Dr. Ilio Stoyanov: 3,600 Bulgarian women get breast cancer every year

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Dr. Ilio Stoyanov: 3,600 Bulgarian women get breast cancer every year
Dr. Ilio Stoyanov: 3,600 Bulgarian women get breast cancer every year

Breast cancer is one of the most difficult diagnoses in every woman's mind. According to the World He alth Organization, the modern lifestyle leads to an increase in the incidence of this disease. Hollywood star Angelina Jolie not only underwent a double mastectomy to avoid the risk of getting cancer, but also told the world about the series of tests and procedures that were successfully completed in April 2013. The decision to remove her breasts was made by the actress after her mother, Marcheline Bertrand, died in 2007 of ovarian cancer, and after Angelina's own tests proved the presence of the BRCA gene. According to experts, the presence of this gene means that its carrier has an 87% risk of developing breast cancer and a 50% risk of ovarian cancer

Which women should undergo genetic testing? What is the path they must take to avoid the development of the tumor process? These questions were answered by plastic oncologist Dr. Ilio Stoyanov.

Dr. Stoyanov, when did people first talk about breast cancer in history?

- The disease is already described in the Egyptian papyri. In reality, however, the beginning of modern oncology begins in the 17th - 18th centuries, when the first attempts at surgery were made. In 1895, the surgeon William Halsted made the so-called radical mastectomy. Since then, the modern treatment of breast cancer also began. It has undergone a great development, now more than 60,000 combinations and treatment options are known according to the histological results, the stage of the disease, prognostic factors and the genetic predisposition of the woman. Treatment includes not only surgery, but also radiation therapy, drug therapy, psychotherapy.

What is the morbidity in our country and around the world?

- The number of women suffering from breast cancer in the world is increasing rapidly. Every year, 321,000 new cases are discovered in Europe alone, according to information from the World He alth Organization. The trend is worldwide, not only in Bulgaria. Between 3,500 and 3,600 women fall ill with breast cancer in our country every year, and between 1,000 and 1,200 die from this disease

A tendency to rejuvenate the disease is also observed - breast carcinomas are more often found in young women. We don't know the reason for sure, but it is most likely related to lifestyle, diet, giving birth at a later age, excessive use of hormonal and contraceptive preparations.

Early menstruation, late childbirth or late menopause, excessive alcohol use are among the most likely major factors that affect the incidence of the disease. It has been proven that women who drink 80 ml of concentrate every day or the same amount of alcohol of another type are more likely to suffer from breast cancer. Hormonal contraception and the use of hormonal preparations in general, if it has lasted for more than 10 years, also increases the risk of developing breast cancer.

Did preventive mastectomy patients increase after Angelina Jolie's radical procedure?

- Rather, there is a chaotic Brownian motion. Women are not familiar, have no idea what to do and wander aimlessly through research and counseling. There are patients with fibroadenomas who remove glands, then put some implants and they don't feel well.

What is the significance of BRCA 1 and 2 genes?

- These are genes producing tumor suppressor proteins. They repair the damaged DNA structure by providing genetic material to the cell. However, some people have mutations in these genes and they do not perform their functions. And from this damaged DNA in the breast, tumor processes develop. BRCA 1 is responsible for the breast genes and BRCA 2 for the ovaries.

If ovarian cancer is diagnosed and the BRCA 2 gene is present, should we also monitor our breasts?

- It is very rare to carry only one gene, in most cases they are linked.

Only women with a family history of breast or ovarian cancer may carry BRCA mutations? Are they also inherited through the paternal line?

- This gene mutation can be passed down from one or the other parent, or both. If one parent carries a BRCA mutation, you have a 50% chance of inheriting the mutation

Every woman with a familial genetic problem should think about and get tested for BRCA carrier status. The most important thing is to explain what is the path to be followed. First, a geneticist is visited for a consultation. Schemes and diagrams of the entire genus are drawn and the risk of disease in percentages is determined. The next step is genetic testing in a specialized laboratory. If she turns out to be a BRCA carrier, the woman usually panics. The good news is that the algorithm is already mapped out. Consultations with a gynecologist follow. An examination by a mammologist, ultrasound examination and nuclear magnetic resonance is mandatory. This is the instant diagnosis showing what the condition of the glandular tissue is.

With the prescriptions from the mammologist, the woman goes to an oncologist, who reviews all the documentation, does his own research and gives a conclusion. If there is currently no evidence of cancer, the patient is monitored every three to four months. - If the result of the genetic test is negative? - In case of family burden, and this is a serious enough motive, the woman should build a regime and visit a mammologist every four months, who will monitor the condition j. Prophylactic mastectomy - the removal of the mammary gland, significantly reduces the risk of breast cancer. That is why genetic research is a chance for a longer life.

In case of carcinoma of one breast, is the other also removed?

