“Show that you care about your family! It starts with you!”
Actions to inform and prevent breast and cervical (cervical) cancer carried out by Asociația „Investește pentru Viitorul Tău” Buzău, who is carrying out an action to inform women about cancer prevention measures in October.
In this sense, we want to create interactive actions and meet with the ladies from Buzău and beyond, to talk about the importance of detecting this disease in time.
In Romania, every year approximately 10,000 patients with advanced breast cancer are diagnosed and many do not survive, because they are diagnosed in advanced stages of the disease.
Breast cancer can be cured if detected early.
Involvement makes a difference!
This information is to help you take better care of yourself
I. What is cancer
Cancer is a term used to describe many conditions that can affect any tissue or organ of the body, when tumors have appeared in them, resulting from an uncontrolled multiplication of some cells. A normal cell turns into a tumor cell through several steps, as a result of the interaction between the patient's genes and various carcinogens.
For more precise information, cancer being a very complex condition, it is essential to consult a specialist.
Breast cancer:
What breast cancer is:
Breast cancer (often called breast) is an uncontrolled growth of some cells in the breast tissue, which eventually end up forming a tumor. Such a tumor is considered malignant when its cells invade nearby tissues or reach other parts of the body.
Breast cancer can form in many parts of the breast tissue – the most common forms form in the ductal ducts, which are the ducts that carry breast milk to the nipples. Breast cancer usually looks like a lump – but this is not an absolute rule. It is good to know, however, that not every lump or cyst that appears in the breast is cancer. That is why it is important that a woman who presents such nodules has them constantly monitored by a doctor.
Breast cancer is the most common form of cancer that occurs in the population of Romania - it represents over a quarter of all cancers that affect women. Compared to other European countries, few cases are diagnosed in Romania - and these at a late stage, which leads to a high death rate.
However, breast cancer is curable – largely when caught early. That is why the number of deaths from breast cancer is decreasing in EU countries. In Romania, it is increasing - something that has several causes, the main one being, however, late diagnosis.
Risk factors for breast cancer:
The chances of a woman developing breast cancer in her lifetime are increased. Data from the United States and Great Britain show that the individual risk is 12.33%, and some factors favoring the appearance of this type of cancer are simply natural - it is about sex (although breast cancer can occur, much less often, in men), age and genetic background. For example, simply increasing in age favors the occurrence of breast cancer. From 30 to 50 years, the incidence increases 10 times. Heredity is also an important factor – people who have at least one case of such cancer in their family are more likely to develop breast cancer. For these cases, there are genetic tests that detect the presence of certain genes that favor the appearance of cancer.
Other factors influencing the occurrence of breast cancer are (more) controllable – exposure to radiation, alcohol consumption, obesity, lack of physical activity, lack of childbirth or breastfeeding are considered to affect the chances of developing breast cancer.
Cervical (cervical) cancer
What cervical cancer is:
Cervical cancer is the abnormal growth of cells in the cervix, the part of the uterus that opens into the vagina. It is important to know that this type of cancer is caused by the appearance of a virus - HPV - which can cause changes in the tissues.
The HPV virus (human papillomavirus) is acquired through direct contact - either through vaginal, anal or oral sexual contact, or through simple touch. HPV can cause an infection in the cervix, and if it persists for a long time, it can cause changes in the nature of the cervical cells. A majority of the population contacts the HPV virus during their lifetime - only a small number develop cervical cancer as a result.
There is a vaccine for HPV – and it is mainly given to girls (around the age of 11-12), but it can also be given to boys, who are carriers.
Cervical cancer is very common, and in Romania it occurs twice as often as in other European countries, thus becoming the second cancer that affects women, after breast cancer. It is important to know that Romania ranks first in Europe in terms of mortality due to this disease - the risk of death is three times higher than the European average. Cervical cancer is the main cause of cancer mortality for Romanian women between the ages of 15 and 44 - 6 women die every day from this cause.
Risk factors for cervical cancer:
Contact with the HPV virus is the first risk factor in cervical cancer. Due to the fact that this virus is transmitted mainly through sexual activity (but not only), it is considered that the early onset of sexual activity and the number of partners can influence the occurrence of this type of cancer. That is why it is important to use a condom with every sexual contact, although it does not completely eliminate the possibility of contacting the virus.
