Disney princesses and breast cancer | Amal Kouchkar | TEDxCasbah

In order to illustrate the factors associated with an increased risk of breast cancer, Dr. Kouchkar invites us to guess which Disney princess is most likely at risk of developing this type of cancer. She concluded her presentation by pointing us to the fact that royalty can also be victims of this disease.

Before getting down
to the nitty-gritty of breast cancer,

I'd like to give you
an overview of the organ itself.

The breast itself.

It's an excellent nursing organ.

I forgot to tell you
that my presentation is quite interactive;

I will need your help at some point,
so I need you to focus.

So what do you see here?

What does this picture remind you of?

A tree, yes, but not to me. It's a breast.

I see breasts everywhere.

(Laughter)

So, the little leaves at the end
will be the milk factories,

the small branches and the large branches

will be the ducts collecting the milk
and carrying it to the nipple.

This is my breast.

On a more serious note,
the breast looks like this:

a network of channels,
all leading to the nipple.

And if some dye is injected,
we'll see that the breast

is made up of several different lobules
leading to the nipple.

These are plates made in 1840.

It is an atlas of anatomy, created
by Sir [Astley Paston Cooper], Bart.,

who drew the breast.

By 2004, drawings didn't change too much,

this is a digital image showing the ducts,
the different ducts and lobules,

and it is here, inside the ducts,
where breast cancer develops.

So, I have some images to show you,

these are 3-D cut sections of the breast.

Here, we see the nipple

and all the major glands I have mentioned,
leading to the nipple.

This is a duct,

much magnified,

where milk flows.

I mentioned these small milk factories,

well, here they are
--here, there are plenty--

that release the milk into the ducts.

Since we're talking about breast cancer,
this is an image of a small, 4mm cancer.

This is the infamous breast cancer,

located close to the skin, that's here.

I divided my topic for tonight

and I'll start by talking about
the history of breast cancer.

How was breast cancer
perceived through history?

Medical scientists have struggled
since ancient times

to understand its cause,
and above all, to find ways to treat it.

Mentions in papyrus scrolls dating back
to the times of the Egyptian Pharaohs

describe eight cases of breast cancers,
of course, reported incurable.

And here you can see
various surgical instruments

used by the Egyptians at the time.

In fact, Hippocrates is credited
for the origin of the word,

he used "carcinoma" to refer
to the crab-like projections,

hence the name cancer.

In Roman times, Mr. Celsius,

who was not interested
just in temperature,

was the first to introduce
the concept of metastasis,

or the spread of cancer
to other locations in the body,

and this is what makes it
such a serious condition.

Another Roman

endorsed
the black bile theory.

This seems far-fetched now,

but it was an accepted theory at the time,

with many concoctions used
to treat cancer.

He was also the first to suggest
food can be a risk factor.

He realised that women
who lived in Northern Europe,

presented fewer cases of cancer
than those who lived in North Africa;

with completely opposite stats today.

These Northern Europeans
ate a lot of dairy products,

while the North Africans
consumed a lot of meat.

Thus, he drew on the notion
of food as being risky.

Moving to the Arab-Muslim era,

where many Arab scholars, doctors,
and surgeons among others,

laid out the foundations
of modern day surgery.

Al Razi warned against
partial exeresis of cancer.

Abulcassis advised exeresis
at early stages.

Ibn Sina or Avicenne,
didn't recommend surgical interventions.

During the Renaissance
and if location allowed,

many artists unknowingly painted

women with breast cancer,

but unaware of it.

These paintings,
exhibited around the world,

show us breasts, where, for example,

slit-like breast retractions
can be observed.

This woman here was unaware
she had breast cancer,

nor was that one,
with stiff-looking, un-supple breasts.

At that time, treatment implied
surgery without anesthesia.

And if you look at the images, you can see
instruments were really rather barbaric.

Natural remedies were varied.

It's not worth listing them.

The advent of the microscope
at the beginning of the 19th century,

made cellular pathology available.

Cells are used for diagnosis.

So we have surgery,

the advent of pathology,

and the accidental discovery
of Sir Belson from 1896

--as it always is with science--

who, while carrying out a castration,

a removal of the ovaries of a lady
with breast cancer

observed that cancer went into remission;
it stopped progressing.

That led to the idea
of hormone-dependent cancers,

of hormones as cause of this condition.

