Categories
General

Epilepsy, the untold truths.


Good morning and welcome back to my blog!

Today, I will be sharing with you the Untold stories about Epilepsy and this was triggered after a 59mins chat with my friend who is Epileptic.

I’ve known her for years but I last saw her over 10years ago.

On seeing her 2 days ago… We chatted for a while. She asked me a lot of questions concerning health and most importantly EPILEPSY.

She is 31years old . Her first Seizure was at 27years. Prior to that, she never had a seizure.

In her words: “I had a misunderstanding with my mother in- law and she threatened to deal with me. Few days after that I started having seizures. Whenever it happens, I fall on the ground, drooling saliva and urinating on my body. No one comes close to me because they believe I will spread it to them. Look at my body Ola, I’ve scars all over from the frequent falls. The other time I woke up naked infront of my house. No body tried to cover me up. Everyone avoids me like a plaque even her husband. Then she broke down in tears.

At this point, my whole body was in shock. I still didn’t believe in 2020 people still think this way. Ignorance at it’s peak

So I tried to pacify her. Then asked her these questions:

  • Does it give you signs before it starts?
  • How long does it last ?
  • Have you seen a Doctor?
  • Any history of seizure in your family?
  • How frequent does this happen in a week?

She has never visited the hospital for it. But has been to over 15 prayer houses. It normally gives her a sign (aura) which is Abnormal taste, which precedes the seizure with 10-15mins. The frequency varies ,could be as much as 10 times in a week to as low as twice in 2 weeks.

So I tried to debunk some of the myths /misconceptions about Epilepsy.

Misconceptions about Epilepsy (myths)

  • Epilepsy is demonic or caused by village people
  • The saliva of the person is contagious
  • You should put a spoon or metal in the mouth to prevent clenching of the teeth
  • Crude oil is needed in children. It is not spiritual
  • People with Epilepsy are disabled
  • You can swallow your tongue

These are all false


EPILEPSY


Epilepsy is a disorder characterized by recurring seizures (also known as “seizure disorder”)

A seizure is a brief, temporary disturbance in the electrical activity of the brain.

That one had one episode of seizure/convulsion doesn’t make her /him Epiletic. It has to be recurrent before the diagnosis of epilepsy is made.

What causes epilepsy?

Electrical storm in the brain

All brain functions — including feeling, seeing, thinking, and moving muscles — depend on electrical signals passed between nerve cells in the brain

A seizure occurs when too many nerve cells in the brain “fire” too quickly causing an “electrical storm”

In about 70% of people, the cause is not known.

In the other 30%, causes include

  • Head trauma
  • Infection of the brain
  • Brain tumors
  • Stroke
  • Hereditary
  • Factors that disturb brain development

Symptoms of Seizures

– Periods of blackout or confused memory
– Occasional “fainting spells”
– Episodes of blank staring
– Sudden falls for no apparent reason
– Episodes of blinking or chewing at inappropriate times
– A convulsion, with or without fever
– Clusters of swift jerking movements of the body that may involve the both the hands and/ or legs or any other part of the body

Diagnosis

This involves patient’s history and interview of eyewitness(es)

  • Examination
  • Tests : blood, EEG, CT-scan etc

Treatment

The aim of treatment is to help these patients lead a productive life. Treatment could be

1. Medication
2. Surgery
3. Nonpharmacologic treatment:
Ketogenic diet
Vagus nerve stimulation
Lifestyle modifications

With appropriate treatment and strict adherence to treatments, the seizures can be controlled. Some patients even go for so many years seizure-free.

Complications that arise when not treated:

– Seizures can be potentially life threatening with brain failure, heart and lung failure, trauma, accidents
– Sudden Unexpected Death in Epilepsy (SUDEP)
– Even subtle seizures can cause small damage in brain
– Long Term problems like fall in IQ, depression, suicide, Social Problems, poorquality of Life

Things that trigger seizures

If you’re epileptic or knows someone who is. These are some factors you must know

  • Missed medication (Number one reason)
  • Stress
  • Anxiety
  • Hormonal changes
  • Menstruation
  • Dehydration (not taking enough water)
  • Lack of sleep
  • Illicit drugs
  • Alcohol
  • Certain drugs
  • Fever in children

DANGEROUS THINGS YOU MUST AVOID

Don’t restrain person having a seizure
Don’t put anything in the person’s mouth
Don’t try to hold down or restrain the person
Don’t attempt to give oral antiseizure medication
Don’t keep the person on their back face up

Don’t put crude oil or palm kernel oil into the baby’s mouth. This can lead to aspiration and dearg ev

Safety Concerns

Epileptics can’t engage in these activities as long as seizures are not controlled.
However, most will advice them to stay away until 2years after the last seizure

Do you agree with me that most Road traffic accidents are probably due to an Epileptic driver?

