"Now the disease can be controlled for years"
In Russia, breast cancer is usually found in older women, but in recent years it has been detected earlier and earlier, Vladimir Evdokimov, head of the Kommunarka Outpatient Cancer Center on Azovskaya Street, told Izvestia. This is due not only to an increase in morbidity, but also to improved diagnostic methods, including in the early stages, the doctor believes. According to him, in young people, the disease can be much more aggressive and not manifest itself for a long time. The oncologist spoke about how to reduce the risk of developing a tumor, about modern methods of treatment and diagnosis in an interview with Izvestia on the occasion of World Breast Cancer Day.
"Breast cancer can be more aggressive in young people"
— How often is breast cancer diagnosed in Russia now? Has the situation changed in the last 10-15 years?
— Breast cancer is the most common cancer in women, and the number of detected cases is growing every year. This is partly because the disease has become better diagnosed even in its early stages.
According to data for 2024, over 84 thousand new cases of breast cancer were registered in the country, which accounted for about 22% of all newly diagnosed malignant neoplasms in Russian women. Breast cancer also occurs in men, but it is extremely rare — it accounts for only 0.5–1% of all cases.
— Can we say that breast cancer is getting younger?
— Like most oncological diseases, breast cancer is more common in older people. Now many cases are being diagnosed in younger women, but it cannot be said that the disease has become dramatically younger. Doctors have become more likely to detect cancer due to greater alertness, preventive examinations and the development of diagnostics.
The youngest patient I ever treated was 25 years old. She suffered from a very aggressive form of cancer. He was discovered shortly after pregnancy, but this is not the cause of the disease — just a tragic coincidence. By the time of diagnosis, the tumor had already metastasized, affecting the liver and bones. Unfortunately, the disease was very aggressive, and the girl lived for about a year after she found out about her condition. Breast cancer in young patients can actually develop more rapidly and lead to serious complications faster than in older people.
— And what is the reason for the development of cancer at a young age?
— Hereditary predisposition plays an important role, in particular, we are talking about the BRCA1 and BRCA2 genes. Normally, they are involved in repairing damaged DNA and thus help prevent malignant cell degeneration, but in the presence of certain mutations, the risk of developing certain cancers becomes higher.
Therefore, if a hereditary predisposition is suspected, the patient is recommended to undergo genetic counseling, which will determine the need for testing. His results are important not only for choosing treatment tactics, but also for assessing cancer risks in other family members.
That patient had a mutation in the BRCA gene. As far as I remember, her mother also developed breast cancer quite early — at about 40 years old.
However, most cases occur sporadically, that is, without an identified hereditary cause. According to research, genetic changes that are inherited cause about 5-10% of breast cancer cases.
It is also important that a hereditary predisposition does not mean that the disease is inevitable. If we know about the high genetic risk in advance, we can individually select a follow-up program and discuss possible risk reduction measures with our doctor.
— What else can influence the development of breast cancer?
— As a rule, it is impossible to name one specific reason, usually it is a combination of many circumstances. Proven risk factors include age, hereditary predisposition, smoking, overweight, alcohol consumption, and low physical activity.
There are various myths surrounding breast cancer. For example, sometimes the development of the disease is associated with a breast injury, but there is no evidence of this. The widespread beliefs that a tumor can occur due to an uncomfortable or tight bra or the use of a particular product have not been confirmed. Tanning beds increase the risk of developing cancer — but we are talking primarily about skin cancer, including melanoma, and not about breast disease, as many believe.
Therefore, when we talk about prevention, it is much more important to focus not on common horror stories, but on risk factors for which there is scientific evidence.
— Can stress trigger breast cancer?
— There is no convincing evidence that psychological stress directly causes breast cancer. Another thing is that chronic stress can affect a person's lifestyle: disrupt sleep, reduce physical activity, change eating habits, promote alcohol consumption and smoking. Therefore, it is important to separate the emotional state itself and the behavioral changes that may accompany it.
"The main task is to detect cancer before the symptoms appear"
— What should I pay attention to? Are there any signs that many patients ignore?
— First of all, the appearance of a lump in the mammary gland should be alerted — a woman can detect it on her own. But we must understand that in the early stages, breast cancer very often does not manifest itself at all. A small tumor is often not even felt, it is detected during a preventive examination, for example, during mammography.
It is wrong to focus only on the symptoms. If the formation can already be felt or there are pronounced changes in the breast, the disease may be more common.
