By way of conclusion, pink October, the month that has always been dedicated in Italy to the prevention of breast cancer, the most frequent neoplasm in women, with 55,000 new cases every year in Italy.
Benedetta de Mattei met with Dr. Nicoletta Orthmann – Medical-scientific coordinator Fondazione Onda – Observatory on women’s health and gender, to understand how to prevent breast cancer and what are the first signs that should not be underestimated for an early diagnosis, which makes the difference.
HOW DIFFUSED IS IT
Breast cancer is the most frequent malignancy in women: one in ten women gets sick. Approximately 55,000 new cases are diagnosed in Italy annually, of which only 1% in males. Although this neoplasm still represents the leading cause of death from cancer in women in the world (about 13,000 deaths / year estimated), thanks to early diagnosis, continuous research progress and new therapies used, many patients can recover from it, as demonstrated the constant growth trend in survival rates.
COME PREVENT IT
To prevent breast cancer it is important to have a healthy lifestyle, based on a balanced and varied diet, low in fruit and vegetables, low in fat, and exercising.
Crucial is also the role of early diagnosis that allows to identify the tumor in the initial phase, allowing better curability and therefore greater chances of healing and less invasiveness of intervention. It is then important to check your breasts, to identify visible alter (changes in the shape of the breasts, nipple retraction, blood discharge or discharge, swelling, changes in the appearance of the skin) and any lumps that are suspicious to the touch. This is why it is important to learn about your breasts throughself-examination as a periodic habit that it would be good to start doing already at the age of 20. Even more attention must be paid and self-examination must be repeated frequently if there are risk factors.
WHAT ARE THE RISK FACTORS
The main risk factors are:
female sex: women have a risk of breast cancer about 100 times higher than men;
age: over 80% of cases of breast cancer affect women over 50, even if the cases registered in the fertile population are increasing;
family history: family history of breast cancer (mother, sisters, daughters or a history of maternal and / or paternal family)
heredity: multiple genes have been identified involved in the hereditary transmission of breast cancer, the mutation of which is estimated to be responsible for 5-10% of all breast cancer cases considered. Most of the hereditary forms are due to the mutation of the BRCA1 and BRCA2 genes, also of the hereditary forms of ovarian cancer;
hormonal factors: early menarche, late menopause, prolonged use of hormone replacement therapies taken during menopause, nulliparity and failure to breastfeed (pregnancy and breastfeeding, being in which the body reduces the production of estrogen, on the contrary have a protective effect against the disease );
obesity: numerous epidemiological studies have shown that a condition of obesity (particularly in the postmenopausal period). Furthermore, in women with breast cancer the incidence on the natural history of the disease, worsening the prognosis and increasing the risk of recurrence.
incorrect lifestyle habits, in particular: excessive fat load in the diet, high alcohol consumption, sedentarism and cigarette smoking.
FIRST ALARM BELLS TO BE CAREFUL
– Presence of nodules
– Bumps or thickening of the breast or axillary area.
– Pits or ridges on the surface of the breast.
– Secretion of fluid from the nipple (if the loss is bilateral, the cause is usually hormonal while the unilateral one should alarm)
– Changes in the shape or size of the breasts.
– Changes in the appearance of the skin, nipple or areola (such as orange peel skin, swelling, redness, sensations of heat, etc.).
In most cases, however, breast cancer does not give obvious manifestations of itself, and it is therefore essential to regularly undergo clinical-instrumental specialist checks..
For young women who do not have a family history of breast cancer, an annual clinical breast examination is recommended. The clinical evaluation can possibly be completed by abreast ultrasound, which is the indicator instrumental examination for the “young” breast due to its dense appearance. From the age of 40 (a few years earlier in case of familiarity), women should begin to undergo mammography, the radiographic examination of the breast, which represents to date the most reliable diagnostic method, being able to highlight the presence of mammary tumors not yet palpable. The modern ones use low x-ray dosages, allow routine repetition of the exam without excessive risk.
Eventually mammography can be accompanied, in selected cases, by other more complex instrumental investigations, such as magnetic resonance. It will be the trusted doctor who will give indications on the periodicity and scheduling of checks, based on the patient’s clinical, personal and family history.
BREAST CANCER PU? BE BENEFICIAL OR EVIL
Yes, the term “breast cancer” includes many and different conditions of disease affecting the mammary gland, which can be classified into two broad categories:
– benign tumors (fibroadenomas) which are common in young women, especially in nulliparous women (who have not yet been pregnant) and are surgically removed only if they are large or if they change their appearance over time;
– malignant tumors (carcinomas, the most common), due to the uncontrolled multiplication of some cells of the mammary gland that degenerate, transforming themselves into malignant cells and detach themselves from the tissue that generated them to invade the surrounding structures and, subsequently, also the other organs.
DIFFERENT STAGES OF A MALIGNANT BREAST CANCER
– Lo stage 0 indicates carcinomas in situ (lobular or ductal). Carcinomas in situ are not tumors themselves, but are true from cellular transformations that more or less can easily evolve into a form of real malignant tumor.
– Lo stage I it is characterized by small tumors (less than 2 cm), without affecting the axillary lymph nodes. Stage cancers have a 98% chance of healing.
– Lo stage II includes larger tumors (greater than 2 cm), without lymph node involvement or smaller tumors but with lymph node involvement.
In stage III the tumor is locally: it is a tumor of the size that has affected the advancement of the incidence of axillary lymph nodes or tissues such as the skin, muscles or chest wall.
– Lo stage IV on the other hand, it includes tumors with distant metastases. The organs to which breast cancer can most frequently migrate are the bones, liver, lung and most frequently the brain. Therapy and prognosis differ according to the stage of the disease.
There are many biological factors that characterize breast cancer and therefore it is the treatment program must be personalized. Almost all women diagnosed with breast cancer, in post-stage, undergo a surgery to remove diseased tissues. In cases where it is possible, conservative surgery is used, removing only the part where the lesion is located, while sometimes more extensive interventions are necessary. Very important is thehistological examination conducted by the pathological anatomy laboratory on the operative piece, since it provides all the characteristics of the tumor, essential for defining a specific and personalized treatment program. It is a sort of identikit, which tells us if the tumor is aggressive, slow-growing, sensitive to hormones, etc.
Depending on the case, the intervention can be followed by radiotherapy or chemotherapy. Alternatively, if the tumor has resulted from hormone-dependent histological investigation, i.e. sensitive to the action of hormones due to the presence of specific receptors, an indication is given for the treatment based on hormone therapy. In some cases, chemotherapy is administered before surgery to reduce the size and aggressiveness of the tumor (in this case we speak of neoadjuvant chemotherapy).
The therapeutic measures available today to treat breast cancer are extremely effective. The effectiveness is greater the earlier the tumor is diagnosed, when it is still small and limited to the glandular tissue of origin.
The recommendation is therefore to carry out clinical and instrumental checks, according to the times indicated by your doctor based on your clinical, personal and family history..
Benedetta de Mattei