Radiotherapy was discovered in 1937,

chemotherapy in the '50s,

and targeted therapies, early in 2000.

In targeted therapies, the administered
drugs target and kill cancer cells only,

and not the whole of the remaining cells
like chemotherapy does.

Let's narrow the story to breast cancer.

I'll present it in a particular way.

What do we know so far?

That one in eight women
will have breast cancer.

So, who among the Disney heroines
is at risk of getting breast cancer?

We're going to look at them together.

Let's take Jasmine and Mulan,

they have the lowest risk
of developing breast cancer.

Why?

Because they are from parts of the world
where the chances are very small.

We know that in Western Europe,
the United States and Australia,

chances are very high,

whilst in other parts of the world,
are much smaller.

Age.

It is a rare condition before 30,

but risk increases after
the age of 50 or menopause.

Diet.

As with any other type of cancers,

diet is important.

Obesity and consumption of saturated fats,

alcohol and tobacco use,
and pesticides are also responsible.

So, unfortunately for Snow White,
even though she ate that apple,

guidelines call for five servings
of fruits and vegetables a day

but her apple was toxic.

So I think she'll be at a higher risk.

And yesterday, my 11-year-old daughter
surprised me preparing the slides

and said to me: "Mum! Is Snow White
at risk of getting breast cancer?"

I said, "No, it's just..."

"Mum, I'll never see her
the same way again. It's over."

Physical activity.

Apparently reduces
the risk of cancer by 35%.

I thought the case of Pocahontas

who canoed and ran through the forest

was adequate.

The anthropometric index.

Women 10 cm taller than the average
are also at risk of developing cancer.

As for the family history,

whether cases occur
on the paternal or maternal side,

with sisters, aunts,
mothers or grandmothers,

the risk of breast cancer is higher
especially if some genes are transferred.

Remember the case of Angelina Jolie,
who had to have both breasts removed

through prophylactic mastectomy

because her mother had breast cancer
and she inherited a mutated gene.

So there was an abnormality in her genes.

Hormons as risk factors.
We talked about hormones earlier.

Women with early menstrual periods
and late menopauses

will be at a higher risk.

On the other hand,

multiple pregnancies
before their thirties,

protect them against breast cancer.

As for breastfeeding, oral contraceptives

and hormone replacement therapies,

there are some debates still going on
and studies have not been fully validated.

So, breast cancer refers to women.
We all agree on that.

But, be aware that men
can be affected as well,

and 1% of them may have breast cancer.

When I presented a paper overseas
on male breast cancer, in Algeria,

the Chairman said to me:
"Madam, you sent a chill down our spines!"

Bear in mind that was a room
full of pathologists,

so I wonder what men's reaction
would be in this room tonight.

(Laughter)

15 to 20% of the affected men
have a family history.

If they have a sister who is affected,
the risk is higher,

and if both mother
and sister are affected

the risk is around 10 times higher.

Algeria.

The first cancer centre
in Algeria was the PMCC,

the Pierre-and-Marie-Curie Centre
in Algiers.

It attracted and treated
all cases of breast cancer

in the whole country.

But, a few years ago,
it was decentralised,

and they now offer treatment
around the country.

Why? Simply because cancer rates
increase exponentially.

Look at the curve, it speaks for itself.

Note that within a few years, we'll reach
same Western incidence rates.

It is the only time when we, Algerians,
will catch up with the West,

(Laughter)

but unfortunately, not in a good way.

The particularity here in Algeria is age.

Note that when women here
develop breast cancer,

they are ten years younger
than in other countries.

Algerian, Tunisian, and Moroccan women
in North Africa

get cancer between the ages of 45 and 55,

while in Europe
it is between the ages of 55 and 65.

The reasons are still unknown,

but there is ongoing research.

To sum up,

who are the women with the lowest risk
of developing cancer?

Young women, Asians and Africans,
with no family history,

late periods, multiple pregnancies,

who breastfeed their babies
and are small and slim.

Now, it's your turn.

Tell me, who among these eight princesses

has the lowest risk
of developing breast cancer?

Who?

None?

Yes, all.

Audience: Pocahontas.

A.K.:Pocahontas,
because she likes canoeing?

No, I'd say Jasmine.

She is small
--there are some winners here--

she is small and slim,
has an Arab-Muslim background

she will surely get married quite early,
have lots of children, breastfeed them.

These are the factors in her favor.

Thank you very much.

(Applause)