1 Driving: a person with epilepsy must be free of seizures that affect consciousness for a certain period of time.
2. Climbing altitudes
3. Swimming/ Bathing alone
4. Operating heavy machinery or weapons that can be dangerous
5. Cooking, hot water (very common ensure you’re making your medications and always stay away from fire)
6. Taking care of babies

“…I just need everyone to remember that things happen for a reason, and that we will cope with whatever comes our way. It is okay zeèßae1qnot to like it, as seizures aren’t fun and can be scary.

Epilepsy doesn’t have to rule our lives — as long as we have people who will listen to us, believe us, and give us honest answers.”___Dr Shahin Nouri

Thanks for not sleeping on me☺️. Please do well to share. I feel there’s need to raise more awareness on this. See you in the comment section

Categories
Cancers General

Tobacco evil, multiple effects


I met Jack a few years ago. He was practically everything I wanted. We got talking and I couldn’t help but admire him. He was an awesome fellow. But I always noticed he had a whiff of nicotine breath each time we met.
By the 3rd week, he confessed to me he was addicted to smoking cigarettes following a request from him to smoke in my presence.

He smoked at least 2 packs of cigarettes each day, he admitted.
Seriously, I tried to talk him out of it. But when it was clear to me he wasn’t ever going to change, I walked out of his life without looking back.


You can call me selfish, yes, but I don’t want to spend my life taking care of a partner who failed to take care of himself while he could, or battling with a disease acquired through passive smoking.

Tobacco kills up to half of its users.

Tobacco kills more than 8 million people each year. More than 7 million of those deaths are the result of direct tobacco use while around 1.2 million are the result of non-smokers being exposed to second-hand smoke.

Cigarette smoking, according to the CDC, causes more preventable deaths each year than the combination of HIV, illegal drug use, alcohol use and motor vehicle injuries.
Smoking is addictive and sometimes difficult for those who smoke to easily walk away from this habit. This addiction also drives up the profit of Tobacco companies. They ain’t gonna stop producing cigarettes anyway.

You can have some of these effects of cigarette smoking even without being an active smoker. Passive smoking is as dangerous as active smoking. Passive smoking is the inhalation of smoke (secondhand smoke) by persons other than the active smoker.


We probably all know at least one person who smokes cigarettes. The effects on the body are varied and widespread, however, no one has told you these things I’m about to share with you today…

  1. Smokers are at an increased risk of CANCERS:
    Smoking can cause cancers almost anywhere in the body.
    Lung cancers, in more than 90% of cases are caused by smoking. Lung cancers are also seen among passive smokers and rarely among non-smokers. The link between smoking and lung cancer is very strong and almost always diagnosed very late.
    Mouth, tongue, laryngeal, esophageal, liver and stomach cancers are also strongly linked to smoking.
    Pancreatic and skin cancers have also been linked to cigarette smoking.
    Many who smoke also ingest alcohol. This combination exponentially increases the risk of all cancers.
  2. Chronic obstructive pulmonary disease (COPD) is a medical condition that affects the respiratory system. In this case, the chemicals from smoking cigarette destroys the lung tissues, making them less efficient in their function. Individuals tend to cough a lot with copious sputum production and poor body oxygenation. It is progressive and irreversible, usually leading to respiratory failure and even heart failure. It commonly reduces the life span of affected individuals.
    Tobacco smoke is capable of triggering an asthmatic attack even in previously undiagnosed individuals.
  3. Atherosclerosis which is the thickening of blood vessels can lead to stroke, heart failure and other diseases. Smoking leads to premature or a rapid ageing of the blood vessels, making them stiffer, clogged and narrower.
    This limits blood flow to vital organs of the body including the brain (causing a STROKE), heart (causing HEART ATTACK or myocardial infarction), kidneys (causing KIDNEY FAILURE), eyes (causing DETERIORATION IN EYESIGHT), leg vessels (causing pain on walking or CLAUDICATION) and the penis (causing ERECTILE DYSFUNCTION).
    Male smokers produce less viable sperms and are more likely to be infertile compared to their non-smoking peers.
  4. Cigarette smoking in pregnancy causes low birth weight, premature labour and an increased risk of sudden death of the baby (within the womb) before it is delivered.
    Smoking also makes it more difficult for a woman to get pregnant.
  5. For those who are so concerned about their skin, smoking damages the skin. Making it rougher, wrinkled with an increased risk of developing skin cancers.
    If you want a smooth and shiny skin, then smoking cigarettes actively or passively must be avoided at all cost.
  6. Maintaining a beautiful set of teeth is out of the question with cigarette smoking. Tobacco blackens the teeth and causes gum disease with early enamel erosion. Regular toothaches and dental visits is their lot. I am yet to see a smoker with an inviting healthy smile.
  7. A bad breath is the norm with smokers too. Long after smoking, it stays with them. A bad breath among smokers can not be eliminated simply by brushing the teeth or licking tom-tom, as the breath comprises exhaled air from the lungs. It can be irritating, a regular source of a bad impression from strangers.
  8. Exposure to cigarette smoking at an early age causes delay in lung maturation.
Exposure to cigarette smoking at an early age causes delay in lung maturation.

