Let's talk about breasts. This is an interesting topic. However, let's not stop at the conversation. Let's touch, examine, explore the subject. By ourselves.

Eliza Dolecka, Zdrowie.gazeta.pl:

You call the breast professor “such no-man's land.” Why?

Prof. Marzena Dębska, specialist in gynecology and obstetrics:

- Breast cancer is the most common malignant tumor among women. In Poland, it is responsible for almost a quarter of cases and a dozen percent of deaths due to malignant tumors in women. Every 1.5h breast carcinoma (that is, breasts, and not, as is sometimes mistakenly believed - alone Warts) kills a Polish woman. The trend is unfortunately growing. It would seem that the concern for wellness Preventive treatment of the female breast must be a preventive priority for the general practitioner and anyone else to whom the patient goes. theirs studi . And it's not.

‍Who takes care of those breasts?

- First of all, gynecologists, although it is different with this. Many of my colleagues actually talk to patients about breasts, explain the importance of preventive examinations, refer women to mammography and ultrasound, some even to ultrasound themselves. However, I meet quite a few patients with whom no one has ever taken up this topic, let alone breast examination. Women often do not know where to go with a change in the breast.

‍No place to get a mammogram?

- The problem is more complex. Gynaecologists very rarely perform breast ultrasound, because it requires not only the right equipment, but also skill and some experience. They also do not have the competence to evaluate the results of mammography or resonance imaging - this is not their role at all, but radiologists. However, many times patients after performing specialized examinations return to gynecologists with a piece of paper and a recommendation that the gynecologist decides on a possible biopsy.

And how should it be?

- The one who performs the examination decides what to do next. After all, it is the doctor who performs mammography or ultrasound who knows best what he found during this examination and it is he who should take responsibility for it. There are many great radiologists in Poland who specialize in breast diagnosis. They do full diagnostics — from ultrasound, through mammography, resonance, including biopsy. They work with oncologists and refer patients to the best centers. But first you have to hit them.

So a lot depends on the gynecologist, who should guide the patient properly.

- I believe that the role of gynecologists is much broader. A gynecologist is a woman’s primary care doctor. The only doctor a healthy woman, with no symptoms, has a chance of seeing. Tired, busy women often don’t see another specialist for many years. It doesn’t matter what a woman comes to the office for: contraception, a post-vacation intimate infection, or stomach pain. You need to take the opportunity to take care of her. I always ask about the last Pap smear and examine her breasts. I also pay attention to other things and ask about her well-being. Many issues can be detected during a gynecological visit, such as anemia, skin conditions, or changes in the abdominal area. Sometimes they are problems that have been bothering a woman for years, but she hasn’t done anything about it.

Aren't we taking care of ourselves?

- Women usually take care of the whole family: children, husbands, parents, and even neighbors. But not themselves. They put themselves last. Illness in the family, aging parents, problems with children – everything falls on the shoulders of women. Even when they feel that something is wrong, they postpone seeing a doctor as long as their life is bearable. Often, they only seek help when it's too late. Cancer typically takes several years to show symptoms that can no longer be ignored. Yet, when detected early, it is often treatable. Women often deprive themselves of the chance for effective treatment.

There are stories about women who took great care of themselves, regularly examined, and yet were killed by breast cancer. What does the professor say to that?

- It’s possible. Very rarely, but it happens that patients who kept up with their screenings, and despite an early diagnosis, still passed away. Sometimes medicine is powerless. There are very aggressive cancers that are resistant to treatment. It's hard to come to terms with, but we must also remember that new drugs and therapies are still being developed. You can’t give up or assume that it's better not to know. Perhaps it’s even harder to accept a situation where a woman could have been saved but didn’t take her chance. I recently asked my neighbor when she last saw a gynecologist, and she said: 'Since Jaś is eight, that means it was eight years ago.' She’s supposedly a smart, educated woman.

Why do we do this to ourselves?

- I think about it myself more than once. Even patients who regularly visit a gynecologist examine their breasts on a case-by-case basis. Sometimes they are motivated by a Mammobus-type action, other times by the news of the death of a friend. Frightened by the rush, they will go to examine themselves, and then forget about their breasts again, even for many years. The numbers do not appeal to the imagination. A mammography performed every two years for 20 years reduces the risk of death from breast cancer by 30 percent. Meanwhile, some women are afraid of screenings because they believe that the 'radiations' might be more dangerous than cancer itself. Of course, this is not true. There are, in fact, many other fears.

For example?

