Every eight hours a woman dies from breast cancer in Chile, a statistic that places this disease as the leading cause of death in this group nationwide. October, the month that the World Health Organization (WHO) set to raise awareness about this pathology, in order to promote prevention and early detection, leaves us halfway through a pandemic in which women show a collapse in realization of your mammogram exams. Today, more than ever, the message is to reach a diagnosis on time and avoid risk factors such as obesity and the consumption of alcohol and tobacco.
A recent study of the School of Public Health of the Faculty of Medicine determined that from the start of the pandemic in Chile, in March 2020, there was a collapse in the diagnosis of serious diseases among women, breast cancer being one of them. This is more than worrying, considering the high incidence of this pathology (every three hours a woman is diagnosed with breast cancer in the country), which represents the leading cause of death of women in Chile.
The vast majority of breast cancer cases occur in women over 50 years of age, mainly between 50 and 65 years. And although among the younger population the incidence is lower, since one in three women under 50 are diagnosed with this type of cancer, specialists call to be vigilant.
“In general, when this cancer occurs in younger women, it does so much more aggressively. In addition, when they are younger patients, it is mainly associated with genetic factors. When we have patients under 40 years of age, we request a genetic study, because many times there are alterations in the BRCA 1 or BRCA2 genes, and that should be ruled out “, explained the Dr. Mario Pardo, Head of the Obstetrics and Gynecology Service of the Hospital Clínico de la U. de Chile.
For those who have direct relatives with breast cancer (mother or sisters), it is recommended to consult ten years earlier than the age at which said relative was diagnosed with this pathology.
“In the case of patients who are found to have these genetic factors, what is recommended is to remove the breasts because this way we lower the risk of developing this pathology by 95 percent. When you mainly have BRACA 1, there is an 80 percent risk of developing breast cancer ”, warned Dr. Pardo, who, however, indicates that having direct relatives with breast cancer does not necessarily imply that you have this genetic factor.
Achieving an early diagnosis, in this sense, is key to accessing an effective treatment against breast cancer. “Treatment for breast cancer that is found on time has an effectiveness of over 90 percent in ten years,” explained the HCUCH specialist.
What are the most effective ways to prevent? There are two types. One is called Primary prevention, which is to prevent the tumor from appearing, and the other is called secondary prevention, which is to determine a tumor as small as possible by mammography and ultrasound.
Primary prevention aims for women to have a healthy lifestyle, avoiding obesity, which is a disease that produces a chronic inflammatory state and can be a co-helper in the appearance of the tumor. For this reason, the ideal is exercising and avoiding unhealthy habitssuch as tobacco and alcohol use. “This should help because it maintains a good metabolic state,” says Dr. Pardo.
Regarding secondary prevention, the specialist takes special care when recommending breast self-examination. “The doctor can search a nodule of half a centimeter or 1 centimeter and women -in general- search the nodules probably about the centimeter, that is too late. And if the palpation is done before the rule, a lot of nodules will be palpated that are not such. So, it is always said to feel them after menstruation. Where is this self-examination useful? In places where mammography and ultrasound cannot be accessed ”, he assured.
Following the previous idea, mammography screening is the right way to reach a diagnosis on time. Regarding the recommended periodicity to perform this examination, there is no total consensus. However, the specialists at the Hospital Clínico de la U. de Chile recommend an annual mammogram from the age of 40, in the case that there is no family history.
Treatments and post-treatment fertility
As the years go by, medical advances have given better and more effective therapies when it comes to dealing with this pathology. Currently, there are three forms of treatment: one is the surgical, which is the partial or total mastectomy, the other is the radiotherapy, and the third is the chemo and hormone therapy. “Breast cancer is like a multiplication, you can start with one or the other and the result will be relatively similar. Formerly we started with surgery and then went to chemo or radiotherapy, depending on the results. But currently there are many cases in which we are starting with chemotherapy, because risk factors are seen that basically tell you that you have to start chemo because the result will be much better ”, explained the head of the Gynecology Service and HCUCH Obstetrics.
In the case of women who experience this disease of childbearing age, the specialist warns that chemotherapy damages the ovaries and thus fertility. However, this does not close the door to those who want to have children after treatment. “We offer these women ovular rescue before chemotherapy. This is how the oocytes are stored and after two years we can suspend tamoxifen, a therapy that patients must take for ten years once their cancer treatment is completed, so that the woman becomes pregnant, and after breastfeeding, the patient can restart. tamoxifen until reaching the ten-year period ”, explained the specialist.
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