Today, Breast Cancer Day is celebrated all over the world, and the entire October is dedicated to educating people about this dangerous disease. Especially for the readers of MedPortal, an oncologist, mammologist of the N.N. N.N. Petrov “Ministry of Health of Russia, Ph.D. Alexander Komyakhov spoke about the diagnosis and prevention of breast cancer.
MedPortal: Alexander Valerievich, what is the current incidence of breast cancer in Russia? Is there any increase, and what is the reason for this: new diagnostic capabilities or other factors?
A.K .: According to the Cancer Registry (note: a program for keeping records of cancer patients in Russian hospitals), the incidence of breast cancer in Russia in 2018 was 89.7 per 100 thousand women. For comparison: in 2017, the indicator was 89.6 – per 100 thousand. That is, we see a small gradual increase in the incidence. This is primarily due to the improvement in the quality of diagnostics and the aging of the population.
MedPortal: There is an opinion that breast cancer has become “younger” recently. Is it so? At what age does breast cancer become a real threat to women?
A.K .: No, it’s not. The incidence has increased due to the improvement of diagnostic measures. But at the same time, statistics do not show an increase in the incidence among the young population. As before, the risk of developing breast cancer increases dramatically in the group of patients aged 45 and older.
MedPortal: What are the current mortality rates from this diagnosis and do they change over time?
A.K .: Since the mid-1990s, we have seen a trend towards a slow decline in mortality from breast cancer: by 0.2% annually.
MedPortal: What about treatment? Are the protocols changing, is there any hope that the treatment becomes (or becomes) more gentle?
A.K .: Current trends in breast cancer treatment are focused on reducing the aggressiveness of treatment. More and more efforts are directed to improving the quality of life of patients. For example, this is manifested in the wider performance of breast-conserving operations instead of mastectomies. Of course, in cases where it is safe for the patient and is technically possible.
MedPortal: The causes of breast cancer, like other cancers, are still unknown, but there are various factors that increase this risk. How big is the hereditary factor?
A.K .: Most often, breast cancer is a sporadic (that is, spontaneously occurring) disease, but in 10-15% of cases it is hereditary. Most inherited forms of breast cancer are associated with the BRCA1 and BRCA2 genes (BREAST CANCER GENES 1 and 2). These genes are responsible for regulating the processes of repairing genetic material (DNA) and preventing possible tumor transformation of cells. However, the presence of defects and mutations in these genes significantly increases the risk of developing breast and ovarian cancer.
MedPortal: There is a lot of mythology around breast cancer. For example, underwired bras have long been blamed. American studies prove the opposite, but maybe there is other evidence? Should women reconsider their views on the choice of lingerie?
A.K .: Damage to the genetic apparatus of cells plays an important role in the occurrence of tumor diseases, including breast cancer. But this process has nothing to do with underwire on bras or other features of underwear.
MedPortal: Is the risk higher or lower in nulliparous women? Are other factors influencing, such as late labor? What about IVF or hormone therapy for infertility?
A.K .: Late labor is thought to be a factor that increases the risk of hormone-sensitive breast cancer. In nulliparous women, the likelihood of developing this disease is indeed higher. But today there are no statistical data indicating an increase in the risk of IVF.
MedPortal: Let’s talk about prevention. How often do you need to visit a mammologist, at what age? Do I need to undergo regular mammography and ultrasound of the mammary glands, and what is the difference between these two types of research? And in general, what should be done to reduce the risk of developing this disease?
A.K .: In accordance with the order of the Ministry of Health on the procedure for conducting clinical examination, women aged 40 to 75 years, inclusive, are recommended to carry out mammography of both mammary glands in two projections with double reading of radiographs once every 2 years. An earlier start of breast cancer screening is recommended for high-risk patients with BRCA mutations: an examination by a doctor annually from the moment of detection of an increased risk of breast cancer, but not earlier than 21 years of age, MRI of the mammary glands once a year.
Age of initiation – 10 years earlier than the earliest case of breast cancer in the family, but not earlier than 25 years and not later than 40 years. For patients with an increased risk of developing breast cancer, which include patients with the BRCA1 / 2 mutation, preventive hormone therapy is warranted.
MedPortal: There have been a lot of illustrative guidelines for breast self-exam in the past. However, I have heard the opinion from doctors that palpation at home will not give anything, including because not all neoplasms, especially at an early stage, can be felt. Does it make sense to conduct some kind of self-examination?
A.K .: Quite often, patients notice the presence of a breast neoplasm on their own. But, unfortunately, in the early stages of the disease, an independent examination of the mammary glands really will not give results due to the too small size of the neoplasm.
MedPortal: The symptoms of breast cancer may not be obvious at all, and sometimes they may not be present at all. And yet, are there any signs (for example, purely visual) that should alert and become a reason for a visit to the doctor?
A.K .: Any external changes should alert. For example, retraction of the skin of the breast, an expression, deformation of the contours of the breast. All this is a reason for immediate medical attention.