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Woman is at risk

June 1, 2020

It is often said that a disease is easier to prevent than to treat it. And when it comes to breast cancer, are there effective prevention mechanisms in this case?

About everything that causes malignant tumors in the chest, today we are talking with an oncologist, surgeon, head of the LISOD Center for Contemporary Mammology Andrii Zhigulin.

— What to do in order not to get breast cancer?

— I'm not sure if anyone knows the answer to this question. In fact, when patients come to us, we often hear: “Why did this happen to me? I led a healthy lifestyle, no one was sick in my family - and suddenly cancer! How did I deserve such a punishment? ” First of all, let's look at what cancer is. This is a disease arising from a certain type of defective cells. Where does it come from? This is a probabilistic process. The human body consists of cells, they divide, and some defects may occur in some of them. The body must find such damaged cells and fight against them. However, this mechanism does not always work.

How is this dangerous? When, under the influence of some factors, the program changes, the cell turns into a cancerous cell and begins to constantly divide, giving rise to its own kind. There are more and more of them, and as a hostile force, they gradually capture the body. We cannot prevent their occurrence, but we know the mechanisms that influence the increase in the number of defective cells.

Risk factors can be divided into three parts. The first group is factors that we cannot influence: age, gender, genetics. Being a woman and getting older is already a risk. If there is a family history, that is, someone in the family had breast cancer or other oncological diseases, this could theoretically increase the likelihood of developing the disease, but only a professional can assess the risks. Perhaps such a woman will be recommended additional examinations.

The second group of risk factors — the most important — those factors that we can influence. This is overweight, lack of physical activity. Will explain. Most tumors that form in the mammary gland are hormone-dependent. There are three main mechanisms for the formation of hormones that can stimulate the development of breast cancer. The first is the activity of the ovaries producing estrogen and progesterone. If a girl begins menstruation early (up to 12 years), a high level of estrogen occurs - this is a risk factor. In such a situation, it should be observed by a gynecologist and, if necessary, an appropriate correction is carried out. The second mechanism of estrogen formation is through the adrenal glands and adipose tissue. For each person, male sex hormones (androgens) are formed in the adrenal glands, and in adipose tissue they are converted into estrogens by the aromatase enzyme. Accordingly, the more adipose tissue, the more aromatase in it, which converts androgens to estrogens. The third mechanism is external hormones. For one reason or another, women can take hormonal drugs — in order to correct hormonal status or to prevent pregnancy - this is also a risk factor.

Еще один очень важный фактор риска, на который можно влиять, — токсичные вещества, нарушающие механизмы функционирования клеток. Внешние канцерогены — курение, алкоголь, хроническая интоксикация через среду, в которой женщина постоянно находится. Это фактор, который увеличивает количество дефектных клеток.

A very interesting risk factor is a violation of sleep and rest. As it turned out, the hormone melatonin is produced in our body - a very powerful regulator of brain activity that affects anticarcinogenic activity. This hormone is produced only when we sleep, and also in the dark. If a person sleeps in the light, melatonin is not produced enough. Accordingly, when a woman should work at night and sleep during the day, for her this is a statistically proven risk factor for developing breast cancer.

The third group of risk factors is the so-called reproductive factors. If a woman does not become pregnant and does not give birth to children under 30 years of age or if she does not breast-feed, this is also a statistically significant risk factor.
Thus, there are various reasons why a disease occurs. And although some do not depend on women, others can be influenced and thus reduce the risk. By the way, interesting studies were conducted that showed that in patients with hormone-dependent breast cancer, physical activity according to a specific treatment program reduced the likelihood of relapse by almost 30%. That is, everything is in our hands - we can change life, ourselves, and so adjust the prognosis and risks of developing the disease. And although change is always not easy, but sometimes it is necessary.

— Is preventive mastectomy justified?

— You know, over the past few years, we understand that this is a very urgent topic. And to understand, you need to clearly understand what a preventive mastectomy is. This is the removal of the breast in a woman who does not have cancer, but at the same time is highly likely to get breast cancer. Such surgery dramatically reduces the risk of the disease. But in fact, preventive mastectomy only works in women who have a genetic predisposition — with a mutation in the genes BRCA1, BRCA2 and some others. There are mutations in many genes that also increase the risk of developing breast cancer or other localizations, but there are no clinically significant statistical data confirming the effectiveness of mastectomy in patients with such mutations, since these are quite rare situations and there is not enough data to talk about the effectiveness of such interventions.

