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Polish women are afraid of breast cancer. They need to be made aware that on average a woman after mastectomy lives 20 years and very often dies of a completely different disease – says prof. Tadeusz Pieńkowski, head of the Department of Breast Cancer and Reconstructive Surgery at the Oncology Center in Warsaw.
Why is the incidence of breast cancer higher in more developed countries?
– This is mainly because women live longer there, and the risk of developing cancer increases with age. Improving living conditions results in an earlier onset of menstruation and later – menopause, and this is also associated with an increased risk.
– However, more developed countries have greater possibilities to prevent this disease?
– We really have no influence on the modification of these factors. We will not change the reproductive behavior resulting from cultural gains. It is hard to imagine that someone will persuade fourteen-year-olds to give birth to children. We are only able to modify our body weight, and this is important because being overweight is also a factor in the development of breast cancer. We can do genetic testing for BRCA1 and BRCA 2 mutation carriers in women who have had this type of cancer in their immediate family, but genetically determined cancer accounts for only 5% of all cancers.
– However, from the age of 18, we can do ultrasound examinations and breast self-examination every year?
– Ultrasound is a very subjective examination. It is the examining physician who decides which change will be recorded in the examination documentation, so it is difficult to compare them later. Moreover, before the age of 35, 100 Polish women develop breast cancer each year.
When it comes to self-examination of the breasts performed once a month in accordance with the recommendations of specialists, it turns out that such habits have not been established all over the world.
– What prophylaxis can young women use?
– I think women know their breasts thanks to the daily toilet. So if they notice anything disturbing, they should see a doctor immediately. It is also important not to exceed the norms of body weight.
– And the old ladies?
– Whole-population screening is the best method for the early detection of breast cancer. Mammography is great for this.
– NFZ inspections revealed a high defectiveness of the equipment used for this study in Poland. It does not inspire the confidence of women?
– It is good that such inspections took place, because it is a rarity in the case of the National Health Fund, that it takes into account the quality of the services provided. Many workshops have had to eliminate hardware faults with these checks. This is extremely important because in medicine it is easier to identify a disease than to eliminate it. The doctor assessing the results of the mammogram must tell the subject that she has any changes or that she is healthy. It is a great responsibility to make the latter diagnosis.
– Not all women benefit from free mammography screenings?
– This is the result of the myth associated with this disease, the false belief that the diagnosis means a death sentence. People need to be made aware that breast cancer patients live much longer than is commonly believed. On average, a woman after mastectomy lives 20 years. It happened to me that a patient came to see me with a tumor the size of the neck to the groin. It was an educated woman – a researcher. When I asked why she had delayed so long, he replied that she was afraid of … the diagnosis. People with cancer are believed to be unable to help. And yet we cannot cure diabetes or hypertension. However, we do treatment in order to live longer and more comfortably.
– How much progress has been made in treating breast cancer since you started treating this disease?
– This is gigantic progress. For example, let me say that today patients after breast removal and reconstruction ask me to what depth they can dive or when they can get pregnant. Once, after such treatment, they were afraid to go on a trip to the forest. The life expectancy and quality of life for women with breast cancer have changed dramatically.
– However, in terms of treatment results, we still differ from, for example, Sweden?
– That’s true. Their indicators are even better. This is mainly due to the fact that the guidelines for the treatment of breast cancer are not followed in Poland. Experts around the world say that it should be held in highly specialized centers. We have 20 of them. Meanwhile, the National Health Fund contracts breast cancer treatment services in 400 places. These are often general surgery departments. Meanwhile, breast cancer must be treated properly and comprehensively from the very beginning. So why spend money on services in non-specialized places for their provision. 20 well-funded centers are able to meet health needs.
– It is said that individualized therapies will be the future of oncology. Will the health insurance system be able to handle this?
– I do not think that pharmaceutical companies will produce drugs for a very small group of patients because it will not be profitable for them. Especially that the system of introducing drugs to the market has already generated such enormous costs, e.g. for insuring clinical trials, which it is increasingly difficult for drug manufacturers to meet. Rather, the future will be to integrate treatments, taking advantage of the advances in knowledge associated with determining the genotype of the tumor. Treatment methods will be less crippling and chemotherapy will not be as degenerating. I just came back from Slovakia, which is not a very prosperous country and the expenditure on cancer treatment is higher. Perhaps our politicians still believe that cancer treatment is not profitable because it is expensive and because patients die anyway. Meanwhile, they need to be made aware that they will die if the financing of oncological treatment in Poland does not improve.
Text: Halina Pilonis