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We do not go to an oncologist, even when we feel a tumor, we are treated by random doctors in non-specialized hospitals. Therefore, in every third Polish woman suffering from breast cancer, the cancer will be advanced and will metastasize. The result of the report of scientists from the University of Warsaw is dramatic. Agnieszka Sztyler-Turvsky talks with Dr. Agnieszka Jagiełło-Gruszfeld, MD, PhD from the Breast Cancer Clinic and Reconstructive Surgery at the Oncology Center in Warsaw.
- Women report to their doctor too late. They delay when they feel a lump in their breasts. – They underestimate the symptoms, they get paralyzing fear – says Agnieszka Jagiełło-Gruszfeld, MD, PhD from the Breast Cancer Clinic and Reconstructive Surgery at the Oncology Center in Warsaw
- Several centers specialized in the treatment of breast cancer have been established in Poland, but this is just a drop in the ocean of needs. Patients go to random oncologists, are treated in centers where there is no close cooperation between doctors of various specialties.
Agnieszka Sztyler-Turovsky: The conclusions of the report look terrifying. Why will every third woman with breast cancer have advanced cancer? Are Polish women diagnosed too late or poorly treated?
The appearance of distant metastases is a result of not only too late diagnosis, but also of unfavorable biology of the tumor and probably also some, not yet fully understood, factors related to immune disorders in the patient’s body. However, it should be emphasized that breast cancer diagnosed at a very early stage can be cured in almost 100% of women and the primary stage criterion is the most important prognostic factor.
When women hear the diagnosis, they wonder whether it is already advanced cancer or not. Do we stick to the definition that advanced is when the tumor has already metastasized to the lymph nodes and other organs?
Yes, indeed, advanced breast cancer is the stage of cancer in which it has metastasized distant to other organs: liver, lungs, bones, brain, etc.
Some women only then diagnose the disease. Is it possible that she has been asymptomatic for so long? Does he give, but women do not pay attention to him?
The most common reason for such a situation is the fact that women report to the doctor too late, although they observe a disturbing lump in the breast. However, either they downplay the symptom, or they experience paralyzing fear that prevents them from visiting the oncologist. Often, it is only someone from the patient’s relatives or family that manages to persuade her to see a doctor. Very rarely, we deal with a situation where breast cancer has developed insidiously and a very small tumor, unnoticed by the patient, has resulted in distant metastases.
See also:
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Poland is also lagging behind with treatment? What diagnostics and therapy are still not available or only limited to?
When it comes to breast cancer diagnosis, we have better access to the basic one (mammography) than in many European countries. However, more than half of the women who should receive preventive examinations do not perform them. Therefore, the diagnosis of breast cancer is delayed. Women do not appear at the oncologist until the tumor in the breast is palpable, whereas it could be detected at an earlier stage if the patient presented earlier for screening mammography.
Late diagnosis. What’s next?
When it comes to treatment, the situation is much more complicated. First of all, in most European countries, the creation of oncological units specializing only in the treatment of breast cancer (the so-called Brest Unit) has been promoted for a long time. It has been proven that if a patient with breast cancer goes to treatment in such a specialized center, she has a much better chance of being completely cured. In addition, the competences of doctors and the entire treatment team also allow the patient to avoid situations when the patient receives treatment that is not necessary in a given case (e.g. performing a mastectomy, while breast sparing treatment is sufficient, unnecessary abuse of postoperative chemotherapy, etc.).
Prophylactically, it is worth performing a genetic test of the most common mutations associated with breast and ovarian cancer. When we find out if we are at risk, we will take faster action to prevent the development of the disease.
See also: Celebrities who beat breast cancer
There are no hospitals or wards in Poland that treat mainly breast cancer?
A few specialized centers have been established, but this is only a drop in the ocean of needs. Patients go to random oncologists, are treated in centers where there is no close cooperation between doctors of different specialties, etc.
