Breast cancer

What are the most common types of cancer in women?

The most common types of cancer in women are breast and cervical cancer.

Is self-examination effective in diagnosing cancer?

In Brazil, mammography and clinical breast examination (CBE) by specialist physicians are the screening methods routinely recommended in comprehensive care for women. The Ministry of Health’s formal recommendation for the general population is that women undergo a clinical evaluation annually, after age 40, and that they undergo routine mammography every one to two years, along with an annual breast exam. , from the age of 50. In the literature, there is also a recommendation to perform screening mammography in women, from the age of 40, associated with monthly self-examination and annual clinical examination. The follow-up policy to be adopted will depend on the patient’s socioeconomic profile and also on the judgment of the attending physician. For women who have access to mammography and to the mastologist, the earlier initiation of measures is very favorable.

But what about breast self-examination?

From the 1950s onwards, in the United States, the technique of breast self-examination was widely disseminated with the prerogative that it would reduce the number of diagnoses of advanced breast cancer. However, based on the results of clinical trials from the late 1990s, which were not successful in proving this hypothesis, it was abandoned in several countries. The practice of breast self-examination, however, has proved to be useful in giving women the role of co-responsible for maintaining their health status. First of all, its main current function is to plant the seed of screening in the lives of the female population, even when they are young. Thus, this method can be seen as an educational measure and every woman over 20 years of age should be encouraged to practice it with some regularity. After all, there is no one better than herself to recognize details of her breast anatomy and identify alterations that deserve individualized evaluation by specialists.

Are large, dense breasts more likely to get cancer?

The breasts are basically constituted by glandular tissue and mammary ducts, responsible for the production and conduction of breast milk, and by fat, which determines the size and shape of the breasts. The proportion between glands and fat is what defines breast density. In general, the greater the number of glands in relation to the percentage of fat, the greater its density. And, contrary to popular belief, this measurement is not related to the size or firmness of the organ, but rather is a characteristic determined by mammography.

For most women, breast density reduces with age. The explanation for this is that, even when young, the milk-producing tissue is fundamental and must be abundant. But as time passes, it loses its function and is progressively replaced by fat. Still, even in old age, some remain dense and difficult to examine.

But why is this important?

Currently, high breast density is related to an increased risk of developing breast cancer. The reasons why this happens are not known for sure. Perhaps the greater number of ductal and glandular cells increases the probability of malignant transformation. In addition, it still makes it more difficult to detect suspicious lesions by mammography, because in these breasts the low presence of fat makes the suspicious areas not stand out in the method.

Despite what has been said, it does not mean that if you have dense breasts you will develop cancer. On the contrary, in isolation it has no value. In fact, this is just one of the traditional risk factors involved in the genesis of the problem. Variables such as age, smoking, hormone exposure, early onset of menstruation, late menarche, pregnancy after age 30, as well as family history of neoplastic breast lesions and individual genetic potential, are just some of the elements that make up the risk.

Are all breast lumps cancer?

The vast majority of lesions that occur in the breast are benign. Breast cancer, however, is the disease of greatest concern because it is the most commonly observed malignancy in women. The term “benign breast diseases” encompasses a heterogeneous group of lesions that may present with a wide spectrum of signs and symptoms. They are often attributed to abnormalities of breast development, infectious and inflammatory conditions, fibrocystic changes in the organ and benign neoplasms, such as fibroadenoma, for example.

With the imaging techniques currently available, such as high-resolution mammograms, high-quality ultrasounds, MRIs, and targeted punctures, a diagnosis of a benign lesion is almost always achieved without the need for surgery. As most of them are not associated with an additional risk of developing breast cancer, invasive procedures should be discouraged. It is important to be surrounded by a reliable medical team, who together can handle the case in a more appropriate way.

Can men get breast cancer?

Most people are unaware of the fact that men, as mammals, are also born with breast tissue. This tissue is made up of a small number of glands and ducts located below the nipples and areola and is distributed equally in boys and girls.

After puberty, the female ovary starts producing large amounts of estrogen and progesterone. In order to prepare the woman for the breastfeeding process, female hormones are responsible for the growth, development and shaping of the breasts, by stimulating glandular proliferation. In males, however, this is not so pronounced. The production of estrogens and progesterone occurs only in minimal and sufficient amounts to maintain the breast volume presented in the prepubertal period.

Like all cells in the body, breast duct cells in men can undergo malignant transformation. However, breast cancer is less common among them, not only because their ducts have less cellularity, but also because they have lower levels of circulating trophic hormones.

In males, due to the rarity of cases, early diagnosis methods are not recommended in the same way as is practiced with women after 40 years of age. Still, knowing their own body is also important for them. Therefore, in view of the perception of any abnormality on palpation, look for a qualified specialist to assist in the diagnosis.