These effects, which by no means is exhaustive as smoking affects every organ in the body, can similarly be caused by either smoking cigars or pipes. So one does not go on playing the ostrich.
You mustn’t be an active smoker to have any of these, passive smoking can also result in these.
Do you see why I said what I said? I can not suffer for another man’s foolishness.

Bringing an end to the habit of smoking is, admittedly, not an easy endeavour. It requires a strong personal desire to quit and stay smoke-free.
One will need:


*Family and friends support…Encouragement from supporting family members can be motivating.


*Behavioral changes (like avoiding joints/clubs or places where others smoke and seeking a diversion for when the cravings arise).


*Nicotine replacement therapy (nicotine patches) help when those who were avidly addicted develop withdrawal symptoms like headaches and the shakes.


*Prescription drugs to discourage smoking are also available.


*Join a support group. These groups comprising anonymous repentant addicts who chose to support each other may be uncommon in Nigeria for now. But some organizations can be reached by phone or online for psychological and material support.

Support group

Taking the first step by making a firm resolution is key as the necessary help can easily be assessed wherever one is in this country.
Say no to cigarette smoking, and say NO today.
Do not wait until the claws of a debilitating disease bring you down to a level of helplessness, forced to give up this habit when it is too late.

The clock is ticking

Disclaimer: The character depicted is fictitious. Any similarity to actual person living or dead is purely coincidental

Categories
General

STROKE, WHAT YOU MUST KNOW


Ladies and gentlemen, our guest for today is Associate Professor Sidney Oparah, a Chief Consultant at the University of Calabar Teaching Hospital.

Associate Professor Sidney Oparah

He has been a Medical Doctor for over 22 years and a Clinical Neurologist for 14 years. His hobbies are travelling, painting and drawing.

It is definitely a great a pleasure to listen to him share with us all we need to know about this very common illness in our environment, from his wealth of knowledge and experience. Let me share this fascinating interview with you. Enjoy


WHAT IS A STROKE?

Stroke is a health condition that occurs when the blood supply to a part of the brain is suddenly cut off. Especially, if the loss of blood supply lingers upto 24hrs. However, we don’t have to wait for 24hours to make the diagnosis of stroke.

What are the various descriptions of stroke in the population

Majorly, it has spiritual connotations. They believe it’s as a result of witchcraft attack, or an evil spirit has attacked. Infact the Ibo’s call it “MBA AGBARA” which means a spirit has evoked the person.

WHAT ARE THE NEUROLOGICAL DISEASES THAT  ARE NOT STROKE?

There are quite some diseases that mimic stroke but are not Stroke. They include

conditions like a tumour in the brain

A fall especially in the elderly can lead to blood accumulation compressing that part of the brain.

Epilepsy especially in ‘Todd paresis’ in focal seizure. That part of the body that was involved in the convulsion becomes weak, and this weakness subsides completely after some minutes or hours.

Low blood sugar

Brain abscess

Some forms of Migraine headache

Bacterial /Viral infections of the brain

All these manifestations will not be as sudden as it in stroke. So they’re not stroke

How does a stroke present?

