Prof Miroslav Granic, BEL MEDIC: When Mammography should be done?

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Today, women under the age of 40 have breast cancer three times more often than 10 years ago. When the tumor of the breast is detected at an early stage, the patient has great chances for complete healing, says prof. Dr. Miroslav Granić, specialist in general surgery

The number of women in breast cancer in Serbia is growing – in 2014 there were 4,600 newborns. Statistics show that today women under the age of 40 are ill three times more often than 10 years ago. In America and Europe, a mammographic mass screening of healthy women aged 50 to 70 years has resulted in a 30% reduction in mortality from breast cancer. In our country, three years ago, breast cancer screening began for this age of women, but the response is now only 30%.


It is therefore important to constantly explain to women that early detection of breast tumors and early diagnosis are a possibility of good prognosis and long-term survival. The goal is to detect a tumor of the breast in the early, preclinical stage, when the patient has great chances for complete healing, says prof. Dr. Miroslav Granić, specialist in general surgery, with whom we discuss issues important for each woman.

When should the first review be done?

It is advisable to have the first clinical examination by observation and treatment by an expert physician for about 30 years of age and then once a year. A number of breast cancer develops in the form of a tangible tumor, and 90% of these are infused by the patient themselves, when the tumor reaches a certain size.
By a periodic clinical examination, once a year, a tumor of the breast can be felt when it is smaller, already 0.5 to 1 cm, which enables timely treatment and good prognosis. From diagnostic procedure in women younger than 40 years is also advisable to work periodically breast ultrasound, to better detect suspicious changes in condensed glandular tissue typical of that age. Mammograms, or x-rays, should be used by women aged 50 to 70 years. It is the most valid method for the early detection of breast tumors, which can also detect an intangible tumor of minimum dimensions, and achieve timely and appropriate treatment.

How much self-diagnosis helps?

Self-diagnosis of the breast can help in the detection of breast tumors if it is regularly performed. It is best to do it once a month, after the end of the menstrual cycle and say every 1st in the month in women in menopause. When self-examination is performed regularly, a woman can notice a change in her appearance and form of breast and contact the doctor in time.

How does self-examination work?
Self-image is first performed in a standing position with hands on the hips, and then with hands raised above the head. Observation of the front of the mirror is determined whether there is a retractable nipple, skin redness, thickening and swelling of the skin as well as orange peel, wound on the nipple, a bloody leakage to the nipple,  skin cancer or a protrusion and the firmness of part of the breast with the node or palpable tumors.
Then lying down on the back right hand fingertips feeling the left breast, right and left, and this round of warts, but outwards in concentric circles over the entire surface of the breast.
The examination also examines both the retinal pits because they can sometimes inflate the enlarged lymph nodes in the form of a mariner or node.

Is every node dangerous?
Not every claim in breast cancer. There is a range of benign processes that resemble malignancy, but it definitely needed a professional diagnosis is clinical examination, followed by ultrasound or mammography, and if necessary, breast magnetic resonance imaging.

What are the symptoms of breast cancer?
The protrusion on the breast nipple retraction, retraction of the skin of the breast, skin redness, swelling of the skin, and thickening resembling orange peel, flake on the nipple, and wounds on the skin of the breast, oozing of blood or not bleed nipple, palpable knot or thickening in the breast, palpable node in armpit.

Which women are at the highest risk of breast cancer?
Positive family history, that is, the fact that a mother or grandmother suffered from breast cancer is the greatest risk factor. For these women, periodic, annual examinations are recommended from the age of 30. By the age of 40, methods for early detection of breast cancer are clinical examination and ultrasound. If there is a suspected tumor, mammography or magnetic resonance is involved. The American National Cancer Center recommends mammography after 40 years on a regular basis for two years if this risk factor exists.

Are there any other risk factors other than inheritance?
Malignant diseases arise as a result of the interaction of many risk factors, among which the most dangerous are genetic factors and environmental factors. Viruses, genetic damage, chemical agents and toxic substances contribute to an increase in the incidence of malignant diseases. This shows a large difference in the number of people between certain geographical areas.

Is it recommended for preventive surgical removal of breast in women who are at increased risk of breast cancer?
The opposite is the attitude of the experts on preventive mutual mastectomy. If there are risk factors and if the BRCA gene analysis is positive and the patient feels fear and psychological burden, I think it is necessary to meet and set an indication for the surgical removal of both milk glands with the preservation of skin, warts and isola, and the simultaneous reconstruction of both breasts.

Why is mammography not working before the age of 40?
Breast tissue by the age of 40 is condensed, with fibrocystic changes that are normal for this age. Therefore, tissue is less transparent in mammography, so ultrasound is the method of choice. In the elderly group, mammography may also occur.

What are all the methods of breast cancer treatment?
Breast cancer can be treated with surgery, chemotherapy and air therapy. Modern surgical treatment of breast cancer implies a sparing operation, in which the tumor of the breast is removed with the protective edge of the surrounding healthy tissue at 1 to 2 cm, along with the sparing of healthy breast tissue. After that, the lymph nodes are checked. If it turns out that they are the seat of breast cancer metastases, the surgical removal is completely removed.
If there is no metastasis in the first peritoneal lymph nodes, the others are not removed.
Post-operative breast surgery is always the postoperative radiation of the breast.
When the tumor affects most of the breast tissue, it is necessary to perform surgical removal of the entire breast, with the partial or complete removal of the susceptible lymph nodes.

Are chemotherapy applied in all cases?
Chemo does not apply to all types and stages of breast cancer. The application of chemotherapy regimen depends on the pathohistological findings, the hormonal receptors present, the type and size of the cancer, and the extent of malignancy.

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