Male or female? Does breast cancer occur in the stronger sex
"Breast cancer (BC) is the most common type of female cancer," says Maria Koroleva, PhD, oncologist. — However, it would be a mistake to consider it a female disease, since it is also diagnosed in men. Of course, it is much less common than in women: it accounts for 1% of all diagnosed cases of breast cancer. But men die from it much more often than women. If a woman has breast cancer in the early stages successfully treated in 95% of cases, the figures for men are much less positive. Perhaps because men do not even know about the existence of such a threat and even if dangerous symptoms appear (breast edema, nipple retraction, enlarged axillary lymph nodes, bloody discharge from the nipple) do not consider it necessary to go to the doctor." Unfortunately, not all doctors know about the possibility of such a disease in men. Therefore, even with timely access to a doctor in 20% of cases, the correct diagnosis is not established, although in the stronger sex, breast cancer has signs characteristic of the later stages of the female disease. Almost 45% of those who applied for medical help have a significant spread of the process — a tumor larger than 2 cm and the presence of metastases.
About features and disadvantages
Not much is known about breast cancer in men. Doctors know that it develops on average 10 years later than in women (in 60-70 years), while in women the peak incidence occurs at 50-59 years.
It is assumed that the disease develops more often in men living in Northern latitudes, as well as in those who 20-25 years ago were exposed to intense ionizing radiation or underwent radiation therapy for the treatment of other diseases. Concomitant risk factors are considered to be obesity and cirrhosis of the liver. Most likely, as in the case of female breast cancer, there is also a hereditary predisposition.
It is clear that due to the rarity of the disease, there is no talk of introducing full-scale screening among men. However, the tendency to increase the incidence of diseases (including due to an increase in life expectancy) can not be overlooked. Therefore, as a preventive measure, men are encouraged to regularly check their Breasts and immediately consult a doctor in case of alarming symptoms. By the way, women are also encouraged to perceive men's Breasts not only as a vest for tears, but also as an object of attention and care. Each and every one?
With regard to the introduction of a nationwide breast cancer screening program, the need for this measure remains open and debated, even for women.
"For the first time, the effectiveness of this measure to reduce breast cancer mortality was shown in the United States in 1963," Irina Kolyadina, MD, Professor of the Department of Oncology and palliative medicine AT the Blokhin national cancer research CENTER of the Russian Ministry of health, told the conference of the Russian society of clinical Oncology (RUSSCO). — That was the first time a large-scale study was conducted in new York.
62 thousand women aged 40-64 years were divided into 2 groups. Women from one group had mammography and breast examination every year for three years, while women from the second (control) group had only an examination. The results of the study shocked scientists all over the world."
70% of all breast cancer cases were detected in the screening group, and one in three women had microcarcinomas that could not be detected by other methods of examination. The results were especially important because in the 60s, effective systemic therapy for breast cancer did not yet exist and early diagnosis of breast cancer was the only way to save a woman.
The success of this research was so great that two years later a second project was launched in the United States. Initially, it was planned that 10 thousand women would take part in the screening (annual mammogram), which was planned to spend $ 2 million.
But the project had such a huge impact that as a result, 280 thousand participants came to the screening, and the project budget grew to $ 20 million. This program was also attended by the wife of the Vice President of the United States, Margaret Rockefeller, who was diagnosed with a microcarcinoma during the examination (after which an organ — preserving operation was performed).
This sad fact, oddly enough, became the best advertisement - after that, crowds of women began to literally storm the mammography rooms.
Since then, many countries have launched screening programs. 7 large randomized trials confirmed a 30% reduction in breast cancer mortality as a result of screening. Reverse side of the coin
Later, doctors increasingly began to discuss the downside of screening programs. As it turned out, they give a large number of both false-positive (when the detected formation was not cancer) and false-negative results. As it turned out, mammography accurately detects microcarcinomas that are well treated, but often misses interval breast cancer (from which most women die). In addition, it turned out that mammography itself can later become the cause of radio-induced cancer.
The international Agency for research on cancer has recognized that this fact, alas, is the case. But in absolute numbers, the probability of radio-induced cancer is minimal and is 1 case per 10 thousand women who have undergone the screening procedure. According to the latest recommendations, mammography should be given with caution to carriers of BRCA mutations younger than 40 years, who constantly form potentially dangerous cells in the breast. For them, radiation, even in minimal doses, can be dangerous, and it makes sense to prescribe other types of examinations.
Today, taking into account all the identified circumstances, the European society of radiologists recommends that digital mammography be performed annually for women aged 40-49 years, with an interval of 2 years for women aged 50-69 years. In this case, the examination should be performed by a certified radiologist. We also recommend double reading of mammograms (by two radiologists) and their subsequent audit (quality control system).