Recently, Beverly Hills 90210 and Charmed star actress Shannen Doherty admitted to People magazine that she was diagnosed with breast cancer. The same terrible diagnosis was given to the star of “Sex and the City” Cynthia Nixon, Jane Fonda. Sharon Osborne and Angelina Jolie had to undergo a double mastectomy at all to avoid becoming victims of cancer. This disease attacks at any age and does not spare either the poor or the rich. Why do we hear more and more about female oncology, can each of us become a target? The most common questions about Woman’s Day breast cancer were answered by oncologist Andrei Koritsky and the founder of the UNIM accurate diagnosis service, Alexey Remez.
Most likely, this is due to the development of screening and diagnosis of cancer, as well as longevity. Japan, for example, is the leader in these two indicators – life expectancy and cancer mortality. In other words, many simply began to live to see cancer. A surge in the incidence always occurs with the improvement of diagnostic methods, then there is a systematic decrease in the incidence even below the initial level. In fact, the cancer death rate has been declining by just under 2% in total every year.
Yes, it is the most commonly diagnosed cancer. Approximately 16% of all cancers in women are breast cancer. It is followed by cancer of the rectum and lungs, the cervix and its body, as well as the stomach.
The following features should cause a visit to the doctor: swelling or thickening (difference to the touch from the rest of the tissue), change in size (one mammary gland is larger or lower than the other), change in the nipple (retraction, change in shape or position), rash (near the nipple or on it), discharge (from one or both nipples), the appearance of folds or pits around the nipple, swelling of the lymph nodes above the collarbone or in the armpit, sometimes constant pain in the area of the breast or armpit. But in most cases, the tumor can be painless if there are no inflammatory changes.
Yes, but the probability is very, very small – breast cancer in children develops in 0,046% of all cases of pediatric oncology. The risk is much higher in women over 40.
Not necessary. Not all breast cancers are hereditary – only 10% of cases are associated with familial genetic mutations. The presence of a mutation does not indicate the inevitability of breast cancer in a particular woman – only a very high probability (up to 90%). Such mutations can be determined by passing a special blood test.
In order to find out a possible hereditary predisposition, you should contact a special specialist – a geneticist. But first, remember in detail the family history – who and when was ill among relatives with serious diseases, especially cancer. This will help the doctor correctly assess the risks in a particular case. For greater objectivity, today you can take a blood test for mutations in the BRCA1 / BRCA2 genes. It helps to determine the hereditary predisposition to the appearance of breast cancer. This analysis is familiar to many in connection with the story of the famous Hollywood actress Angelina Jolie.
Screening tests for such a woman will undoubtedly be more frequent and detailed than for those who are not hereditary. Mandatory monthly self-examination of the mammary glands (on the 5-7th day of the cycle, when the breast tissue is least stressed), examination of the mammary glands by a specialist 2-4 times a year and annual mammography after reaching the age of 25. Normally, a monthly self-examination is performed, an examination of the mammary glands by a specialist once every six months or a year, an annual ultrasound scan up to 40 years old, and after 40 – an annual mammography. Since these mutations are associated not only with the occurrence of breast cancer, but also with the possible development of ovarian cancer, you should also undergo transvaginal ultrasound once every six months and determine Ca125 once every six months upon reaching 35 years of age. In addition, after the end of fertility, the doctor may recommend prophylactic mastectomy and oophorectomy (removal of the ovaries), followed by hormone replacement therapy for up to 50 years. These operations minimize the risks, even lower than in ordinary women, since the tissues from the cells of which the malignant tumor develops are removed.
Up to 70% of breast masses are found during self-examination. It should start from the age of 20, since breast cancer practically does not occur until the age of 20. At the same time, self-examination, unfortunately, is not a panacea, since it does not allow detecting formations up to 1 centimeter in size. It is better to rely on ultrasound data, and after 40 years – on mammography results. The technique of self-examination is as follows. 1. Undress and stand in front of a mirror, lower your arms along your body. Examine the mammary glands carefully, paying attention to any changes – pits, folds, asymmetries. 2. Place your hands behind your head and repeat the inspection. 3. Lower one arm and examine the breast from the opposite side with it. Move with smooth pressure with four fingers from the periphery to the center in a spiral. We examine the left breast with the right hand, and the right with the left hand. 4. Repeat the examination from item 3 for the second gland. 5. Examine the nipples. Squeeze and see how the nipple is restored, whether it is pulled in, whether there is discharge. 6. Take a horizontal position, put one hand behind your head. Repeat the examination from point 3 for both glands. 7. Examine the armpits for lumps one by one, placing the hand behind the head from the side to be examined.
Anything – mastopathy, benign cysts, fibroadenoma, lipoma, intraductal papillomas and even a malignant neoplasm. Do not panic, since at least three quarters of the neoplasms found on self-examination are benign. It is better not to be tormented by fears and suspicions, but to visit a mammologist.
