Our experts:
Mammologist-radiologist, senior researcher at the National Center for Oncology of the Reproductive Organs, Moscow Oncology Institute named after. P. A. Herzen, candidate of medical sciences Mikhail Mazo.
Head of the Department of Breast Tumors, Leading Researcher at the Federal State Budgetary Institution National Medical Research Center of Oncology named after. N. N. Petrova" Ministry of Health of the Russian Federation, Doctor of Medical Sciences Petr Krivorotko.
Oncologist, hematologist, candidate of medical sciences Mikhail Laskov.
Radiotherapist, oncologist, chief consultant on radiation therapy and oncology, chief freelance radiotherapy specialist in Moscow Salim Nidal.
There has been a real breakthrough in the treatment of one of the most common cancers, breast cancer. Thanks to this, the terrible diagnosis, which once sounded like a death sentence, ceased to be perceived as fatal.
The enemy is advancing - we are not giving up
Of course, we are still far from considering cancer an insignificant threat. Moreover, the relevance of this problem today is greater than ever. After all, breast cancer is the leading cancer in women, with a tendency to constantly increase. Globally, the incidence is increasing by 1–2% per year. And over the past 20 years it has grown by 64%!
In Russia, more than 60 thousand people are diagnosed with this diagnosis every year. And more than half a million patients are already under the dispensary supervision of an oncologist. Moreover, the disease is rapidly getting younger. Over the past decade, the number of patients under 40 years of age has increased by 34%. And one more sad point - despite the possibilities of early diagnosis, about 40% of patients find out about their disease in the later stages, when it is already very difficult to help them.
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Breast cancer in Russia: will we win or lose?
Early diagnosis and modern treatment are a chance for life.
Every year, approximately 57 thousand Russian women hear the terrible diagnosis of breast cancer. Until recently, this type of cancer was spoken of as an incurable disease, considering it virtually a death sentence. In recent years, the situation has changed for the better: an increasing number of women are able to recover, defeating the disease. Here, for example, are three stories of three patients at an oncology clinic. They are completely different from each other - different ages, from different cities, work in different fields - and all they have in common is illness and a happy escape from it.
“When you learn about such a diagnosis, your reaction is fear and tears. You think, “Why me?” - and suddenly you realize that death is very close. It’s hard to realize this,” says 44-year-old Valeria, head of a department at a large St. Petersburg bank. Valeria was diagnosed in 2005. After the operation, she was prescribed a course of chemotherapy. After some time, doctors discovered that the tumor was growing again. “I was offered to replace chemotherapy. The new scheme turned out to be more effective. Despite the strong medications, I tolerated the treatment better than I expected: I did not take sick leave and continued to work at the bank,” she recalls. Time has shown that these drugs helped Valeria cope with the disease. “I was lucky that the new therapy was prescribed at the expense of the state, because I myself would not have been able to pay for the expensive drugs,” she said. Valeria beat cancer. Eight years have passed since the diagnosis. During this period, she not only advanced her career, but also became interested in Latin American dancing, and is even thinking about participating in professional competitions. “The support of my loved ones helped me a lot. I also realized that life should not just be lived, but it should be felt. You need to enjoy the sun, greenery, and communication with people. And then you can overcome any disease,” Valeria is sure today.
Olga, an opera singer and vocal teacher, knew from childhood about hereditary predisposition to breast cancer. “I was constantly seeing a mammologist and was sure that everything was under control, but, alas, you don’t choose your fate. The doctor sat me in a chair and said very simply: “You have cancer. Now sit down, calm down, and I will tell you what you need to do.” Within a week, my tumor was removed. To my great happiness, the breast was saved. But then they told me that surgery is only 10% of the treatment, there is still chemotherapy ahead.” At some point, Olga wanted to refuse further treatment, because appearance was of great importance to the singer. But her husband and son did not let her stop. “I still have the wig I wore right after chemotherapy. I even went to Italy wearing it and performed at a competition. And then I immediately took it off. I wanted to get rid of it, because while I was in it, I always felt that something had happened to me,” she recalls. Olga heard the terrible diagnosis eight years ago - and managed to overcome the disease. “I want to tell everyone: believe that cancer is not a death sentence, cancer is a disease. The disease passes - we continue to live!” - says Olga. She recently became a grandmother. Watching your little granddaughter grow is a great happiness, which would not have happened if Olga had stopped halfway.
Nadezhda, a 27-year-old doctor from Mtsensk, also believes in her full recovery. She was diagnosed in 2012. By August of this year, she had already completed six courses of chemotherapy and radiation therapy. Now the most important thing is to take care of your health and regular, once every three months, consultations with a doctor. “When they brought me the first IV, I was hysterical. I was scared, I didn't know what it was. After all, not only cancer, the course of chemotherapy itself is also scary,” she shares her memories. Breast cancer is most often diagnosed after 40. By the age of 27, Nadezhda had already undergone surgery and undergone treatment. I must say that the girl was lucky: she was among those who were treated for free, at the expense of state quotas. Now she is looking forward to returning to work, believes in the best and draws strength from the support of friends and family: her husband, two little daughters and parents.