That is, you must clearly remember that preventive mastectomy is the removal of the mammary glands in patients with confirmed genetic problems. At the same time, removing the mammary gland in patients with benign changes in the mammary gland (polycystic, mastodynia, fibroadenomas) is usually not rational.

By the way, women often come to us with the following question: “I had fibroadenoma (cyst) several years ago, doctors just watch, and my mammary glands hurt before menstruation, so I want to get rid of my breasts, because it’s scary that all this can turn into cancer." And when this is said by a woman who is under 30 or a little over 30, it causes a certain, to put it mildly, bewilderment of the surgeon. I always ask if the patient imagines what a mastectomy is, even with reconstruction, and what this means for her future life. It is here that I want to explain: the surgery to enlarge the mammary glands with implants, which women are guided by, thinking about mastectomy with reconstruction, is a completely different surgery. It does not radically violate the anatomy of the mammary gland. The implant is inserted into the gap between the gland and the chest wall, and nothing is removed. A mastectomy (even if it is performed according to the best technical standards) is the complete removal of the mammary gland along with all the vessels, nerves, etc., it is a surgery that seriously injures the tissues of the chest wall, causing skin insensitivity, leading to certain anatomical disorders. I'm not even talking about the likelihood of purely surgical complications, because such complex surgeries have a not very large, but significant percentage of complications - not only early but also late. Changes in tissues against the background of implants can last for years and decades. I am sure that a woman before a mastectomy and after a mastectomy is two different women, with different sensations and well-being. Therefore, conducting a preventive mastectomy is a very serious decision, which should be reasoned. In my deep conviction, such an intervention should only be carried out when it cannot be avoided. And in general, in breast surgery, an advantage should be given to organ-preserving surgeries. You know, among surgeons there is a very accurate expression: the best surgery is the one that has not been done. So, I am very afraid of speculation on this topic. Of course, there are situations when a mastectomy is really needed: we are talking about common breast cancer or a multicentric type of disease, when the gland is affected in many areas, and we cannot save it. Then this is a justifiable risk and a justifiable injury.

Another aspect of this problem. It happens that a woman comes who has a tumor in one mammary gland. And she asks to remove another gland — prophylactically, otherwise suddenly a disease will arise there. I want to note that if a tumor is detected in one mammary gland, in the absence of genetic pathology, removal of the mammary gland on the other hand reduces the likelihood of relapse by about 1%. Only 1%, despite the fact that this is a serious traumatic surgery!

— What are the indications for a genetic examination?

— If we are talking about determining the mutation in the BRCA1, BRCA2 genes, then the indications for their detection are as follows:
* the development of cancer in a patient under the age of 45 years;

* the presence of the so-called triple negative cancer in a patient under the age of 55 years;

* Breast cancer in a man (this also happens!);

* a woman has at least one direct relative (mother, sister, maternal aunt) who has developed breast cancer before the age of 40;

* the presence of two close relatives with breast cancer, regardless of age;

* the presence of a relative or relatives with several oncological diseases at the same time (for example, breast cancer and colon cancer, stomach cancer or lung cancer).

But there are other mutations that can cause cancer of other locations. Therefore, it is better to consult a clinical oncologist about the diagnosis or risks of a particular person.

— Does cancer appear because of antiperspirants?

— No. Studies have been conducted that have shown that there is no association between antiperspirants and breast cancer. There is also no connection between breast size and the likelihood of developing cancer. And yet there is no connection between the model of a bra (with or without bones) or the absence of such an item in a woman’s wardrobe and breast cancer. These are myths.

— That is, it turns out that a woman should be examined, lead a healthy lifestyle — and is that all she can do?

— You need to understand: today, breast cancer is a disease that in the vast majority of cases can be cured — of course, if it is detected at an early stage. Regular examinations allow you to diagnose the disease when the tumor is small, when there are no symptoms, and the woman feels healthy — it is at this time that the highest chances of a full recovery after treatment. Such examinations need to be done annually. Up to 40 years, an ultrasound scan is performed, after which a mammogram is performed, annually or at least once every two years. This is what a woman who takes care of her own health can and should do.

To be afraid of diseases is normal. It is bad when fear makes you not to be examined, but to avoid doctors. At the LISOD Center for Contemporary Mammology, you can get breast screening with modern equipment and quickly get the exact result. This is how you can make sure that everything is in order with health. If the disease is diagnosed, then the specialists of the Center will do everything possible in the best way so that the patient recovers and retains her female beauty.

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