The presence of some benign neoplasms increases the risk of developing a malignant process, so they cannot be ignored. Follow your doctor’s recommendations for treatment and education monitoring. Be sure to consult with an oncologist if you feel a “knot”.
If at the time of pregnancy and childbirth there were already atypical cells in the tissues of the mammary glands, then pregnancy, as a global hormonal restructuring of the body, can provoke the rapid development of the pathological process. But overall, the risk of breast cancer decreases with each birth.
More often than not, the matter is not in the malignancy of the medic, who definitely wants to put you on the operating table. If the doctor is unable to establish a benign or malignant diagnosis in a patient, with a fair amount of confidence, then he will lean towards a malignant neoplasm. In case of delusion, the patient will lose health, and if the doctor misses the malignant formation, the patient will lose his life. This phenomenon is called overdiagnosis. It seems that the lesser of evils is obtained, but this is far from the best way out. Now there is the possibility of revising histological glasses, both with their physical transportation to another doctor, and with viewing images digitized on a special scanner – our company UNIM is engaged in both directions. In a matter of days, the patient has the opportunity to be convinced of the quality of the diagnosis and, if there are any inaccuracies or errors, to correct it with the best specialists. This is very important, since the treatment is selected based on the results of the morphological examination. Practice shows that about 40% of diagnoses require correction, up to the replacement of a malignant diagnosis with a benign one. This happens every week. Regarding the number of checks – ideally, the glasses should be examined according to the principle of consultation – three doctors simultaneously look at them through a special microscope and make a diagnosis. It should be the same for all specialists. Of particular value are the opinions of narrow pathomorphologists who specialize in this type of disease (for example, lymphomas). It is impossible to gather such specialists in one place, therefore, a special SAAS platform is used for remote consultations, where the same consultation takes place, only the specialists do not sit on neighboring chairs, but in different cities or even in different countries.
First, you need to go to the polyclinic at the place of residence to a therapist for an initial examination and examination. If receiving a mammologist or oncologist, try to get an appointment. These specialists will determine the laboratory and instrumental studies necessary in your case – for example, blood tests, ultrasound, mammography, MRI. Based on the results of these studies, the doctor can refer the patient to an oncological dispensary. There they will determine the need for a biopsy – taking material for cytological or histological examination. This can be a fine-needle aspiration biopsy (TAB) – it is used for cysts, the selected material is sent for cytological examination or trephine biopsy – it is used for not too dense and small neoplasms, the material is sent for histological examination. Conducting trephine biopsy is more informative, since during the procedure a column of tissue is taken from the neoplasm, it also allows not only histology, but also immunohistochemical research. If a trephine biopsy or puncture is not possible, then a biopsy is performed as an operation, where the neoplasm is completely removed and sent for histology. The end point of the diagnostic search is always morphological studies – histology, immunohistochemistry. Histology is the study of neoplasm tissues at the cellular level. Immunohistochemistry differs in that the study uses special antibodies that react with certain tumor proteins. Based on the results, a final diagnosis is made, in accordance with which the treatment will be carried out.
Yes. There may be errors in the sampling of material or in the analysis of glasses in the laboratory.
Cancer treatment is a constantly evolving field, very knowledge-intensive. New methods are being developed, clinical trials are being carried out. The results of such tests are reflected in the recommended treatment protocols for each type of nosology. The organizations that issue such protocols include the European Society of Medical Oncology, the American Society of Clinical Oncology, the European Society of Surgeons and Oncologists, the US Federal Drug Control Agency, the European Organization for Research and Treatment of Cancer, the American Society for Cancer Research, the Russian Association of Oncologists, Russian Scientific Center of Roentgenoradiology, Russian Scientific Center named after N.N.Blokhin, Moscow Scientific Research Institute of Oncology named after N.N. P. A. Herzen and many others. These protocols are publicly available, doctors rely on such documents when selecting the most suitable treatment for the patient. In some cases, you can also get into clinical trials of the latest drugs, if you fit the parameters of the study and there is such a desire. The effectiveness of treatment largely depends on the stage at which the tumor was found. The sooner the disease is diagnosed, the more effective and gentle the treatment will be.
Yes, today, when removing breast tissue, in most cases, it is possible to carry out simultaneous reconstruction using one’s own tissues and implants. One-time reconstruction is the “gold standard” in many developed countries. This undoubtedly improves the quality of life of a woman after surgery.
The return of the tumor after removal and additional treatment, provided there are no metastases within 6 months of treatment, is called a relapse. The likelihood of its occurrence depends on the degree of proliferation of the lesion at the time of diagnosis, as well as additional foci of the tumor undiagnosed at the stages of examination. The more advanced the case, the higher the likelihood of the disease recurring.