“Globally, breast cancer is considered a highly treatable cancer. And Russia has finally begun to adopt world experience and introduce international standards of therapy. I sometimes remember my patients whom I treated 20 years ago, and I think that we could definitely help many of them today,” says Rashida Orlova, professor at St. Petersburg State University, Doctor of Medical Sciences, doctor of the highest category.
Recently, medicine in Russia has made tremendous progress in the treatment of breast cancer. The state allocates huge amounts of money to provide those in need with free, modern, highly effective drugs. But this is not enough yet. The quotas that the state allocates for treatment are received by several dozen patients, and thousands of those in need. According to statistics, only approximately 26% of patients are treated according to international standards, which guarantee the best results, and more than 23 thousand people die from breast cancer every year. “The existing system forces us to decide for ourselves who to give life-saving therapy and who not, who to give life and who to deprive of it, because, unfortunately, there are not enough modern effective drugs for everyone. I don’t want to take on the role of God, something needs to be done about this,” the doctors say. But how long will this continue and how to correct the situation are questions that have no answer yet.
Breast cancer is one of the most pressing problems of women's health in Russia. Every year the disease is diagnosed in 57 thousand patients. Moreover, the number of deaths from it exceeds 23.5 thousand per year. Every day, 47 children in Russia are left without their mothers, whose lives are claimed by this terrible disease.
In developed countries, breast cancer is already considered highly treatable. The use of highly effective drugs allows for complete recovery in the early stages and significantly improves the prognosis in the later stages of the disease. In the USA, the proportion of patients living five or more years after treatment reaches 90%, in Europe - 80%. In our country this figure is only 57%.
Until it's not too late!
In America, 1 in 8 women is at risk of developing breast cancer during their lifetime, in Europe - 1 in 12, and only in Asia is this disease relatively rare (in Japan it occurs in 1 in 80 women). Although Russian women are somewhere in the middle in terms of risk, the percentage of 5-year survival (in oncology this indicator is almost equivalent to cure) is much lower (55% instead of 80–90% in the USA and Western Europe). But it is quite possible to radically improve the situation. To do this, women simply need to be examined regularly, without waiting for symptoms. Fortunately, diagnostics have come a long way. According to research, if a woman under 50 years old gets regular mammograms, she reduces the risk of dying from breast cancer by 15%. And for women over 50 years old, this percentage is even higher – 23%. This test can be completed free of charge once every 2 years as part of a medical examination at a district clinic.
Important!
The risk of the disease increases with age. There are no statistics in Russia, but, for example, in the USA, about 5% of all breast cancer diagnoses occur in women under 40 years of age. About a quarter of cases are detected between 40 and 50 years of age. The remaining patients receive their diagnosis after 50 years of age (peak at 70 years of age).
Today, film mammography has been replaced by digital breast tomosynthesis - three-dimensional mammography. This study shows the gland not in two projections (top and side), but in volume, which avoids the effect of “tissue overlap” and increases the accuracy of the method. In doubtful cases, contrast spectral mammography is also used (with the introduction of a contrast agent into the body). Traditional ultrasound has also been modified - today automatic 3D scanning of the mammary glands is already used, which is not only more accurate, but also more informative than the manual method, since it analyzes more parameters. Invasive diagnostic methods do not stand still either. Instead of the usual fine-needle biopsy, which was previously used to investigate suspicious neoplasms in the mammary gland, vacuum aspiration biopsy has been used in the last 10 years. It is not carried out blindly, but under the control of ultrasound, x-ray or MRI. By the way, this method can not only distinguish “good” from “evil”, but also cure a benign tumor of the mammary glands without a scalpel.
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Save everything you can
Surgical treatment has also changed significantly. Today, the priority is organ-saving methods. And it's not just about aesthetics. After all, the traditional operation used since 1882 - radical mastectomy - not only disfigured, but also crippled the woman, since in addition to the mammary gland, the surgeon had to remove the patient’s pectoralis major and minor muscles, as well as regional lymph nodes. After such an intervention, there was a very high risk of developing lymphedema (lymphatic swelling), dysfunction of the shoulder joint, pain, and loss of tissue sensitivity. Nowadays, such a volume of surgery is performed extremely rarely - only when the tumor is very large and grows into muscle tissue. After all, it has been proven that a modified radical mastectomy, in which only the axillary lymph nodes are removed and part of the skin of the breast and underlying muscles remains intact, works just as well.
