14 December 2017

Don't be afraid of a mammologist

Breast cancer: how early diagnosis saves the lives of thousands of women


Overcoming the fear of examinations is not an easy task. The prospect of finding out a possible diagnosis shackles with fear of the future. The figures speak for themselves: every seventh Russian woman will be diagnosed with breast cancer during her lifetime, but if the disease is detected at an early stage, then in 94% of cases a woman returns to a full life. The insidiousness of a mammary gland tumor is that if you yourself have felt a seal in your chest, then most often the moment is missed.

As part of the social initiative #YAPROSHLA, which is conducted by Philips and the charity program "Women's Health", women were given the opportunity to undergo a free breast examination on modern equipment during October. Who needs to be examined first and is it possible to beat cancer?


We asked the oncologist, plastic surgeon of the MEDSI Clinical Hospital in Botkin Passage, who took part in the action, Vladimir Anatolyevich Kalyadin.

If the chest hurts before the cycle, is it worth worrying?

The mammary gland is a hormone–dependent organ that reacts to monthly changes in the female body. And just 10-12 days before the start of the cycle, this hormonal restructuring begins.

Is it possible to feel the tumor yourself?

Any breast formation that is more than one centimeter, a woman can find on her own. An oncologist or oncologist-mammologist, gynecologist should already understand what kind of education this is. (You should not hope for self–examination, see above: "if you yourself have felt a seal in your chest, then most often the moment is missed" - VM).

Who needs to be examined by a mammologist?

Any girl should start breast examination at the same time as going to the gynecologist, with the first hormonal surge, at 14-15 years old. A mandatory part of the examination is a breast examination. In the protocol, the doctor must indicate the condition of the breast, whether there are any secretions, whether there are deformities, redness. Already from about 18-20 years of age, a separate preventive examination by an oncologist-mammologist is recommended. Let's just say that benign formations and oncological diseases are detected, including at an early stage, but much less often. And from about 18-20 years of age, benign formations are quite common, so from this age a girl should visit a mammologist once a year and do an ultrasound of the mammary glands. Regarding the timing of the ultrasound study, there is a recommendation that it should be carried out from the fifth or sixth to the 12th day of the cycle. If a woman has mastitis, for example, we do not have the opportunity to wait for the fifth day of the cycle. We will watch here and now. In principle, the examination of the mammary glands can be performed on any day of the cycle. And if there is an education, then it will be found any day, and it will not disappear on the 20th day of the cycle.

What formats of breast research exist? Which of them recognize the problem at an early stage?

There are two standard breast examinations recommended for each age category: breast ultrasound and mammography. After 35-40 years, mammography is added to the ultrasound examination. Tissues look different on ultrasound and mammography. Some parameters can be seen, and some are omitted. For example, calcifications are perfectly visible on mammography, but not on ultrasound, the size is too small. Mammography will show that there is a tumor, its shadow, but at the same time it will not be visible how it is supplied with blood. This will be clearly visible on the ultrasound. Someone does only mammography without ultrasound, but this is wrong. There are situations when mammography is not enough. Most often this applies to women who have undergone surgery for breast enlargement. Then an MRI of the mammary glands with contrast is connected. Now it is not prescribed so often, because modern mammographs with contrast have appeared. But again, if we have done both ultrasound and mammography and no study answers our questions, then we prescribe an MRI. Many people have a fear of undergoing mammography, there is a myth that mammography is a strong radiation exposure. But this is absolutely not the case. In modern mammographs, the radiation load can be compared to a three-hour flight in an airplane.

Can I have a mammogram if I have implants?

Can. During mammography, there is a slight compression of the implant, which physically cannot lead to its rupture. Is breast cancer a hereditary disease? In 30% of patients, when passing an analysis for a genetic mutation, hereditary factors on the maternal line are detected. But even if there is a negative option, this does not mean that the risk of breast cancer is excluded. Unfortunately, the cause of the disease may not only be hereditary, there are many different risk factors during life.

Please name these factors. For example, if I am pushed in the subway in the chest or hit by a volleyball, can I get sick?

If a hematoma or hemorrhage occurs in the breast tissue during the impact, then an inflammatory process appears. In turn, the inflammatory process can cause malignancy of this area, but this happens very rarely. In my practice, there were cases when patients said that there was a blow two or three years ago in the chest area, a large hematoma appeared. And in principle, it all started with this. But the cause of cancer in any case is not in the blow, it was a kind of trigger. There are proven factors that will aggravate the situation: late lactation, late pregnancy, living environment. Obviously, large megacities do not contribute to improving our health, well, heredity most often.

What are the ways to treat breast cancer? Is it necessary to remove the breast?

In modern medicine – no, it is not necessary to remove the breast, although everything depends, of course, on the stage of the process. At an early stage, partial resection of the breast is possible, rather than complete removal. There are different options when there is a simultaneous endoprosthesis of the mammary glands. More and more often women agree to this because they do not want to wake up without a breast. There is such a possibility, but again at an early stage.

Is the preventive mastectomy that Angelina Jolie did an extreme measure or a necessity?

This is an extreme measure. In Russia, only the identified genetic mutation is not enough for a full-fledged subcutaneous mastectomy. This operation is quite traumatic. It is done in our country, if malignant formations are detected in one gland, a mastectomy operation is to be performed, and at the same time a woman wants to maintain the volume and put an implant. In most cases, the possibility of a contralateral subcutaneous mastectomy is discussed, provided that a genetic mutation has just been identified. There is another indication: multiple benign breast formations that almost completely occupy the volume of the breast, that is, there is no healthy glandular tissue as such. This year, as part of the social campaign against breast cancer, a presentation of the documentary film by Leonid Parfenov and Katerina Gordeeva "#I have PASSED" about the importance of early diagnosis was held. The film was created with the support of the Women's Health charity program and Philips and is available on YouTube and on the #I have passed campaign page on the Philips website. Watch the movie and do not postpone the visit to the mammologist for later.

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