- That the biopsy hurts, that treatment always involves mutilation, and in fact, it doesn't help because cancer is better left alone. The fact is, a biopsy may not be pleasant, but it’s bearable. And it’s crucial; without it, treatment cannot begin. The earlier the disease is detected, the easier it is to accept the effects of treatment – surgeries are less disfiguring, the arm doesn’t swell when lymph nodes don’t need to be removed. Quick breast reconstruction is possible. The effectiveness of treatment with early detection exceeds 90 percent. So, where do these thousands of deaths come from? Unfortunately, early detection is rare. We don’t even detect several-centimeter changes in ourselves because we avoid even self-examination."

‍Why self-examination, if it allows you to feel a change that is already about a centimeter, and on ultrasound or mammography, a much smaller tumors are detected, even nodules that are 2-3 mm?

- Breast self-examination is still the most important diagnostic tool, because most breast changes are still detected by their owners. Usually because they don't do other research. It also happens that the tumor grows rapidly and the lesion can develop dangerously in the period between imaging tests such as ultrasound or mammography. It is worth remembering that breast cancer does not necessarily manifest itself as a lump - it can be strange change on the skin, discharge from the nipple, ulceration. Any disturbing change needs to be clarified with the doctor. Unfortunately, young women do not have easy access to breast diagnostics under health insurance.

Why?

- The risk of developing breast cancer increases sharply after the age of 50, which is why actions to encourage mammography to apply to women in the 50-69 age range. At this age, you can be examined prophylactically, without any justification. For younger women, a specific reason is needed, a referral from a doctor. Meanwhile, you can get sick at any age, and the risk group for breast cancer includes all breast owners. Of course, this risk is varied, but sometimes it frustrates me how much the focus is placed solely on high-risk groups.

Is it good that there is a lot of talk about the importance of family burden or the role of diagnostic tests in women using HRT?

- Of course, because it brings results. My observations show that women who have been found to have mutations BRCA 1 and 2A cancer, which increases the risk of developing female cancers, is examined regularly. Like patients who use hormone therapy during the period Menopause. Interestingly, in the case of the latter, contrary to popular belief, the risk of developing breast cancer increases only minimally. A, a. Unfortunately, women after breast cancer are not allowed to use hormones. I say, “unfortunately,” because the health gains, aside from the issues of well-being and comfort of life, are priceless.

What are the benefits of using hormones for women?

- In the age of scaring women with hormones, there is little mention that hormones used after menopause reduce the frequency of dementia, including Alzheimer's disease, cardiovascular diseases, and some cancers, such as those of the colon and uterus. Hormone therapy is also a very good way to prevent osteoporosis. Osteoporosis is another 'neglected' disease. It’s unclear who is really dealing with it. At the same time, few people know that it is also a silent killer of women. A 50-year-old woman has a comparable risk of dying from a hip fracture as from breast cancer. There is a pattern that women using hormones regularly visit their doctor. As a result, the prevention of many other diseases, including cervical cancer, improves. A lot is said about genetic testing and mutations, so women who are not in high-risk groups often feel exempt from ultrasound and mammography. This could cost them their lives because cancer, unfortunately, strikes at any age and in any condition, even during pregnancy or breastfeeding..

Pregnancies and breastfeeding are treated rather as a cancer-free period. Moreover - reducing the risk of getting sick in the future.

- And yet women get sick and sometimes die, orphaning little children. There are pictures of children on the shelf in my office. I remember very well these siblings, two boys and a girl. Their mother died of extremely malignant breast cancer. These are unimaginable dramas. I hope that now they will happen less often, because for several years in Poland there have been recommendations that say that every pregnant woman should be recommended to undergo an ultrasound examination in the first or second trimester; this is mandatory for women after 35 years of age. Unfortunately, despite this, many people still believe that pregnant women can not be diagnosed, much less treated. That's not true. These types of myths cause the diagnosis of breast cancer in a pregnant woman to be often delayed up to several months.

Breast ultrasound during pregnancy? It is said that even in the second phase of the menstrual cycle, it is not recommended.

- An ultrasound is indeed more difficult to perform when the breasts are swollen and changed due to hormones, but it is still possible and completely safe for the baby. If necessary, a mammogram can be performed with the pregnant woman's abdomen shielded. Even chemotherapy can be administered during pregnancy in a way that maximally protects the baby. Unfortunately, this knowledge is not widespread. Generally, cancer is not something people think about during this stage of life. Sometimes it’s the opposite—when a young woman is diagnosed, she too rarely encounters a doctor who remembers to protect her fertility so she can conceive and have children after treatment. However, life after cancer is possible. A happy motherhood is also possible, provided that before starting cancer treatment, the patient’s future is considered.

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One in eight women will develop breast cancer at some point in their lives. Every 1.5 hours, this cancer kills a Polish woman. It doesn't happen in a vacuum. It's about your family, your friends, you, us. And although we are aware that our pink editorial action has no chance of millions of clicks, we write about breast cancer because we think it is important. Take care of yourself and your health. Join us, explore yourself.