The brain controls the rest of the body. So the manifestations depend on the part of the brain affected and the extent of  brain injury.


It is always of sudden occurrence because it has to do with blood vessel. Generally they present with,

Deviation of the face
  • Weakness on one side of the face. The face deviates to the good side
  • The weakness of the hand, leg or both.
  • Headache may or may not be present
  • Problems of vision
  • Difficulty with speaking. May understand you, but may not vocalise, or may not understand nor vocalise.
  • Numbness
  • Difficulty in movement of any part of the body
  • Difficulty with balance

What causes a stroke with emphasis on the common causes in Nigeria?

The actual cause of stroke still remains “sudden” loss of blood supply  to a part of the brain. Which could be as a result of
1.) obstruction to a blood vessel (Ischemic stroke)
2.) Rupture of a blood vessel (hemorrhagic stroke)


There are however RISK FACTORS. We usually classify them into NON-MODIFIABLE RISK FACTORS AND MODIFIABLE FACTORS.

The Non-modifiable factors are factors that are not within our control and they include


1) Increasing Age: The risk of stroke doubles for every 10 years after the age of 55 years. However, it doesn’t mean someone below 55 years can not have a stroke. This shows that increasing age doubles the risk of stroke.  Unfortunately, we can not do anything about it.

2) Male gender : Stroke tends to occur more in males than females especially before menopause. This is believed to be as a result of some level of protection the female sex hormone oestrogen confers. However, after menopause,  the risk is same

3) Black race: The risk is higher among the Negroes than the Caucassians.

4) Having a previous stroke is a risk factor for a repeat stroke. 
5) Family history of stroke especially from first-degree family members like father, mother, brother or sister. It increases the chance and possibly due to genetic factors. These are all non-modifiable because we can not do anything about them.

The Modifiable risk factors are those factors which are within our control and they include

  • Hypertension , which is the most common risk factor. Infact, hypertension should never be forgotten as the number one cause of stroke.
  • Poorly controlled Diabetes Mellitus
  • Cigarette smoking
  • Obesity or overweight
  • Alcohol
  • Sedentary lifestyle
  • High cholesterol level especially the Low density cholesterol also known as ‘Bad cholesterol’
  • Blood diseases like hemophilia
  • Heart conditions like valvular heart disease, abnormal heart rhythm which can encourage clot formation
  • Use of oral contraceptives pills, oestrogen supplementation after menopause in Hormone replacement therapy.

There is something called Stroke in the young.
A condition where stroke occurs in those less than 50yrs. The causes include

  • Sickle Cell Disease which is common in the young and is a risk factor for stroke in the younger age group.
  • HIV infection which is found more in persons of reproductive age (15-49years)
  • Recreationsl Drugs like cocaine causes constriction of the vessels which can lead to loss of blood  supply to the brain.

In what ways can we readily diagnose a stroke?

For a layman, look out for some of the symptoms of stroke, and the timing too. Was it of sudden onset? Which is characteristic of stroke. Check out for the symptoms earlier stated.

  • Tell the person to look at you , then you look at the face and see if it’s shifted to one side. If it’s not obvious, you tell the person to smile. It will be more obvious.
  • Raise the hand to see if there is any difficulty in doing so or if there is any weakness.
  • Ask the person to talk (speech) and look out for any changes.

For the physician, he does an objective assessment to confirm the symptoms stated by the patient or the relative and examines the patient thoroughly. Then send for an urgent Brain CT scan which is the investigation of choice.

CT scan is an advanced form of Xray.

It shows if there’s a stroke, the location of the occlusion and the type of stroke. Other imaging like MRI can also be done.

Normal brain CT scan

The Physician will also look out for the likely cause of the stroke by asking the relevant questions and sending for some investigations depending on the likely cause.

How should stroke patients be optimally managed when they do occur?

The management of stroke is divided into four phases

Acute phase
Early Subacute
Late Subacute phase
Chronic phase

In the management, it should be a very fortunate thing to treat the stroke as early as possible in the Hospital especially in the acute and early Subacute phases

Once there’s “FAST” which stands for

F- FACE DEVIATION

A- Weakness of the ARM

S- Change in SPEECH

T- TIMING which are all of SUDDEN ONSET
You have to quickly bring the person to the nearest hospital. This is not the time for prayer house, traditional healers, Patent medicine dealers, pharmaceutical shops, native doctors, etc.

