About modern surgical techniques in mammology

 

I have worked in countries such as Italy and Ireland, where there is a well-organized breast screening program. The first survey program in Europe was launched in the 1970s and 80s in Florence, where I was an intern, and it was organized by Prof. Cataliotti, who was my mentor. Thanks to this program, currently more than 30% of breast cancer cases are diagnosed at a very early stage of the disease, at stage 0 (in situ).

 

In Ireland, this program covers women between the ages of 50 and 64. They get a free mammogram every two years. As part of the BreastCheck screening program, they receive an individual letter inviting them to be diagnosed at one of the 8 national centers. Mobile stations equipped with mammographs are used in rural areas. Women get a mammogram near their homes, then a breast X-ray specialist at one of these 8 major centers decodes the image. The best specialists in the field of radiology come from these centers. It happens that they analyze over 5,000 mammograms per year. But the more images a specialist has to analyze, the more experience he gets. If a disease is detected during the examination, treatment, including surgical operations to remove tumors, breast reconstruction, if necessary, chemotherapy, radiation therapy, etc., is carried out free of charge (expenses are reimbursed as part of the BreastCheck screening program). I have worked in 2 of these 8 centers. 50% of patients came for treatment thanks to the screening program. Here, in Russia, most patients go to the doctor with pronounced symptoms (self-detected lump).

 

Different countries have adopted different survey standards, and they are constantly changing. But we must remember that the main purpose of screening is to raise awareness about breast cancer – this is exactly our main message. Women should overcome their fears and regularly check the condition of their mammary glands.

 

All over the world, people are afraid of cancer. The only difference is that in Western countries, patients have much more information, which makes it a little easier for them to accept the diagnosis. Thanks to the media, they already know that BREAST CANCER IS NOT A DEATH SENTENCE. Today, breast cancer treatment has advanced significantly, it gives excellent results, and patients with the disease at an early stage have a very high chance of a complete cure. This means that it is much better to start treatment on time than to be afraid and postpone visiting a doctor until it is too late. Unfortunately, I have the impression that many people in Russia believe that it is impossible to cure breast cancer. Therefore, women do not go for treatment without expecting good results from it. That's why I want to tell them that it's okay to be afraid, and to overcome their fears, you need to gather as much information as possible. Even if your diagnosis is confirmed, treatment can be very effective, so please come for an examination on time.

 

Unfortunately, there are cases in oncological practice when we cannot help a patient. I once worked with a woman whose tumor was the size of a baby's head. I can't imagine how she lived with it for many years. Fortunately, such cases are very rare.

 

It's a pity, but as far as I know, in many hospitals in Russia, full mastectomy and axillary dissection are standard and universal procedures for all breast cancer patients. A lot has changed in the field of breast surgery over the past thirty years. Since the 1980s, organ-preserving surgery and radiation therapy have been considered alternatives to mastectomy. Of course, there are indications for these two operations. However, if a mastectomy is unavoidable, patients should be aware that there are a number of possibilities for immediate reconstruction using implants or the patient's own tissue, taken, for example, from the back or abdomen. This minimizes the stress caused by breast loss, increases the level of satisfaction with treatment and quality of life. In addition, today, with mastectomy, it is possible to preserve the skin of the breast, and sometimes the nipple. This approach is used when immediate reconstruction may be required, and its great advantage is to preserve the natural appearance of the breast and achieve an aesthetic effect. Over the past 15 years, skin-preserving mastectomy and mastectomy with the preservation of the nipple-alveolar complex have become widespread, and it has been proven that the oncological safety of these procedures is similar to standard mastectomy, of course, performed according to certain indications. It is safe to keep the skin, because breast cancer is a disease of the glandular tissue, not the skin of the breast.

If we talk about my surgical experience, I think I learned the most at the University Hospital of Florence. In Ireland, I learned an evidence-based approach to treatment and acquired the habit of constant professional development, regular reading of scientific journals and, generally speaking, constant self-education.

 

From the point of view of patients, I think the best mammology department I worked in was in a private hospital (Fondazione S.Maugeri) in Pavia, Italy. This facility was completely focused on the needs of patients. On the same floor, patients could meet with an oncosurgeon and a plastic surgeon, in the same building there were departments of radiation therapy and oncology, rehabilitation and radiation diagnostics, and a histologist specializing in breast diseases worked there. By and large, everything that we have in the EMC was there.