise, tachycardia (heart palpitations), to disturbances of the digestive system. All of these symptoms can also be attributed to stress and it is impossible to put the blame on cell phone use only.


Genotoxic effects
Research published in 2004 by a team at the University of Athens had a reduction in reproductive capacity in fruit flies exposed to 6 minutes of 900 MHz pulsed radiation for five days. Subsequent research, again conducted on fruit flies, was published in 2007, with the same exposure pattern but conducted at both 900 MHz and 1800 MHz, and had similar changes in reproductive capacity with no significant difference between the two frequencies. These effects could be due to degeneration of large numbers of egg chambers after DNA fragmentation of their constituent cells.

In 1995, Lai and Singh reported damaged DNA after two hours of microwave radiation at levels deemed safe according to government standards in the journal Bioelectromagnetics. Later, in December 2004, a pan-European study named REFLEX (Risk Evaluation of Potential Environmental Hazards from Low Energy Electromagnetic Field (EMF) Exposure Using Sensitive in vitro Methods), involving 12 collaborating laboratories in several countries showed some compelling evidence of DNA damage of cells in in-vitro cultures, when exposed between 0.3 to 2 watts/kg, whole-sample average. There were indications, but not rigorous evidence of other cell changes, including damage to chromosomes, alterations in the activity of certain genes and a boosted rate of cell division. Reviews of in vitro genotoxicity studies have generally concluded that RF is not genotoxic and that studies reporting positive effects had experimental deficiencies.


Mobile phones and cancer
In 2006 a large Danish study about the connection between mobile phone use and cancer incidence was published. It followed over 420,000 Danish citizens over 20 years and showed no increased risk of cancer.
In order to investigate the risk of cancer for the mobile phone user, a cooperative project between 13 countries has been launched called INTERPHONE. The idea is that cancers need time to develop so only studies over 10 years are of interest.

The following studies of long time exposure have been published:

• A Danish study (2004) that took place over 10 years and found no evidence to support a link. – negative
• A Swedish study (2005) that draws the conclusion that "the data do not support the hypothesis that mobile phone use is related to an increased risk of glioma or meningioma. - negative
• A British study (2005) that draws the conclusion that "The study suggests that there is no substantial risk of acoustic neuroma in the first decade after starting mobile phone use. However, an increase in risk after longer term use or after a longer lag period could not be ruled out. – negative with word of caution
• A German study (2006) that states "In conclusion, no overall increased risk of glioma or meningioma was observed among these cellular phone users; however, for long-term cellular phone users, results need to be confirmed before firm conclusions can be drawn. – negative with word of caution
• A joint study conducted in northern Europe that draws the conclusion that "Although our results overall do not indicate an increased risk of glioma in relation to mobile phone use, the possible risk in the most heavily exposed part of the brain with long-term use needs to be explored further before firm conclusions can be drawn. – negative with word of caution

Other studies on cancer and mobile phones are:

• A Swedish scientific team at the Karolinska Institute conducted an epidemiological study (2004) that suggested that regular use of a mobile phone over a decade or more was associated with an increased risk of acoustic neuroma. The increase was not noted in those who had used phones for fewer than 10 years.[34]

• The INTERPHONE study group from Japan published the results of a study of brain tumour risk and mobile phone use. They used a new approach: determining the SAR inside a tumour by calculating the radiofrequency field absorption in the exact tumour location. Cases examined included glioma, meninigioma, and pituitary adenoma. They reported that the overall odds ratio (OR) was not increased and that there was no significant trend towards an increasing OR in relation to SAR-derived exposure. In a February 2008 update on the status of the INTERPHONE study IARC stated that the long term findings ‘…could either be causal or artifactual, related to differential recall between cases and controls.’

Sleep and EEG effects
Some studies have claimed to show that mobile phone signals affect sleep patterns and possibly delay sleep onset during exposure. In another clinical study, carried out by Sweden's Karolinska Institute and Wayne State University in the US, the authors concluded their research suggested an association between RF exposure and adverse effects on sleep quality within certain sleep stages, though participants were unable to determine better than chance if they had been exposed to actual radiation or sham exposure. The UK National Health Service criticized the research because of
• the small sample size used, and
• because of the 53% of participants who reported sensitivity to mobile use, a proportion unlikely to be representative of the general population.

Health hazards of base stations
Another area of worry about effects on the population's health have been the radiation emitted by base stations, because, in contrast to mobile handsets, it is emitted continuously and is more powerful at close quarters. On the other hand due to the attenuation of power with the square of distance, field intensities drop rapidly with distance away from the base of the antenna. Base station emissions must comply with ICNIRP guidelines of a maximum power density of 4.5 W/m² (450 microwatts/cm2) for 900 MHz and 9 W/m² (900 microwatts/cm2) for 1800 MHz.

These guidelines are set for short term heating, which is the only understood mechanism of electromagnetic fields on biological tissue.

