Famous doctor reveals: Women with larger breasts more often get breast cancer

- Early first menstruation and late menopause, after 52 years, are risk factors for breast cancer, which is most common in the sixth decade - says prof. Dr. Radan Dzodic, director of the Institute for Oncology and Radiology of Serbia

Serbia is no longer on the infamous second place for dying due to breast cancer, although the number of patients increases and the age limit moves, this vicious disease affects young ladies as well, said in an interview for Telegraf.rs Professor dr Radan Dzodic, Acting Director of the Institute of Oncology and Radiology of Serbia (IORS).

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Professor Dzodic talking to our portal explains that breast cancer usually affects women who are obese and with larger breasts, women with early first menstruation and late menopause. 

Italians, French and Norwegians are getting sick more often compared to women from Serbia. He said that in order to fight this disease, we should eliminate obesity, alcoholism and smoking, and give birth before 30, and to breastfeed as long as possible. 

Our interviewee reveals that their youngest breast cancer patient was only 19 years old, and he said to all ladies to answer the screening, because breast cancer is a chronic disease, and not a death sentence, and if it is diagnosed in early stadium it is curable 100%.

- I would like to ask our ladies to answer the screening or if they notice some deformity in the breast to go to the examination, so they could be helped on time and to get treated. They should not allow the sickness to spread to the lymph nodes and distant organs (fourth stage). Breast cancer can be touched, even when it is one centimeter, and let alone bigger. 

Where is Serbia when it comes to the number of breast cancer patients?

- Breast is first of all a symbol of women's beauty, motherhood. Unfortunately, breast cancer is the most often malign tumor in the modern age of women. Serbia is somewhere in the middle by the number of patients when it comes to European countries. Italian, French and especially Norwegian are getting sick more.

- So we are not the only country with large number of diseased, but we are in the group of countries that have not completely developed screening for breast cancer. We have the increased number of sick, but the number is growing in the entire world, in Europe, North America, Canada. The number of sick is growing everywhere, but the mortality rate is going down, that is because the breast cancer is diagnosed in the first or the second stadium, when it is curable.

- Breast cancer is chronic disease, its not a death sentence, that is a key message. Breast cancer found in the early stadium is 100% curable sickness and ladies should be motivated to answer the call for screening because that can provide timely treatment and cure for patients that don't have manifested sickness. 

When did mortality rate of breast cancer start dropping in Serbia?

- Breast cancer mortality rate was increasing until 2004, maybe even to 2010. Now it is slowly declining.

- In other words, we are no longer on the sad second place by the number of dead due to breast cancer. That place is shared by Balkan countries that have similar level or protection care, however, the data that the mortality rate is declining is encouraging.

Are there risk factors we can influence on, and are there some we can't?

- Genetic factors contribute to the appearance of breast cancer that you can't influence on, and it is about 10 % of those. So if someone in your closest family has breast cancer (mother, sister, grandma), and if it is proven that there is some genetic mutation, patient has a high risk of having breast cancer. 

- In that case, often monitoring is recommended, or preventive surgery to prevent the risk for almost 100%, but the risk can't be entirely removed. More often, the chances of getting breast cancer after 10 to 15 years are one to three percent.

- Hormone factors of risk are hard to eliminate because girls get their first menstruation before they are 12, due to their diet, and some even before 10. Early first menstruation and late menopause, after 52 years, are risk factors for breast cancer, which is most common in the sixth decade.

On the other hand, giving birth can be affected on. We should motivate young ladies to give birth before 30. It is best ti give birth at the end of second, or at the beginning of third decade, not to wait for fourth decade, and especially not for fifth.

Late labor is a high risk that can be influenced on. It can't be influenced  on early menstruation or late menopause, but on birth, breastfeeding and obesity can be influenced. 

Breastfeeding saves the mother from breast cancer, but does it save the baby?

- Mother absolutely, as far as the child is concerned, the ones that were breast fed were generally healthier, but i don't know any study don on the subject if the breastfeeding saves girls from breast cancer. However, as breastfeeding is the protective factor for breast cancer, it is protective factor for various infections and sicknesses for the child.

You mentioned obesity. Does that mean that obese women have greater risk of getting breast cancer?

- Obese ladies often get breast cancer from slim or normally fed. Eliminating obesity the number of patients would reduce. Alcoholism as a sickness increases the risk of breast cancer as well.

- Smoking causes the heart and blood vessels sickness, or premature death, although there are no sure evidence they cause breast cancer. However, people should stop with this ugly habit because it can lead to lungs cancer, stomach cancer, bladder, kidneys... So, obesity, alcoholism and smoking should be eliminated, and to give birth in the right time and to breast feed as long as possible. 

We have girls younger than 25 and 28 that have breast cancer?

- Unfortunately, not just Serbia, but the entire world, the age limit is coming down below 50, into fifth, fourth and even third decade of life. Breast cancer can appear at early age. Our youngest patients were 19, 20, 21. Those are extremely rare cases, less than 1%, but they happened.

- In other words, you have to be very serious with every lump on the breast. One of the thousand fibroadenom (the most common benign tumor of the breast) can be malign. There are so called early fibroadenoms that appear with girls before the age of 21.

- But there is a possibility that there are more of them, and when there is more of five or ten it is called fibroadenomatoza. In that case, only those which are suspicious, that are growing, should be operated on.

- Glandular tissue should not be removed because it will spoil the format of the breast, which is a symbol of woman's beauty and it must not be scarred with terrible scars. Scar must be covered, to be virtually undetectable and the patient should forget ever having a surgery.