In the management

For acute phase,

The clot causing an iscaemic type of stroke can be dissolved in hospitals where they have facilities for such a treatment, if there are no contraindications.
If this is done within the first 3 to 4 and a half hours, the outcome is encouraging. Thrombolysis (the breakdown of the clot) within first 4 and half hours can be quickly done with a certain drug.

However, the drawback is our patients normally present late, beyond this window period (3 to 4 and a half hours) and the drug which dissolves the clot is not readily available in this part of the world.

But you have to also handle other issues like blood pressure control, blood sugar control, adequate hydration, etc

Physiotherapy
Speech therapy
Other forms of rehabilitation including occupational rehabilitation would be needed. Even after the stroke survivor is discharged from the hospital , physiotherapy should be continued for some time.

Are there alternatives to hospital care of stroke patients?

Stroke management must be in the hospital. So there are no alternatives to hospital care.

Is having a stroke the end of one’s normal activity, like his job, sexual activity and social activities?

No. There is a 1/3rd rule in stroke. It shows the outcome of stroke

I/3rd of stroke patients die from the stroke.

Another 1/3rd recover with little or no deficit

And the remaining 1/3rd are left with moderate to severe deficit

The ones with little or no deficit go back to their normal life.

Those with moderate to severe deficit will need rehabilitation.

Sexual activity is not affected.

People should understand that stroke is an illness, a disease. No one calls for that. There’s something called Post-stroke depression.
It can be a bit challenging, but it is beneficial to be well motivated.
In fact, the recovery in motivated persons is much better. It’s not the end of life

What are the challenges to diagnosis and management of stroke in Nigeria?

It could be from the Society, Physician or the Authority.

  1. Level of society

Inability to recognize a stroke

Coming to the hospital late

Ignorance and unhelpful beliefs, and attitudes toward stroke

Poverty

  1. Level of the Physicians
    Though not common, there can be misdiagnosis. Mostly as a result of the patient/Doctor ratio here, which is very abysmal.
    You see one Doctor attending to so many patients, and some of them may have some tendencies to inadvertently gloss over some issues. However, this should not be an excuse for negligence.
  2. Level of government
    Most of the imaging facilities are expensive, and require constant power supply. We all know what the power supply is like in this country.
    Some of the facilities needed are not readily available in this part of the world like CT scan, MR1 machines etc
    Even when they are available , they’re not very affordable. The reality is that people pay out of their pocket for health care in our setting. For example to do an MRI in Calabar, costs #70,000, while the cost of CT-scan ranges from #40-50,000
    Then what’s the minimum wage? #30,000!

And what solutions can you offer towards these challenges?

There’s need to create more health awareness on stroke like you’re doing with your blog and I must applaud you for that. Also, the government should pay more attention to the Health care system and provide the necessary facilities needed to better the healthcare of her citizens.

What can Nigerians do to prevent having a stroke?

Anyone that wants to prevent stroke must do this

-Know your blood pressure
Hypertension does not give signs. That’s why it’s called a silent killer. And it still remains the commonest cause of Stroke

Know your blood pressure

And once the blood pressure is up to 140/90mmHg, you must work with your doctors to keep it under control.

It is important to check your blood pressure at least once a year if you’re not Hypertensive.

More often if there’s a history of high blood pressure,
And even more also if there’s a history of high blood pressure in the family.

-Know your blood sugar especially for diabetic patients

-Cholesterol level both for High density cholesterol (good cholesterol) and Low density cholesterol (bad cholesterol)

-No smoking. Smoking doubles the risk for stroke.
If someone quits smoking, over time, the risk for stroke reduces.

-No excessive alcohol.
Alcohol should be in moderate amount.
However, studies have shown that there is no benefit of alcohol. No amount is harmless
It affects the brain (stroke), liver, kidney.
It has has been implicated in some cancers like colonic cancer and breast cancer.

-Healthy diet
Especially avoid saturated fat
Eat more of unsaturated fat

Rule of the thumb is, if the oil congeals under room temperature is likely to be saturated fat. Avoid such oil. Omega3 & 6 are good.

-Eat more of vegetables and fruits, nuts high in potassium.

-No added salt, it doesn’t mean you should not use salt. It simply mean after cooking, no extra salt.

Avoid refined sugars especially for those who have diabetes.

