KSMU News

OCTOBER IS THE MONTH OF THE FIGHT AGAINST BREAST CANCER
17th October 2022

Vladimir Khvostovoy: “In Kursk, there is everything for the treatment of breast cancer that is available in the world!”

As early as 1993, the World Health Organization designated October as the month of fighting breast cancer. Indeed, there are many myths associated with breast cancer, such as the fact that long-term use of oral contraceptives leads to it or that a woman does not have a chance of becoming pregnant and giving birth after the disease. In a word, we talked about this, as well as many other things with the Head of the Department of Oncology of KSMU, Candidate of Medical Sciences, Oncologist and surgeon of the highest qualification category, surgeon of the Regional Budgetary Healthcare Institution Kursk Scientific and Clinical Oncology Center named after G.E. Ostroverkhov VLADIMIR VLADIMIROVICH KHVOSTOVOY.

– Vladimir Vladimirovich, the first question, of course, is about factors that promote breast cancer.

– Risk factors are reflected in the clinical recommendations of the International Cancer Union. First of all, it is age. Despite the fact that there are more and more rumors – breast cancer got “younger”, the older a woman becomes, the greater the risk of the disease. Nobody’s cancelled the hereditary factor as well. It is also: hypoestrogenic status, overweight, inactive lifestyle, late first birth or no motherhood at all in a woman’s life, early menarche and late menopause, alcohol abuse and smoking (especially during lactation!).

Another risk factor is dyshormonal hyperplasia or mastopathy. Many women experience breast pain and tension before menstruation and often call it premenstrual syndrome – PMS. Mastopathy should not be ignored either.

– Medicine is constantly developing. New methods of diagnosing breast cancer and cancer in general are constantly emerging. Could You tell us about them?

– In fact, in order to make a diagnosis of breast cancer, you do not need any supernatural devices, a digital mammograph is enough with the possibility of archiving, as well as double-triple control. There are also mammography machines with the ability to use artificial intelligence in image processing, as well as with digital tomosynthesis systems – this is a computed tomography, giving the highest image quality. There are few such facilities in Russia, but there is one in Kursk Regional Cancer Center.

If we talk about new methods, it is mammography with intravenous contrast enhancement. The essence of it is that the patient is injected with a special contrast, so that lesions that were not clearly identified in the usual image become visible. There are also innovations in the ultrasound diagnostics system, for example, elastometry, when the density of the finding in the breast is determined using a special computer program.

Not only in the cancer center, but also in other medical institutions of the Kursk region, there are all conditions for detecting breast cancer at an early stage.

– And in this regard has the statistics of number of disease cases changed?

– That’s the right question. Over the past 3-4 years, breast cancer occupies I and II place in the structure of cancer incidence, “overtaking” lung cancer, and even skin cancer in some years. But figures of incidence “grew” because of early diagnostics. While five years ago the number of newly identified cases was about 500, now there are more than 700 cases, mainly due to the early stages. That’s good. And, again, it’s not just the cancer center. There are many good digital mammographs in medical institutions of the region – more than 30. Also, thematic actions and programs have their effect. For example, total examination of women in Zheleznogorsk was carried out not so long ago as “pilot” one. Large-scale projects, such as Mothers of Russia, play a positive role when 60,000 women were surveyed in the Kursk region, after which a certain number of women were included in a risk group and actively called for examination.

Thanks to all these measures, 75% of cancer cases in our region are stage zero, stage one and stage two.

– There are many myths associated with breast cancer. For example, the best prevention is breastfeeding. Is that true?

– Not exactly. Yes, a woman who is not breastfeeding has a higher risk of illness. The preventive effect of breastfeeding is realized in the intervals from 4 months to 1.5 years of total feeding. If a woman has been breastfeeding for more than 1.5 years in total, the risks begin to increase again.

– I also want to mention that early childbirth – that is, before 20 years – is a good prevention. Indeed, in Burma and Bangladesh, as well as other small countries where women become mothers early and often give birth, the incidence rate is almost reduced to zero. After all, pregnancy hormones are a very powerful factor in the prevention of breast cancer.

– There is a myth that oral contraceptives contribute to the occurrence of breast cancer.

– Recent research suggests this is not the case. It is possible only in individual cases, for example, in hereditary breast cancer caused by genetic disorders. This myth appeared many years ago, after the study of drugs used for contraception with a very high content of estrogens, which have not been used for a long time already. The same applies to postmenopausal hormone replacement therapy. It does not pose significant risks.

– Does breast cancer always require breast removal?

– No, at present it is made only in the neglected cases when the disease already is glaringly obvious, and the woman notices that something is wrong, but doesn’t apply to doctors. Now, the whole evolution of breast cancer treatment in the world has gone along the path of reducing the volume of surgery. And in the first or second stage, it’s possible to save breasts. And even if removal is necessary, if the patient wishes, it is possible to perform reconstruction surgery. By the way, 15 years ago, doctors could save breasts in about 20 percent of cases, and now – almost in 90!

But some patients insist on mastectomy instead of organ-preserving operations, after which postoperative radiation therapy is mandatory. But this is an additional stay in the hospital, and the therapy has certain side effects, especially in elderly women.

– What new methods of breast cancer treatment are available for the Kursk region?

– In our region, there is everything that is available in the world, including opportunities of organ-preserving surgical intervention. We abandoned the routine removal of axillary lymph nodes, which led to swelling of the arm, impaired mobility in the shoulder joint. We are now using a high-tech sentinel lymph node biopsy technique.

The biggest advances in the treatment of breast cancer in the world are not related to surgery or radiation therapy, but to systemic treatment – the development of new drugs and regimens. It should also be understood that behind these words “breast cancer” there is a very large number of diseases, which themselves are so different: in terms of the speed of the course, speed and possibility of developing metastases, sensitivity to therapy. It means that there are completely different molecular genetic variants of cancer. And in order to treat breast cancer, we need to know what type it is.

Targeted molecular therapy has been added to the treatment of breast cancer. When certain receptors have been identified in the tumor that are important for cancer cell viability. And for them, the drug was invented that as a key fits the lock, while destroying them. And such treatment is applied in Kursk.

Also another recent advance in oncology is immunotherapy in the form of a blockade of immune checkpoints. When a patient’s immune system is helped to recognize the tumor and destroy it. This therapy is also used in breast cancer, even when there are already metastases.

– May a woman, having recovered from breast cancer, become pregnant and give birth to a child?

– Of course. It is normal practice! If breast cancer is not hormone-dependent, then after treatment and chemotherapy it is necessary to wait a year, after which it is possible to become a mother. And if the cancer is hormone-dependent, it is necessary to “turn off” the ovarian function after treatment (for at least 5 years), and then pregnancy is also possible.

– And at the end of our conversation nevertheless we will talk about prevention. So, what should women do to prevent breast cancer?

– We already told about that: childbirth and breastfeeding are important. One should not ignore mastopathy and should definitely contact a doctor with this problem. The correct pathogenetic substantiated therapy of mastopathy is currently recognized in clinical recommendations as a factor of breast cancer prevention. When prescribing drugs with proven efficacy, but not vitamins or dietary supplements, the risk of breast cancer may be reduced by 20-30 percent. Graduated exercises also have a beneficial effect. There is a French study that proves that if a woman does housework for an hour a day or works in the garden, she is 40% less likely to develop breast cancer during her lifetime. Carefully monitor your blood sugar and thyroid function. And, of course, it is necessary to pass medical check-up every year. It is necessary to do ultrasound of the breast up to 40 years, and then – mammography. And be healthy, cheerful and beautiful!