Breast cancer — a growing problem in Russia. Every year in our country registered more than 50,000 new cases of the disease, and in the future this number will increase. In the arsenal of modern medicine is an effective means to deal with malignant tumors of the breast, but they must be applied in a timely manner. On how the modern approach to this problem can save women's lives and reduce the number of FGM, told MedNovostyam corresponding member of Academy of Medical Sciences, Honored Worker of Science, Professor, Director of the Cancer Research Institute. NN Petrova Vladimir Fedorovich Semiglazov.
The reasons for the growth of breast cancer cases studied well enough. The main role is played by external factors, especially the modern civilization. This, in particular, the so-called Western-style food, excess fatty write, overeating and as a result, a growing number of overweight people. It is known that the fat deposits in the body promotes growth hormone levels, triggering breast cancer and uterine cancer.
Additional growth of malignant tumors contribute to changes in the physiology of modern women. 60 years ago the average age of the "inclusion" of menstrual function accounted for 16 years, and its discontinuation occurred in approximately 42-44 years. Moreover, this relatively short period of 5-10 had birth. Now the monthly cycles begin at the 11-year-old girls and continue until 52-55 years of age. Accordingly, the period of the effects of sex hormones significantly increased, and the predetermined function of the nature of childbirth and lactation is not performed. All this increases the likelihood of malignancy of the breast tissue.
C increased risk of breast cancer associated and use of hormone therapy to correct undesirable effects of menopause. This effect is proven by studies in large cohorts of patients in the U.S. and other countries. Similar concerns were expressed with regard to hormonal contraception, but they have not been confirmed: the increased risk was found for women who for a long time (8-10 years) used hormonal contraceptives for the prevention of a first pregnancy.
Finally, it is worth to say about genetic risk factors. Well known genes BRCA1 and BRCA2, which are a number of options associated with hereditary forms of cancer that develop at a young age. The prevalence of these genes varies among different peoples. For example, representatives of the Ashkenazi Jews caused by genes forms of breast cancer are found in 10 percent of cases. Our country has a special, "Slavic" form of the gene BRCA1, which is associated with about 5 percent of cases detected. For the remaining 95 percent of breast cancer cases no relation to known genetic disorders can not be traced.
In recent years abroad were several large-scale clinical trials of chemoprevention of breast cancer in women at high risk (with a hereditary predisposition to the disease, or with identified precancerous processes). Currently, the most promising direction is the prophylactic use of aromatase inhibitors. These drugs inhibit the synthesis of estrogen, the excess of which provokes the formation of tumors. Preliminary results of the international multi-center studies involving our institute gives promising results. However, techniques that would prevent the development of tumors, are still at the stage of clinical experiments, so that an effective means of monitoring the incidence of breast cancer among doctors still do not.
Catching up on morbidity, mortality ahead
Rapid growth in the number of breast cancer cases observed in all regions of the world. The number of patients increased in Latin America and in Africa, where a few decades ago, this disease is extremely rare. The same is happening in Russia, and, catching up with the West on the incidence, we, unfortunately, are ahead of their mortality.
Why is this happening? In the United States, and the old EU countries mortality from breast cancer decreased significantly after the introduction of mammography screening programs total for women aged 50-70 years. It is a program of preventive examinations of healthy women to detect cancers at an early stage of development. Early detection can cure disease with conservative surgery, usually without chemotherapy and other systemic methods of influence. This approach not only increases the survival of patients, but also — and more importantly — makes it possible to keep such an important organ for women without compromising the aesthetic function. If a similar program has earned in Russia, it would allow for five to seven years to reduce mortality from cancer breast 20-30 percent.
We need a system
In 2007 the Ministry of Health and Social Development issued a decree on the establishment of offices in Russia mammography screening activities for women after the age of 50 years. Number mammography indeed significantly increased. However, one gets the impression that the radiologists themselves and policy makers in the field still do not capture the essence and purpose of screening. The majority of Russian patients, who are now the mammogram, or they themselves have suspected at the tumor, or it has been revealed by your doctor. Meanwhile, the purpose of screening is to discover latent diseases in apparently healthy, not having any complaints of women.
In addition, mammography — it is only the first link system for early detection of breast tumors. The detection of non-palpable tumors need a little more expensive equipment for stereotactic biopsy tumors, morphologically to confirm or deny its malignancy. In 80 percent of cases, tumors are benign, but if it is not, you need to determine which part of the breast tissue to be removed and whether you can limit sparing surgery. In the case of small tumors, this again requires sophisticated research, which in our country is held in insufficient quantities.
For full oncologists need feedback — monitoring the fate of the treated patients. Need to collect specific information in the cancer registry, which makes it possible to assess the situation in many ways, not just on the overall statistics of morbidity and mortality in the country. The only way to reliably evaluate the effectiveness of the system as a whole. The primary endpoint is a reduction in cancer mortality among patients. While for breast cancer did not occur in any of the regions of Russia.
Unfortunately, the creation of a complete system of screening — the event is extremely expensive. Together with experts from the International Agency for Research on Cancer (IARC), I tried to calculate the approximate amount of costs: Get that only the first year of the project needs about 5 billion rubles. In addition, the first results (reduced mortality) will be in five to seven years.
An oncologist can not cope with this
Finally, a must-have is the total screening mass propaganda. At 100,000 surveys conducted in the worst case, there were 100 cases of cancer detected. This means that the absolute majority of women who are screened for decades, the disease would not be detected. Just try to explain to them the need for such surveys. It is known that when participating in the screening of less than 60 percent of women to be examined statistically significant results, it does not generate.
Should be brought to the public that mammography — it is a safe study, which is necessary in order to confirm the absence of dangerous disease. An oncologist can not cope with this. Unfortunately, all our atte
mpts to contact the media, on television have been inconclusive: we were told that they would not consecrate the problems of oncology not to "scare" the audience …
In the west, promotion of knowledge about breast cancer is the powerful social organization. They publish stories of women successfully treated, psychological support newly diagnosed patients. In the U.S., for example, everyone knows that the wife of a prominent politician had an operation for cancer of the breast, and feels fine after a few years of operation. We have also distributed mainly negative, intimidating information. All this leads to the fact that patients turn in on themselves, begin to avoid inspections, refuse treatment. Now, when breast cancer can be treated successfully, this situation is unacceptable.
In Russia recorded 50,000 cases of breast cancer per year, and have received treatment for the disease, there are 250-300 thousand. No one better than them, not up to the task to spread knowledge about the disease. And now, many women are turning to timely oncologists on the advice of friends who have had cancer breast cancer. Such patients — our ally, their massive involvement in advocacy work would be a very strong move.
The text prepared by Mikhail Alekseev