Dangerous symptoms, risk factors and stereotypes around breast cancer

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Expert Comment: Cancer in the early stages is asymptomatic

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Despite the highest detection rate of breast cancer, approximately 30% of women have this type of cancer diagnosed at a late stage. In addition, cancer is rapidly getting younger – all oncologists talk about it. If earlier it was believed that this form of oncology affects women mainly after the age of forty, now diagnoses are increasingly being made at 25-year-olds. And we also understand that financial opportunities are also not a guarantee of getting rid of this disease, because the rich and famous are among the victims. It all depends on the location of the tumor, its size, the presence of metastases, treatment regimens.

“Breast cancer in the early stages is asymptomatic and is usually detected on a mammogram. But what should definitely alert you is seals in the chest and in the armpit or above the collarbone, clear or bloody discharge from the chest, retraction of the nipple, a change in the color or structure of the skin of the chest, asymmetry.

Non-specific symptoms include persistent pain in the thoracic spine. In Russia, the proportion of detections of breast neoplasms is the largest among the detections of other oncological diseases, it is 18.3%. Breast cancer is now seriously rejuvenated and it is found not only in people of the older age group, but also in very young people. Women over 40 years of age, as well as those who have relatives of the first and second generations (mothers, sisters, grandmothers, aunts) diagnosed with breast or ovarian cancer, must undergo screening examinations once a year to detect BRCA-1 gene mutations. and BRCA-2. Such an analysis helps to identify the disease at the earliest stage, start treatment on time, and in 95% of cases maintain a functionally complete mammary gland.

Important: in the presence of implants, the patient can no longer perform mammography, an important screening method for breast cancer. But there is an alternative – ultrasound. Breasts with implants must be checked every year by a mammologist with an ultrasound examination. For a more in-depth diagnosis in the presence of implants in the chest, magnetic resonance imaging is prescribed.

Risk factors

If there is a cancer diagnosis in first-line relatives (mother, grandmother, sister), it is worth doing a DNA blood test to identify the presence of the BRCA-1 and BRCA-2 genes. If they are found, it is not necessary to decide on a prophylactic mastectomy (breast removal, which Angelina Jolie did), but you will definitely need to closely monitor your condition and regularly visit a mammologist.

So, once again, what are the risk factors. Doctors distinguish:

  • heredity;

  • the presence of BRCA-1 and BRCA-2 mutant genes;

  • age, first late birth (after 30 years);

  • excess weight (visceral fat begins to produce carcinogens that can contribute to the formation of cancer cells).

In order not to miss a dangerous diagnosis, it is necessary to visit a mammologist every year. After 35 years, it is worth doing every year. It is believed that up to the age of forty, breast compaction can be detected using ultrasound, and after forty, mammography can be used. Before the age of 40, mammography is considered pointless, since the dense tissue of the mammary glands will not allow you to get a reliable picture, but a number of doctors believe that this study can be prescribed after 35 years. And, of course, everyone does not get tired of repeating about self-examination – this is the most affordable way to identify dangerous lumps in the chest. But not all – the tumor can hide between the lobules of the breast, so the manual examination method should not replace visits to the doctor. By the way, breast ultrasound and mammography are included in the annual clinical examination program, that is, you can do these examinations for free.

Many subtypes of the disease

“Breast cancer, along with malignant lesions of the skin and cervix, is included in a group of tumors that can be suspected, and sometimes diagnosed, when examined by a doctor. But breast cancer is detected in our country at stages 1 and 2 relatively little. A significant part of patients seek help at stages 3 and 4 of the disease, when the symptoms of the disease significantly reduce the quality of life. Breast cancer is one of those diseases that is well treated in the early stages – this is a small amount of operations (for example, lumpectomy, i.e. removal of only the tumor), and a good prognosis in the long term. The disease in the later stages already requires more aggressive treatment, due to the mass of tumor tissue, and has an unfavorable prognosis.

It is also important to know that there are many biological subtypes of this disease. Now scientists adhere to the hypothesis that each tumor is unique and has its own individual set of characteristics. Due to this, the modern treatment of breast cancer is largely based on the individualization of therapy in each individual case. Due to such an abundance of tumors and their biological characteristics, this disease proceeds in different people in completely different ways. There are both very aggressive and rapidly growing tumors and difficult to treat, and with a fairly favorable course and respond well to systemic therapy.

What can protect

The concept of “risk zone” does not exist as such. Everyone (and in any age group) is at risk of developing breast cancer, even men. This pathology can occur both at 17 and at 90 years. Of course, there are much fewer cases of breast cancer in young and old age. Most often, breast cancer is detected in women aged 40 to 60 years.

There are several international studies that have studied various factors that may influence the risk of developing breast cancer or, on the contrary, help to “protect” against it. For example, pregnancy, childbirth and breastfeeding up to 30 years of age significantly reduces the risk of developing breast cancer. On the other hand, the presence of gene mutations, endocrine disorders, excess weight can increase these risks. About heredity must be said separately.

There are mutations in certain genes that can be passed from parent to child and significantly increase the risk of developing breast cancer, ovarian cancer, and other cancers. The most famous of these are the BRCA1 and BRCA2 genes, thanks in large part to Angelina Jolie, who was diagnosed with this mutation and treated prophylactically. In such women, the risk of developing breast cancer is significantly higher compared to the population. Other unfavorable factors also play an important role – ecology, radiation, bad habits, etc.”

Doing self-examination correctly

Self-examination should be performed between the 5th and 12th days of the menstrual cycle. The scheme is simple: with the hand behind the head with the other hand, clockwise, starting from the top, we slowly feel the chest with our fingers. Alertness should be caused by seals, changes in skin color, “orange peel”, discharge from the nipple. Repeat the same lying down. Then, with your arm down, you need to examine the lymph nodes under the armpits – they should not be palpable.

According to experts, the presence of primary symptoms of cancer often indicates that the tumor has been localized in the mammary gland for quite a long time. That is, patients can detect a malignant formation with the help of palpation when it comes to stage III-IV cancer. This is also why it is so important not to neglect ultrasound and mammography. And with the onset of menopause, palpation should be done every month, since with age, the risk of breast cancer, alas, increases.

Stereotypes around breast cancer

There are many myths surrounding this cancer. Probably, including because the doctors themselves sometimes do not agree. For example, there are those who believe that breast ultrasound has too low specificity and sensitivity for cancer, that is, it is pointless to do this study without symptoms.

But everyone agrees that breast cancer does not occur due to wearing tight bras with underwire, smoking, abortion, the use of antiperspirants, the presence of silicone implants. Breast injuries do not affect the occurrence of oncology, since before the clinical manifestation, the cancer develops very slowly, literally for years – it does not occur overnight.

We also add that now they are less likely to try to use a mastectomy, that is, completely remove the breast (this is not the case of Angelina Jolie). It is already known that breast cancer is a systemic disease, at the cellular level, therefore it is pointless to remove large, excess volumes. The task is to “remove” the sector of the mammary gland with the tumor.

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