Does birth control prevent breast cancer?

Natural estrogens and progestins have been shown to influence the growth and development of ductal and glandular structures in the breast. Since oral contraceptives are made up of synthetic congeners of these hormones, researchers were interested in trying to correlate their use with an increased risk of cancer. The results were able to better delineate this link with endometrial and ovarian cancer, giving oral contraceptives a protective role in these diseases. However, in terms of breast cancer, data from the main studies are conflicting and inconsistent. Despite the doubts, most of them tend to link the use of contraceptives with a greater risk of developing the disease. While this is true, the actual risk increase is minimal and should not be of major concern in the general population. This information may be relevant, however, in cases of high-risk women, who have predisposing genetic mutations or a rich family history of the disease, for example.

Can I remove the mammary glands to prevent breast cancer?

There are women who, despite having never had breast cancer, are known to have a very high risk of developing the disease. For example, women who have a strong positive family history of breast and/or ovarian cancer or who have a family or personal history of male breast cancer have a high probability of carrying a deleterious mutation in the BRCA gene. When this occurs, the possibility of the appearance of cancer becomes very high, with chances approaching an alarming 80%, throughout your life.

In the light of current knowledge, in these cases, medicine is able to propose methods that help reduce this risk. Certain patients, after clarification of cost-benefit, may opt for invasive procedures, such as removal of the breasts and/or ovaries, in the same way as the famous actress Angelina Jolie did.

For the prevention of breast cancer, the most effective surgery is bilateral prophylactic mastectomy with reconstruction. The technique basically consists of removing all the glandular and ductal breast tissue, where the disease truly begins, and may or may not preserve the nipples. Maintenance of the nipple-areolar complex improves cosmetic results, giving the breast a more natural appearance after reconstruction with a silicone implant. On the other hand, in terms of risk reduction, the more conservative the surgery, the smaller the benefits.

The choice between operating on a healthy person and not operating or even choosing between possible surgical modalities are difficult decisions and need to be taken with considerable maturity. Even if the patient opts for total mastectomy, which in theory would provide greater protection, it is important to recognize the possibility of remaining in hidden glandular areas. Not infrequently, small tissue foci remain adhered to the skin and muscle wall, or in extramammary areas, such as the armpits, for example, and serve as nests for tumor growth. To make the process as easy as possible, consulting with a multidisciplinary team made up of professionals experienced in handling this type of situation is recommended.

How long after a mastectomy can silicone be placed?

Most women who have a mastectomy for breast cancer will have the chance to have reconstructive surgery. This procedure may occur immediately or may be delayed. In the first case, the breast implant is implanted on the same day, right after the mastectomy surgical time. In cases where reconstruction is delayed, it is performed days, months or years after the end of cancer treatment, with the chest wall already healed. Perhaps the situation that most influences this decision is the indication of radiotherapy. If the reconstruction is more delicate, irradiation can impair healing and make the final results unsatisfactory.

A third option would be immediate-delayed reconstruction, in an intermediate process to what was previously exposed. With this method, an expander is implanted under the skin during the mastectomy, which preserves space for a prosthesis. Depending on the patient’s therapeutic program, the silicone piece can be placed in its position earlier or later, in a simpler way and with an excellent aesthetic profile.

Does all breast cancer have to be treated with surgery?

First, it is extremely important to be protected by a multidisciplinary medical team with experience in the treatment of breast cancer. Often an interdisciplinary approach between the breast specialist and the clinical oncologist is the most desirable, as the therapeutic recommendation involves a wide variety of nuances. Age, the clinical conditions in which the patient is and the stage of the disease, for example, are extremely relevant factors in the indication of a mastectomy. It is necessary to remember that, despite being simple, the procedure carries, built-in, a non-negligible risk of complications and, if it is not well indicated, instead of contributing, it can harm the patient.

Technically speaking, surgery is the most effective way to eradicate the disease and should be recommended whenever there is a chance of cure. On the one hand, for women in whom metastatic involvement is not characterized and who have adequate clinical conditions for the procedure, surgery is the main treatment strategy. It can be performed before or after chemotherapy and, in both situations, provides equivalent gains in survival. Generally, mastectomy must be complemented by chemotherapy and/or radiotherapy and/or hormone therapy, in order to avoid recurrences.

On the other hand, breast cancer becomes an incurable disease, but controllable, from the moment it spreads to other parts of the body. Therefore, the surgical indication of the primary tumor becomes a questionable objective. In fact, in this scenario, this measure does not confer important advantages in terms of survival in most cases and, often, has a purely aesthetic and hygienic application. Firstly, to avoid the growth of the tumor in the breast and all the stigmas caused by infiltration of the skin and muscles. And, finally, because it minimizes pain and the chances of tumor infection, both potentializing agents of suffering in cancer patients.