SELF-TESTING IS NECESSARY

The World Health Organization (WHO) has been conducting its annual, month-long, international campaign against breast cancer since early October.

The purpose of the WHO campaign is to motivate women to monitor their own health, to contact their doctor promptly and to have examinations and regular mammograms. This will help oncologists to identify breast cancer at an early stage when it can be cured completely. It will also save women's lives. It is known that more than 10 million women develop breast cancer every year. According to WHO experts, by 2020 this figure will rise to 15 million. Breast cancer kills more than 6 million women every year. In Azerbaijan, after stomach and intestinal cancer, breast cancer is the third most common cause of death among the female population. The country has more than 8,000 cancer patients, of whom nearly 1,300 women have been diagnosed as having breast cancer. And, every year, the death rate from this disease is rising.

That is why the WHO initiative is supported in all countries. For example, in Israel mobile X-ray equipment has been available for three years now in places where women can have an examination if circumstances prevent them from having a mammogram in their place of residence. The US operates breast cancer prevention centres, which any American woman can attend, talk with a doctor, calculate the risk of the disease and have a mammogram. The UK holds Health Days dedicated to the fight against breast cancer; women can share experiences and get information on prevention and treatment of the illness.

Russia has a social programme for early diagnosis and prevention of breast cancer in which it organizes special conferences for oncologists and "hot lines" with senior regional specialists. Women receive complete information through the media about the illness. Posters and flyers are distributed to hospitals to familiarize women with the basics of self-examination and urge them to visit doctors regularly and have mammograms in good time. As part of an integrated approach, and in addition to early diagnosis of the illness, women receive high-quality drug therapy to Western European standards, and there are rehabilitation programmes for patients. Regardless of national characteristics, the basic idea that needs to be conveyed to every woman is that "breast cancer is not a sentence, it is only a diagnosis."

Better to remember

The statistics are as follows: breast cancer is the most common malignant tumour found in women. Every year, breast cancer is detected in one million women. Half of them die. The incidence of breast cancer over the past 20 years has grown by 40 per cent and continues its threatening upward trend. The most dangerous factor is that it is affecting more young women. The incidence of breast cancer among women under 30 amounts to 28.5 cases per 100,000 of the world's female population.

What causes breast cancer? Normal body cells reproduce only when necessary. However, in some cases, the cells begin to divide in an uncontrolled manner, resulting in a mass of tissue called a tumour. If the newly-formed cells are normal, such a tumour is benign, but when cells lose the properties of normal cells, the tumour is malignant.

Every malignant tumour or cancer has its origin, i.e. breast cancer originates in the tissue of the mammary gland. Like other tumours, breast cancer grows into the surrounding tissue. In addition, tumour cells are able to penetrate other organs and tissues through the blood and lymph nodes, where new tumours or metastases form, while the process itself is called dissemination of the tumour.

Doctor of Medicine Nasimi Qasimov, chief physician at the Oncology Clinic of the Azerbaijan Medical University, told R+ that research indicates that rural women are less susceptible to this pathology. Consequently, the increasing incidence is influenced by urban life, in other words, urbanization. In addition, women's hormonal status changes in the course of life, and this can influence the development of breast cancer. For example, at a young age the disease can be caused by elevated levels of oestrogens in the blood. In these cases the disease can be cured by appropriate hormonal agents. Women aged 45-60 face risks associated with ovarian failure. Other risk factors are obesity, an irregular sexual life, abortion and the early onset of menstruation.

At an early stage

In Azerbaijan, breast cancer detection in the early stages - the first and second stages - is from 10 to 40 per cent. In the US, this figure reaches 80 per cent. Detection of the disease in the final stages entails mandatory surgery. According to the doctor, such high levels of the disease are due to the fact that women visit experts too late. This is the case for all diseases in Azerbaijan, and low levels of breast cancer detection at an early stage are observed throughout the former Soviet Union. "I see a way out of this situation in broad familiarization campaigns that should be conducted across the country - women over 40 should understand that they should have an examination at least once a year." This will reduce mortality from this disease.

The initial stage of cancer is indicated by the presence of a nodule less than 0.5 cm in size, which cannot be determined by the naked eye. That is why instrumental diagnostic methods in women under 35 are very important at this stage - ultrasound examination of the mammary glands and, after 3, preventive annual mammograms. Thus many developed countries, such as the USA, Britain, France and Scandinavian countries, have long had special screening programmes that identify nonpalpable neoplasms. In fact, the nodule in the breast, like a pea in density, is often detected by the woman herself, who then visits a doctor. As a rule, this should be an oncologist at the place of residence or, in the absence of an oncologist, a surgeon or gynaecologist. After initial examination, these experts send the woman for an examination at the National Centre for Mammary Gland Pathology.

In later stages, due to the growth of the tumour, there may appear other symptoms such as nipple retraction, changes in the shape of the gland, retraction and local thickening of the skin, growth in axillary lymph nodes and, in more advanced cases - supraclavicular lymph nodes, indicating that the process has gone too far. In this case, as a rule, the prognosis for the woman's life is less favourable and the presence of metastases, usually in the bones of the skeleton, is more likely. The last stage of cancer is characterized by a growth in the entire gland, which is caused by oedema and metastases in axillary lymph nodes. There may be skin ulceration at the site of the germination of the tumour and lung damage. In this case, the prognosis for life is extremely unfavourable. It is therefore important to conduct monthly breast self-examinations and visit a doctor at least once a year. Every year from 20 to 30 thousand people are examined by the National Cancer Centre. Regular medical checks are also carried out in the regions.

However, if a nodule is detected, women should not immediately become upset and panic. This may be benign mastopathy or a normal fibrous nodule that may disappear by itself. Most of these nodules are not cancerous. Nevertheless, constant self-testing is necessary. Breast cancer is the main cause of death for women aged 35-54 and is second to lung cancer throughout life. Only 5-10 per cent of breast cancer cases are hereditary.