HPV infection is very common – up to 80% of the population will come into contact with the virus at some point in their lives. Only infections that cannot be eliminated over a longer period of time can cause cervical cancer. Some strains of the HPV virus are oncogenic (with a high risk of causing the appearance of cancer cells). High-risk strains (genotypes) are 165 18 (most common – causes 70.7% of cervical cancers), 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73 and 82.
Other factors may be smoking, immuno-suppression, long-term use of oral contraceptives from a very young age. Chlamydia infection can promote the creation of fertile ground for the development of cancer cells.
Among the factors that affect the mortality rate in Romania (the number of deaths as a result of cervical cancer), an essential one is the lack of screening - the Babeș-Papanicolau test. Most women in Romania have never been tested. The test can identify infections or abnormal cervical cells at an early stage and, when done regularly as directed by your doctor, is the most effective way to prevent cervical cancer.
II. Screening and prevention - what to do to stay healthy
Prevention:
The International Agency for Research on Cancer (IARC), coordinated by the World Health Organization, emphasizes that access to treatment is not enough if it is not combined with prevention measures. It is estimated that the number of cancer cases will increase by up to 70% in the next 20 years.
in Romania, the number of new cases detected has doubled from 1990 until now, so the growth trend is obvious. The really problematic part is that, unlike the rest of Europe, where mortality is decreasing, in Romania the trend is of accelerated growth.
Avoiding exposure to carcinogens
There are certain physical or infectious substances or agents that promote cancer.
These are called carcinogens. Primary cancer prevention means minimizing exposure to these agents. Carcinogenic agents are either chemical substances (such as those contained in tobacco, alcohol, food, drugs, water or air pollutants), or physical (UV radiation, X-rays, radioisotopes, nuclear fission), or infectious (HPV, Epstein-Barr virus, hepatitis B and C virus, HIV, Herpes simplex, HTLV, etc.). Sometimes lower exposure to such factors is possible, in other cases there is a vaccine (see HPV) so the risks can be reduced.
It should be known, however, that they cannot be completely eliminated.
The Agency for Research on Cancer (IARC) claims that up to half of cancers could be prevented if there were public health strategies to talk to the public about the risks. That's because, in addition to factors that can't be changed (such as age, heredity, or gender), many risk factors can be removed. Of these, smoking, alcohol, excess weight, physical inactivity, unhealthy diet and infections are important.
The European Code against Cancer (2014 edition) shows that they are different recommended steps to reduce the risk of developing cancer. They are:
– quitting smoking,
– maintaining a healthy body weight,
– daily physical activity,
- adopting a healthy diet (eating whole grains, legumes, vegetables and fruits, limiting foods with high fat or sugar content, avoiding sweetened drinks, avoiding processed meats, tomatoes, foods with a high salt content),
– giving up alcohol,
– avoiding exposure to the sun and using sun protection products,
– protection from carcinogenic substances at work,
- limiting exposure to radon radiation in one's own home.
In the case of women, breastfeeding also reduces the risk of cancer. When possible, breast-feeding should be done. Hormone replacement therapy (female hormones that replace, after menopause, those produced naturally) favors the occurrence of certain types of cancer.
Vaccination:
Newborn vaccination programs for hepatitis B and human papillomavirus (HPV) are effective in preventing some cancers.
in the case of cervical cancer, the HPV vaccine can prevent between 70 and 85% of the cells that can become cancerous. The typical vaccine contains the most important strains that lead to cancer, and together with regular screening, it can lead to a significant reduction in risks. ask your GP about the HPV vaccine.
Early detection
When they talk about prevention, however, doctors are talking more precisely about detecting cancers in their early stages (or even pre-cancerous lesions), when they are easier to treat and have a very high chance of cure. in these cases, the risks are reduced simply by destroying or removing cancerous lesions or those that have the potential to become cancerous. Early detection is done through screening, that is, the identification of those abnormalities that can turn into a certain type of cancer.
When an early diagnosis is possible, intervention measures are added to it. This is not a classical way of prevention, given that the person already shows signs of the disease, but it works and significantly improves the prognosis. Screening is all the more important when targeting those who have genetically inherited risks, but is generally most effective when targeting the entire population. It is the GP who has all the data to share screening information with their patients and refer them to screening.
