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How to protect yourself from breast cancer?

Breast cancer is the most common malignant tumour in women. It accounts for more than 20% of all malignant tumours. The most important factor significantly influencing the results of treatment is detecting cancer at the earliest possible stage.

We talk to general and oncological surgery specialist, doctor Marcin Zając, about this dangerous disease, treatment options and, above all, prevention.

Doctor, how does breast cancer develop?

- The starting point for the development of cancer is a mutated process in the breast cells that leads to their uncontrolled division and growth. Unlike normal cells, cancer cells have lost the restriction of programmed cell death (apoptosis), they have the ability to invade surrounding tissues and form distant metastases. Breast cancer in most cases originates from the cells lining the inside of the milk ducts. Breast cancer cells penetrate the lymphatic vessels and then reach the lymph nodes, which cause their enlargement. At the same time, this is a sign that the disease is becoming more aggressive (breast cancer) and there is a greater chance that the cancer cells have also entered the blood and may have colonised other organs, i.e. have metastasised.

Can we list the main causes of developing breast cancer?

- The etiology of breast cancer is not fully understood, despite many studies and analyses. The situation is further complicated by the fact that the same morphological neoplasm may be caused by several or even more than a dozen carcinogenic factors.

Increasingly, however, genetic determinants are being identified in breast cancer risk. About 10% of breast cancers are hereditary. The probability of developing the disease increases with the number of first-degree relatives (mother, sister, daughter) suffering from this cancer. So far, not all genes whose mutations can lead to breast cancer have been identified. The most certain criterion for hereditary breast cancer is the finding of mutations in the BRCA1 and BRCA2 genes. In women with a BRCA gene mutation the lifetime risk of breast cancer is 80%.

Other genes whose mutation may increase the risk of breast cancer are: ATP, BRIP1, TP3, CHEK and PTEN.

Other factors that predispose to breast cancer include: age (the risk of breast cancer increases with age, with most cases occurring in women over 50), early onset and late termination of menstruation, late pregnancy (after age 35), and lifestyle.

It is well known that the earlier a cancer is detected, the better the chances of a cure. How can you recognise changes at an early stage of development?

breast cancer

- The first symptom is a non-painful lump usually located in the upper lateral part of the breast (about 35% of cases), less frequently in the lower medial part. Other symptoms of breast cancer are asymmetry of the nipples, retraction of the nipple, ulceration of the nipple or the skin of the breast, additional lumps in the area, pain without an identifiable cause, slight thickening of the skin, itching or burning of the nipple, leakage of fluid from the nipple.

The developing cancer is accompanied in many cases by enlargement of the lymph nodes under the armpit and in further stages by enlargement of the cervical and supraclavicular nodes. The symptoms of the so-called inflammatory breast cancer are quickly increasing swelling of the skin, combined with its redness, excessive heat and pain.

Women in their twenties should make a habit of self-examination of their breasts. Standing in front of the mirror you should raise your hands high up and look whether you see any changes in the shape of your breasts, whether the skin is not discoloured, wrinkled or tight. The same should be checked with your hands on your hips. Then check by pressing on the nipple that it is not leaking any fluid.

While in the shower, place your left hand on the back of your head and use your right hand to control your left breast. Using light pressure, use the three middle fingers to make small circles along the breast, from top to bottom and back again. Repeat with the right breast.

Fluctuations in hormone levels mean that before and during menstruation, most women's breasts can be swollen and tender. The texture of their tissue also changes slightly.

For this reason, breast control (both self-examination and ultrasound or mammography) should be performed one week after the period.

The most important diagnostic methods breast cancer include:

  • mammography,
  • ultrasonography,
  • biopsy,
  • surgical slice,
  • examination of nipple secretion cells.

What exactly does a mammogram involve?

mammography screening

- Today, mammography is recognised as the best way to detect early breast cancer in women over 40. Mammography is a radiograph of the breast. This examination makes it possible to detect very small cancerous changes that cannot be felt by hand. The sensitivity of mammography is estimated at 80-90%.

The examination is safe, the radiation during the examination is similar to that during a dental X-ray.

Some women may experience some discomfort during the breast compression required for the examination.

Digital mammography is an extremely important step in the development of diagnostics. It definitely increases the precision of imaging, allows for analytical transformation of the image, magnification of any fragments for more accurate analysis. Larger contrast range, the ability to adjust the contrast are particularly useful in the examination of breasts with a large amount of glandular-fibrous tissue. Programmed image filtering not only serves to improve image quality, but can assist in diagnosis, e.g. by automatically locating microcalcifications.

Mammography allows the determination of the probability of cancer for the diagnosed lesion and the selection of an appropriate follow-up procedure. The results of your mammogram should be classified by your radiologist according to the BreastImaging Reporting and Data System (BIRADS). Based on these results, the specialist/nurse practitioner will determine further recommendations and management.

The first mammogram is recommended around the age of 40 and should be performed every 1-2 years. Between the ages of 50 and 69, screening is recommended every two years. After the age of 70, due to increasing life expectancy, it is recommended that regular screening be prolonged until the age of 73.

But be warned, if you have a family history of breast cancer (mother, sister, daughter), or if you have been diagnosed with mutations in the BRCA 1 or BRCA 2 genes, you need to consult your doctor about how often you should be tested.

For this group of women, there are specific management regimes (more frequent mammography, alternating with MRI, and gynaecological examination for ovarian cancer).

If the result is abnormal, the patient should go for an oncological consultation. Your doctor will decide whether to perform further tests: targeted mammography, ultrasound, ultrasound-guided thick- or fine-needle biopsy.

What are the treatments for breast cancer?

- Treatment of breast cancer is a combined treatment and should be carried out in specialised oncological centres. The methods used include surgical treatment, systemic treatment - chemotherapy, hormone therapy and targeted therapies - and radiotherapy.

Early detection of breast cancer allows for breast-conserving treatment, i.e. only the lesion is removed and the breast remains. This is the treatment of choice; if it cannot be done, the breast must be amputated along with the lymph nodes and breast muscle. In patients who have to have the breast amputated, breast reconstruction can be done.

Chemotherapy is based on pharmacological treatment, the administration of mostly intravenous cytostatic drugs. It is used to destroy clinically undetectable micro-metastases that may already have appeared in the early stages of cancer or to reduce the size of advanced tumours.

Radiotherapy - involves treatment with ionising radiation.

It is often used as an integral part of sparing treatment.

Thank you for the interview.

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