- Yes, that would be good. If a small tumor is found in one breast and a carrier of a BRCA1 mutation, it is better to remove the other as well. When a patient has a fibroadenoma, it does not lead to the development of breast cancer. In the case of multiple fibroadenomas in one or both breasts, it is not necessary to proceed with prophylactic mastectomy.

Who determines the type of mastectomy?

- The methods and type of mastectomy are determined by the surgeon and therefore this operation is best done by a plastic oncologist. Along with the removal of the gland, a breast lift, augmentation and shaping can be done.

When is a psychologist needed to join the team?

- When carrying the BRCA 2 gene. When the ovaries and fallopian tubes are removed, the woman enters an artificially induced menopause. For most, especially the young, this is a real shock.

Psyches, lifestyles, attitudes towards others and the world change. Then the psychologist helps them overcome the breakdowns and resets them to another wave.

Making a decision about surgery is difficult. It is also difficult for the surgeon - the operation lasts 4-5 hours. But every case is different. This is specified during the consultation. The approach to each patient is individual.

Who pays for research and surgery in our country? How is it in other countries?

- In all countries from Belgrade onwards, genetic testing is covered by their he alth funds, including plastic surgery, implants and everything else. In our country, everyone pays for them himself. Genetic testing costs over BGN 2,000

How often should we go to the doctor to avoid major surgeries?

- As early as age 20, women should learn how to self-examine their breasts. This examination takes 10 minutes and is done the week after your cycle. The first clinical examination is recommended after the age of 35 for women who have no complaints, and the first mammogram at the age of 40.

The situation is completely different with women burdened with family or those who have complaints. With them, examinations should start earlier and be more frequent. Genetic tests BRAK 1 and BRAK 2, nuclear magnetic resonance and other specialized tests and research are done.

Be careful with cigarettes and hormones

Family burden is one of the most important risk factors for breast cancer. It matters if the relatives were sick not only on the first line, but even on the second line. However, lifestyle is also very important in triggering the disease. The long-term use of hormone replacement therapy has a proven negative role. Being overweight, alcohol, even cigarettes are all related to cancer. Stress is also very important. Nutrition is also of great importance - the Mediterranean menu, rich in olive oil and vegetables, is the he althiest. It is believed that because of it, these peoples are less likely to suffer from breast cancer. Foods high in cholesterol and fat, however, have the opposite effect. It is very important for a person to be physically active, to play sports, advises the specialist

Itching and heat

are some of the symptoms

The fight against breast cancer is characterized by symptoms that require a thorough examination by a specialist. However, it is important to know that these symptoms are not always definitive proof of the presence of cancer. Sometimes they indicate hormonal or other disorders. Some of the familiar and more obvious signs are related to changes in breast structure, lumps, changes in skin color and/or nipple type, etc

However, there are also some slightly more unusual signs that you would hardly associate with the presence of cancer. Pain and tenderness in the breast area is a normal phenomenon during menstruation, but in the presence of breast cancer, this discomfort is also present outside the period of the monthly cycle. In addition, swelling and warmth can be a sign of the lesser-known inflammatory breast cancer. It causes swelling and itching and can be painful.

Most women who have experienced this type of condition report that at first they thought it was an allergic reaction associated with tingling and itching. The most distinctive sign of inflammatory breast cancer is redness, which may periodically disappear, then reappear.

Changes in the skin of the breast are also very characteristic of this disease - there are changes in the skin texture that lead to the appearance of the so-called orange peel. Keep in mind that this type of cancer develops relatively quickly. Therefore, redness, itching, an inexplicable feeling of warmth in the breast area, a change in the appearance of the skin, as well as a sudden increase in breast size require immediate measures

Back pain is sometimes from metastases

In many cases of any cancer, pain is seen in the back, usually in the upper part between the shoulder blades. Unfortunately, these pains are often considered to be muscular, attributed to spinal problems, tendon sprains, etc.

But the development of the tumor deep in the tissues of the mammary gland is a very common cause of the discomfort in the back area. The other possibility is related to metastases in the area of the ribs or spine.

Research shows that the axillary lymph nodes are the first place tumor cells spread. And just as swollen lymph nodes in the throat and neck area are a sign of the flu, swollen, painful lymph nodes in the armpit area can indicate the presence of a tumor. Any pain, tenderness, thickening or swelling in the armpit area is a serious reason for a thorough examination and examination.

One of the common signs of the presence of a tumor is a change in the color and shape of the nipple. The feeling when touching the nipple also changes - the sensitivity decreases, which is felt especially during sex. And more - discharge from the nipple, similar to milk, clearer, or bleeding can be a definite signal of the presence of a tumor.

It is generally accepted that the most visible sign of breast cancer is lumps. However, this is not exactly the case. It was found that in many of the patients, one breast began to differ significantly from the other in its shape. Most often, one breast becomes more elliptical than the other. Therefore, regularly monitor for changes in the shape of your breasts. Do so even in the absence of any other distinguishing features.

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