-Exercise
30mins in a day up to 5 days in a week is highly recommended

It decreases the risk of progression of heart conditions

Beneficial to having good blood pressure readings, losing weight and maintaining a healthy weight, and carbohydrate metabolism.
Helps in optimizing insulin sensitivity. Insulin is a hormone that helps in metabolism of sugar.
It is advisable to perform activities you’re likely to continue. Consistency is key. It must not be jogging up and down.
One can adopt other activities like climbing up and down the staircase several times every morning, briskly walking around your house, deliberately parking your car at an appreciable distance from your office etc. For me, I love to wash my cars every morning.

For overweight and obese patients, weight loss can help in increasing the good cholesterol, while reducing the bad one. It also helps to reduce blood sugar in diabetic patients.

Apart from this, it is important for people to know the symptoms of stroke and take appropriate actions like rushing the person to the hospital

If you have any medical conditions that can cause stroke, you should cooperate with your doctor to manage such conditions like hypertension, diabetes, SCD, etc

In conclusion, what in essence should anyone do if he sees someone suspected to have suffered a stroke?

Always remember “FAST

Quickly rush the person to the hospital.

The burden is higher in this part of the world, with hypertension as the number one risk factor.

Stroke is something we can manage and the best place to manage it, is in the hospital.

Once again, if you suspect someone has had a stroke, quickly rush the person to the hospital. It is not the time to deliberate on prayer houses, patent medicine dealers, money, native doctors etc.

Comply with the instructions from the doctors and other health care providers, and put in some of the measures that aid in prevention of stroke.

Categories
Cancers

BREAST CANCER


Breast cancer is the most common cancer affecting women worldwide.

It affects both men and women, but more common in women in a ratio of 100:1. I in 12 Black women will have breast cancer

Risk factors

  1. Age: rare before 20 years. More common in those >40 years.

  2. Gender: more common in women. Accounts for over 40% cancers in Nigerian women, and 1% in men

  3. Genetic predisposition

  4. Prolonged exposure to estrogen as in early menarche, late menopause, nulliparity (childllessness) and and prolonged use of oral contraceptive pill (over 5 years)

  5. Tobacco Smoking and alcohol consumption

  6. Previous breast lump

  7. Obesity

  8. Radiations

What do you know about it?
Ok! I know you know it is currently the most common cancer in women.
But do you know you can detect it at its earliest stage, and continue with your life?
Long ago, it was thought to occur only in elderly women, but now studies have found it can occur at an earlier age in African women.

Symptoms

Breast cancer usually presents as a

  1. Painless lump in over 90% of the cases. do this is the reason why you should always examine your breast every month, as you may never know until it’s too late.

  2. Blood stained Nipple discharge

  3. Nipple changes like inversion, retraction

  4. Ulceration of nipple and overlying skin

  5. Lump in the armpit or arm etc

Prevention

  1. SELF EXAMINATION. This simple method can help you detect breast cancer at its early stage, making prognosis very good.

How is this done?

  • Ideally it should be done every month #(7days after your menstrual flow).
  • Lying down face up (supine).
  • The two breasts should be examined. ….checking for a lump including the areola/nipple area.
    Don’t forget your #axilla (armpit). Yes, the breast can extend to that region in some women. It’s called Axillary tail. Lumps can be located in any part if the breast.
  • This is recommended for every female from #20years. Yes! 20years.
  • Any abnormality found should be reported to a Doctor.

However, if you have a relative who had breast cancer be it mother, aunt, sister, grandmother; in addition to Self breast examination, you should be examined by a Doctor every year.

  1. Prophylactictic mastectomy : this is the surgicsl removal of the breast to prevent cancer of the breast.

Angelina Jolie, the famous American actress and Academy Award winner, announced that doctors told her she had an 87 percent risk of breast cancer because of a certain gene she was carrying. Shortly after that, Jolie underwent a preventative double mastectomy.

Angelina Jolie

  1. Early marriage to ensure first pregnancy is achieved before the age of 30 years. First pregnancy after 30 years increases the risk of breast cancer.

  2. No tobacco or alcohol consumption

  3. Mammogram: Women with an average risk of breast cancer should undergo regular screening mammography starting at 45 years of age

  4. Avoid sedentary lifestyle and exercise more often.

Forget all myths you heard about it, an early detection provides you an excellent chance of long term survival.