Today, more and more often (of course, if possible), surgeons refuse to completely remove lymph nodes. Although, starting from the 19th century and until the end of the last century, excision of lymph nodes under the armpit was carried out for all patients in a row. But today this intervention is carried out only when indicated. To determine the extent of the operation, a biopsy of the so-called sentinel node (the lymph node closest to the tumor) is performed. If tumor cells are not found there, then most likely they are not in other lymph nodes and, therefore, their removal is not required. Of course, there is a small risk of error, so a definitive examination of the sentinel node is required after surgery. If metastases are still found in it, the remaining lymph nodes under the arm will have to be removed during an additional operation.
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Each case is unique
One of the recent achievements is the discovery of the role of genes in the development of cancer. Thus, it is known that the mutation of the BRCAS1 and 2 genes (which are called the Angelina Jolie genome) greatly increases the risk of developing breast and ovarian cancer. If in the general population such a risk in a woman is 12–13% and 1–2%, respectively, then the presence of such a mutation increases these risks to 35–80% and 40–60%. Therefore, women with such mutations need to be more attentive to their health and undergo diagnostics more often than others.
Molecular genetic research methods are revealing more and more new subtypes of the malignant process. It is not for nothing that oncologists today say that cancer of even the same organ is not one, but many different diseases. Therefore, the choice of treatment (as well as prognosis) for cancer is based not only on the stage, but on the type of tumor (which is determined by immunohistochemical analysis). The identification of receptors to which the tumor is sensitive has made it possible to carry out targeted therapy (from the word “target”). With this treatment, drugs act specifically on the tumor, affecting less healthy cells. All this increases the effectiveness of treatment and reduces side effects.
Despite the fact that the traditional triad (surgery, chemotherapy and radiotherapy) is still relevant, there is evidence that some types of tumor can already be completely cured only with chemotherapy, without surgery. And although this is still the exception rather than the rule, it nevertheless inspires optimism. Modern chemotherapy is also not what it used to be. She uses a large number of active drugs, because each cancer has its own medicine. In addition, thanks to effective modern antiemetic drugs, this treatment is much better tolerated by patients. The area of preoperative chemotherapy is actively developing. Increases the effectiveness of “chemistry” and its combination with new drugs. Today, women with breast cancer are prescribed hormones for 5 years - this reduces the risk of relapse. Oncologists have great hopes for the actively developing area of immunotherapy. This method assumes an active role in the fight against cancer by the patient's own immune system.
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Prevention
One of the main points of successfully fighting cancer is its prevention. It is aimed, first of all, at ensuring that any woman can know what needs to be done to prevent the development of such a pathology. Prevention can be primary and secondary.
Primary methods
- Having a child before the age of 30, breastfeeding for at least 6 months, correct use of hormonal contraceptive methods, and avoiding abortion.
- Giving up bad habits, avoiding stressful situations.
- Self-examination monthly, on a certain day of the cycle.
Secondary Methods
- Annual mammography (this applies to women after 40-45 years).
- Ultrasound examination of the mammary glands.
- Timely detection and treatment of mastopathy or fibroma (which are considered precancerous).
Control shot
New opportunities have also appeared in radiation therapy, which uses ionizing (radioactive) radiation. The method can be used after breast surgery and/or subsequent chemotherapy to completely destroy any cancer cells that may remain in the breast, chest wall or armpit area. But sometimes radiation therapy is performed before surgery to reduce the tumor.
The most common treatment for breast cancer is external radiation, which is similar to a regular X-ray but takes a little longer (a session lasts 10 to 20 minutes). Treatment usually takes place 5 days a week (except weekends) for 6–7 weeks. The accelerated irradiation technique, which is actively used in Canada and the UK, also appeared in Russia. During daily sessions, the patient receives a higher dose of radiation, but the entire course is completed in 4 weeks.
There is another method of radiological treatment - intraoperative radiation therapy, in which one large dose of radiation is given directly in the operating room during a lumpectomy (surgery to remove part of the breast). This increases the effectiveness of treatment, reducing the risk of relapse.
Question answer
How can women avoid hereditary cancer?
Principles of breast cancer treatment
For a very long time, the treatment of breast cancer plunged everyone into horror. The methods were completely barbaric, starting with cauterization and amputation. Now we can say with confidence that the treatment has become more tolerable, and most importantly, less traumatic. Doctors try to preserve the mammary gland and leave the patient after the operation the same as she came. Surgeons strive to perform organ-conserving operations whenever possible. Thus, today doctors are moving from mutilation to the minimum possible damage, namely:
- the volume of surgical intervention is reduced;
- There is an active development and implementation of gentle treatment methods using radiation therapy;
- Individualization of drug therapy is developing.
And the main thing is that doctors strive to maintain quality of life without compromising the effectiveness of treatment, which is very important for all of us.