What is the standard treatment of breast cancer in Polish?
In the simplest terms, it can be said that cancer in its early stages is treated surgically and systemically (i.e. with chemotherapy or hormone therapy). Complementary radiotherapy also plays an important role. The order of the methods used depends on the biological subtype of the cancer, the size of the tumor, the presence of metastases to the axillary lymph nodes, etc. Advanced cancer is mainly the domain of systemic treatment.
Can you talk about a typical scenario in the course of breast cancer? When do the next stages appear, to which organs do they usually first metastasize, how long do remissions last? There is a moment when you can assume with high probability that a woman is healthy?
Of course, early stage cancers are completely healed in most cases (70-85 percent). However, if we are dealing with a generalized disease, we cannot expect a cure. Our main goal is to achieve the longest possible control over the neoplastic disease with the available methods of therapy.
I’m afraid to ask for how long. Every woman can read on the Internet – these callous-sounding so-called five years of experience. What should a patient do when she learns that she has cancer to increase the chances of a cure? What should the first steps be?
It is important to go to a center with appropriate medical staff and diagnostic and treatment facilities specialized in the treatment of breast cancer. Then we have the best chance of curing the disease.
What are the side effects of treatment with chemotherapy or radiotherapy for the breasts and lymph nodes?
The side effects of chemotherapy depend on the drugs used. The most common ones are weakness, immunodeficiency, nausea, vomiting, alopecia, and peripheral nerve damage. Local reactions in the irradiated skin area and weakness usually occur after radiotherapy.
How then to effectively support a loved one so as not to worry or irritate them with your help?
First of all, a person suffering from cancer should be treated as simply as a person suffering from all other diseases, not to make an unhealthy sensation of it.
Talking about illness at work? Ask for help, e.g. adjusting working hours to the treatment plan (hospital stays for chemotherapy, etc.) Or is it just a risk of dismissal?
Many employers still treat people with cancer as quick layoffs, while many women are willing and able to work throughout the treatment period as long as they are given the right conditions (e.g. possibility of shortening working hours, part-time work, etc. .)
Research shows that almost half of sick women feel that they are negatively perceived by society. What happens to them? What kind of behavior, comments are you talking about?
Most often, patients complain of being excluded from their friends’ milieu. They are treated like people with a terminal illness, rejected by their friends.
Scary, it’s hard to believe. Let’s get back to diagnostics. More and more doctors say that it is much healthier for the patient to perform breast ultrasound alternating with magnetic resonance than mammography? It is MRI that is recommended by doctors in the West, and still not in Poland, certainly because mammography is much cheaper, so the Ministry of Health prefers to reimburse it.
Ultrasound is not an examination to detect early breast cancer. It is an auxiliary test. On the other hand, magnetic resonance imaging is recommended in the group of patients with mutations in BRCA genes and nowhere is it considered a screening method for the entire female population.
I have a little doubt about regular breast self-examination. It seems to me that it can lull the vigilance. Most women probably won’t do it exactly enough to feel the microzone anyway, and therefore won’t go to an oncologist.
Self-examination of the breasts is the best method to detect even very small lumps. Rarely, a doctor will be able to detect a lump that the patient herself cannot see, provided she is checked regularly. However, it is by no means a test that can replace mammography, which can detect cancers in the non-smoking stage.
What about preventive mastectomy? Is it really available in Poland and it can be done with simultaneous breast reconstruction in one operation?
A few weeks ago, the Sejm decided to reimburse prophylactic mastectomy with reconstruction in women at high risk of developing breast cancer.
And who should be referred to a genetic clinic and a free test that will show whether a woman is at risk due to a dangerous mutation? Patients say doctors are refusing their referrals.
Women whose relatives develop breast cancer before the age of 50 should be referred to a genetic clinic.
Dr. Agnieszka Jagiełło-Gruszfeld from the Department of Breast Cancer and Reconstructive Surgery at the Oncology Center in Warsaw