Changes in the shape or size of the breast, retraction of the nipple or skin, unusual discharge from the nipple, skin changes on the breast or the appearance of enlarged lymph nodes are reasons to consult a doctor. But the main task is to detect the disease even before the onset of pronounced symptoms.
— Is it often possible to detect the disease at an early stage?
— Yes, and this is one of the main achievements of recent years. Today, breast cancer is often detected in the first or second stages. For example, in Russia, only 23.4% of cases are diagnosed at the late third and fourth stages.
Thus, more than three quarters of patients learn about the diagnosis at an early stage. In a significant part of them, the disease no longer returns after treatment. That is why it is so important to detect the tumor in a timely manner: this increases the likelihood of radical treatment and full recovery.
— Can a routine ultrasound scan detect cancer? What other diagnostic methods are used today?
— Yes, ultrasound allows you to detect formations in the mammary gland and is widely used in diagnostics. However, it is important to understand that ultrasound and mammography do not replace, but complement each other and are used depending on the age of the woman, the characteristics of the breast tissue and the specific clinical situation.
Mammography remains the main method of breast cancer screening. Modern digital equipment makes it possible to detect small formations and changes that cannot yet be detected by palpation. In Russia, this examination is included in the medical examination program: for women starting from the age of 40, it is carried out once every two years.
In some cases, MRI of the mammary glands with contrast is used, for example, when it is necessary to clarify the prevalence of the tumor process or to obtain additional information after other studies. If a suspicious formation is detected, the next step may be a biopsy (a diagnostic method in which living cells or tissues are taken from the patient for examination. — Ed.).
"Breast reconstruction surgeries are available under compulsory medical insurance"
— What modern methods of therapy are used in Russia? How do they affect the length and quality of life of patients?
— Today, breast cancer treatment includes a whole range of methods. First of all, modern surgical treatment. Depending on the specific situation, radiation and drug therapy may be added to it.
Drug treatment has changed especially noticeably in recent years — 10-15 years ago, the possibilities of therapy were much more modest. In addition to classical chemotherapy, hormonal and targeted therapies are now being used (a treatment method that exclusively affects tumor cells. — Ed.) and immunotherapy.
The choice of method depends on the biological characteristics of the tumor, in particular, on the hormonal and HER2 status (an indicator of the amount of a certain protein on the surface of tumor cells. — Ed.), the presence of molecular genetic changes, the stage of the disease and other factors.
For example, in HER2-positive breast cancer, targeted therapy drugs targeting this protein are used. In advanced hormone-dependent HER2-negative cancer, additional information for the choice of treatment can be provided by the study of the PIK3CA, AKT1 and PTEN genes. The identified changes help to determine which targeted therapy options may be suitable for the patient.
The methods of modern medicine can not only reduce the likelihood of the disease returning after surgery, but also in some cases significantly reduce the tumor even before surgical treatment.
In metastatic cancer, the task is more often to control the disease for a long time. Due to the emergence of new drug possibilities, breast cancer can be controlled in some patients. Previously, their life expectancy could have been very short, but today some of them have been living with the disease for years, receiving consistent lines of therapy.
— Is it possible to remove the tumor while preserving the breast?
— Absolutely. And this is one of the areas in which breast cancer surgery has made significant progress. Mastectomy, that is, complete removal of the breast, is not required by every patient today. The specific amount of surgery is always determined individually, based on the stage, size and location of the tumor, its biological characteristics and other factors.
Breast reconstruction operations are available under compulsory medical insurance — if there are appropriate indications and capabilities of the medical organization. Many patients receive reconstructive treatment precisely within the framework of state guarantees.
— How to reduce the likelihood of developing breast cancer?
— First of all, it is necessary to reduce the influence of risk factors that a person is really able to control. It is important to stop smoking, limit alcohol consumption, maintain a normal body weight, as well as exercise regularly and adhere to a balanced diet.
At the same time, there is no lifestyle that can 100% protect against cancer. According to WHO, about 80% of breast cancer cases occur in women with no specific risk factors other than gender and age.
The second and equally important thing is to undergo preventive examinations in a timely manner. Breast cancer should preferably be detected before symptoms appear: women aged 40 and older undergo mammography once every two years as part of a medical examination. Thus, the optimal approach is to combine a healthy lifestyle with regular diagnosis.
Переведено сервисом «Яндекс Переводчик»