Several surveys have found increases of symptoms depending upon proximity to electromagnetic sources such as mobile phone base stations.
• A 2002 survey study by Santini et al. in France found a variety of self-reported symptoms for people who reported that they were living within 300 metres (984 ft) of GSM cell towers in rural areas, or within 100 m (328 ft) of base stations in urban areas. Fatigue, headache, sleep disruption and loss of memory were among the symptoms reported. Similar results have been obtained with GSM cell towers in Spain, Egypt, Poland and Austria. It is, however, important to note that these surveys do not show statistically significant clustering or causality and those complaining of adverse symptoms may be displaying the nocebo effect, unless this is controlled in the study.
• However, a study conducted at the University of Essex and another in Switzerland concluded that mobile phone masts were unlikely to be causing these short term effects in a group of volunteers who complained of such symptoms.

Occupational health hazards
A variety of studies over the past 50 years have been done on workers exposed to high RF radiation levels; studies including radar laboratory workers, military radar workers, electrical workers, and amateur radio operators. Most of these studies found no increase in cancer rates over the general population or a control group. Many positive results could have been attributed to other work environment conditions, and many negative results of reduced cancer rates also occurred.


Safety standards and licensing
In order to protect the population living around base stations and users of mobile handsets, governments and regulatory bodies adopt safety standards, which translate to limits on exposure levels below a certain value. There are many proposed national and international standards, but that of the International Commission for Non-Ionizing Radiation Protection (ICNIRP) is the most respected one, and has been adopted so far by more than 80 countries. For radio stations, ICNIRP proposes two safety levels: one for occupational exposure, another one for the general population. Currently there are efforts underway to harmonise the different standards in existence.

Evolution of Safety Standards
The following is a brief summary of the wireless safety standards, which have become stricter over time.

• 1966: The ANSI C95.1 standard adopted the standard of 10mW/cm2 (10,000 microwatts/cm2) based on thermal effects.
• 1982: The IEEE recommended further lowering this limit to 1mW/cm2 (1,000 microwatts/cm2) for certain frequencies in 1982, which became a standard ten years later in 1992 (see below).
• 1986: The NCRP recommended the exposure limit of 580 microWatts/cm2.
• 1992: The ANSI/IEEE C95.1-1992 standard based on thermal effects used the 1mW/cm2 (1,000 microwatts/cm2) safety limit. The EPA called this revised standard "seriously flawed", partly for failing to consider non-thermal effects, and called for the FCC to adopt the 1986 NCRP standard which was five times stricter.
• 1996: The FCC updated to the standard of 580 microWatts/cm2 over any 30-minute period for the 869 MHz, while still using 1mW/cm2 (1,000 microwatts/cm2) for PCS frequencies (1850-1990 MHz).[59]
• 1998: The ICNIRP standard uses the limit of 450 microwatts/cm2.

Adequacy of Current Standards
The controversial question is whether the current safety standards are adequate enough to protect the public's long-term health. A few nations have set safety limits orders lower than the ICNIRP limit. In particular, the Salzburg Resolution for Austria recommends safety limits many times lower (0.6 V/m = 0.1 microWatts/cm2 for pulsed radiation.[60]

Precautionary principle
In 2000, the World Health Organization (WHO) recommended that the precautionary principle could be voluntarily adopted in this case. It follows the recommendations of the European Community for environmental risks.
According to the WHO, the "precautionary principle" is "a risk management policy applied in circumstances with a high degree of scientific uncertainty, reflecting the need to take action for a potentially serious risk without awaiting the results of scientific research." Other less stringent recommended approaches are prudent avoidance principle and ALARA (As Low as Reasonably Achievable).
Although all of these are problematic in application, due to the widespread use and economic importance of wireless telecommunication systems in modern civilization, there is an increased popularity of such measures in the general public, though also evidence that such approaches may increase concern. They involve recommendations such as
• the minimization of cellphone usage,
• the limitation of use by at-risk population (such as children),
• the adoption of cellphones and microcells with ALARA levels of radiation,
• the wider use of hands-free and earphone technologies such as Bluetooth headsets,
• the adoption of maximal standards of exposure, RF field intensity and distance of base stations antennas from human habitations.

Sunday, May 18, 2008

Is There a Cure for Cancer ?

The name CANCER brings to our minds innumerable questions, and most importantly the picture of a painful and dreaded end. I being an oncologist, view these from a different perspective.
Cancer, as we all know, is a disease that arises from uncontrolled proliferation of normal cells in the body. The causes are innumerable starting from carcinogenic insults ( drugs, habits, occupation, radiation in hazardous doses etc.), genetic alterations, intracellular events and still unknown etiology. Whatever the cause is the end result is the development of cancer.
So what is the answer for cancer ? Traditionally, there are three modalities of treatment - radiation, chemotherapy and surgery. While radiation and surgery are local forms of treatment, chemotherapy, on the other hand, is a systemic form of therapy in which the entire human body is subjected to the chemotherapeutic drugs with the understanding that it will look after the local as well as the systemic disease.
Time has come now to think beyond these tradtional methods of treatment. In the recent years much progress has been in this regard. Targeted therapy is one such innovation in which drugs are being marketed and are being researched in a phased manner to target the cancer cells specifically. There are millions of target - both intracellular and extracellular which are being targeted. Millions and millions of dollars are being spent on these research with the end result that these drugs ( targeted therapy) are prohibitively expensive.
Now the time has come to think of an universal target, which if targeted can specifically destroy the cancer cells with minimal toxicity to the normal human cells.