When should a woman go to the first exam, and what are the symptoms or a sign that should be an alarm?

- First of all, breast cancer does not hurt, at least not at the beginning. With malign tumors, pain appears when there is visible lump that is taking a part of the nerves, so the pain is the late sign of sickness. There are no rules when the first exam should be done. 

- It can be done if there is suspicion that something is developing inside the breast which is not common. Exams should be done every month, during a shower or after that, when you are applying cremes. Woman knows her breast the best, and she will diagnose tumor in breast better than a doctor who is not even dealing with breasts.

- In other words, self examination should be done every month. Deformity can be noticed during every shower, and anything that is causing suspicion should be examined. 

- Breast cancer can't form over night, you should go to regular controls, and especially those who had the sickness in the family.

Can a breast cancer affect conception?

- Brest cancer can appear during pregnancy, but there are strict rules of conduct when chemotherapy can be applied without damaging the child. On the other hand, cancer during pregnancy is more aggressive than usual, but the models of treatment are the same. 

- Sometimes, if the pregnancy is at beginning, or if the sickness is really aggressive, the abortion is the best solution. However, one can carry out the pregnancy. There is no radiotherapy during pregnancy, only surgery and chemotherapy.

When after breast cancer can a patient remain pregnant?

- When she enters a quiet period, the therapy is finished, and it all depends on biological aggressiveness of the tumor, the years of the patient and the treatment.

- Sometimes the pregnancy is not advised at all, however, most often, if the early breast cancer is diagnosed and the treatment is successfully done, there are no prohibitions to the patient to become pregnant. 

How often the breast cancer is with men?

- Breast cancer with men is only in 1 to 2 percent of the cases of total number of sick. It is most often with breast similar to female, in the enlarged glandular tissue (gynecomastia). Along with breast cancer in women, discreet increase of diseases is recorded in men as well.

What should we eat to avoid this type of cancer? Japanese people are good at it.

- Women in Japan have the least numbers of breast cancer patients in the world, and island countries in general, because they often have fitoproteins in their diet, or vegetable proteins from soybean and corn and beans which have a protective factor for breast cancer.

- However, we should keep in mind that breast cancer usually appears in larger breast, and Japanese have smaller breasts. But, in the past 10 years, they are more used to the fast food, and the volume of the breasts is increasing, and the frequency of breast cancer as well.

So, the larger the breasts the larger the risk of cancer. What if we have a really beautiful girl, slim with big breasts?

- In general, obese ladies have breast cancer more than slim, but it is a good question... I think that these ladies are not in such a high risk.

With Japan for example, should we eat food they also have on the plate?

- No, we should eat more diverse food. Fresh vegetables, fruit, mixed food which is appropriate to our climate.

- Of course, eat all times of meat and all in moderation. Not meat three meals a day. In past times, meat was eaten once a week with a lot of vegetables, for Sunday lunch, and that is gone.

Where is Serbia for breast cancer mortality rates?

- We should get the data from the statistics organisation on the global level for cancer where all the countries of the world are listed. Serbia was second in 2012, however, there is a data that Croatia is now taking the second place. We moved on the ladder of health systems in Europe from the second to last place to place in front of several members of EU.

Who do we have to thank for that?

- We introduced the informational system, which is still not ideal, but it was introduced, the number of screening units is increased, the level of radiotherapy in Serbia has been significantly increased. We got three new accelerators in Sremska Kamenica, - two on the Institute for Oncology of Vojvodina, one for the Institute for Pulmonary Diseases Vojvodina, two new in Nis, one in Kragujevac, and one in IORS. Neurological center with the gamma knife has been built.

- Total of 8 new radiotherapy machines in few year. In other words, thanks to the great investments and good health policy, we significantly improved this sector. Of course, it can always be better.

- I hope it will be even better when we get six more accelerators this year, then we will have great conditions, golden standard for radiotherapy and we won't be different from medium-developed European countries.

There are guidelines for breast cancer in Serbia 

As far as the treatment goes, breast cancer is treated in Serbia under European standards. We made guidelines for breast cancer, and the book "Breast cancer" that won the award of the city of Belgrade. We have very educated surgeons for breast cancer and oncologists and radiotherapists, so the treatment on a very serious and good european level, but we should work on educating the citizens. It is unacceptable that only 20% of the patients that are called for screening show up.

What should the response be?

- Total response should be over 70% so we can diagnose the breast cancer in early stages which is entirely curable disease. The loss of a breast is a serious loss for the patient, that makes serious psychological and social problems, but mastectomy, or the removal of the breast, is done when there are more malign tumors in the breast or because the tumor has advanced.

- Of course, breast reconstruction is done in our centers, and the costs are regulated by Republic Health Insurance Company. In other worlds, it exists, and all the therapy will be soon available, and the timely radiotherapy, and we won't have to radiate the patients in three shifts. We got the approval for few innovative drugs for breast cancer. A lot has changed in the bast two three years. A lot of this should have started a decade ago, but nevertheless, we can make it, because we have educated doctors.

When will Serbia complete all the requirements for screening?

- We will complete screening in a few years. Now we have 40 screening units. They include the object for digitized mammography machine, space for reading and an anteroom where patients prepare for examination.

- Of course, we need over 100 screening units, so we could comfortably do the examination to our women between 50 and 69 years of age on every two years. That is around a million women for two year period.

(Telegraf.co.uk / Ljubinka Racic – lj.racic@telegraf.rs)