Early detection for breast cancer:
There are several ways in which breast cancer can be detected early. These are breast self-examination, clinical breast examination, mammography, ultrasound, nuclear magnetic resonance and tomosynthesis.
Breast self-examination
Self-examination is not an actual, medically recognized screening method for early detection of breast cancer. but it helps to know your own breasts and to detect any changes as soon as possible. Breast self-examination is done in five steps.
The step 1: By looking in the mirror with your back straight and hands on your hips, you can see if your breasts are the usual shape, size and color. Things you should report to the doctor if you notice them in this phase are any wrinkles, dimples, inverted nipples (also called inverted nipples, when the nipple is pulled inwards), redness, irritation, swelling.
Step 2: Observe the same possible changes, this time with your arms raised above your head.
Step 3: You can also notice if there is any discharge from the nipples (fluids can be of the consistency of water, milk, yellow or with traces of blood).
Step 4: lying on the bed, with the arm corresponding to the breast you are examining under your head, examine your breast using your other hand (right for left breast, left for right breast). Using the three middle fingers together, spread out, make circular and firm movements that gradually cover the entire surface of the breast. Use these circular movements from one end of the surface to the other, from the collarbone to the abdomen and from the underarm to the sternum. The pressure of the movements should make you feel the entire tissue in turn, down to the ribs. You can repeat by moving up and down.
Step 5: Using the same motions as in step 4, resume the examination while standing or sitting, with the hand corresponding to the breast being examined held overhead. You may find it easier to do this examination in the shower when the skin is wet and slippery from the soap.
If during these steps you notice unexplained changes, swelling, irritation, either underarm or in the texture of the breast or nipple, report them to your family doctor immediately.
Clinical examination of the breast
The clinical examination is usually done by the doctor in combination with more advanced screening methods, such as mammography. As mass screening does not exist in our country, this regular examination, which can be performed by the family doctor, is useful (but not sufficient).
The examination consists of inspecting and palpating the mammary glands and the lymph nodes near them.
Ultrasound
Ultrasound detects formations (cysts, nodules, etc.) that may appear in the breast, but should not be used as a substitute for mammography. This method is used especially in the case of young women.
Mammography
It is the method used for screening in the general population between the ages of 50 and 69, when the IARC strategy recommends that such an examination should take place once every two years.
Early detection for cervical cancer
Screening for cervical cancer can be done either by simple visual inspection and acetic acid staining, or by the Babeș Pap test performed at regular intervals, or by HPV testing.
In Romania, women between the ages of 25 and 64, whether or not they have health insurance, can benefit from a FREE Pap test. The Babeș Pap test is performed annually in the first phase, and doctors recommend that the first such test be done at the age of 21 or three years after the first sexual contact, if it took place before this age. depending on the test results, the doctor can decide whether you will continue to have the test annually or at longer intervals. European guidelines recommend that asymptomatic women have such a test every 3-5 years if the test results are normal.
In Romania, the organized screening of cervical cancer is carried out at intervals of five years. Thus, all women between the ages of 25 and 65 should be tested. Thus, when suspicious (precancerous) cells are found, they can be treated, stopping the disease before it actually starts.
The Babeș Papanicolaou test involves the collection of cells from the cervix, which will later be examined under a microscope. Such collection can be done during any gynecological examination.
III. Diagnosis and treatment:
Diagnosis of breast cancer
Breast cancer can be diagnosed through several methods, whether it is mammography, ultrasound, magnetic resonance imaging (MRI), or other imaging tests. If these tests show a change that may be cancerous, the doctor will recommend a needle biopsy. This is the sure way to confirm the existence of cancer cells. The biopsy consists of taking some cells from the suspicious area, which will be examined later in the laboratory. Some biopsies are performed with a needle, others with incisions, depending on the criteria established by the doctor. Laboratory results that will confirm or deny the presence of cancer take about a week. Sometimes the doctor may also recommend a lymph node biopsy.
This procedure is generally done using a needle.
Confirmation of a breast cancer diagnosis may lead to further tests if the doctor thinks the disease may have spread to the rest of the body. Therefore, x-rays, tomography, scintigraphy or MRI examinations can be done.
Breast cancer treatment
Depending on the type of cells, staging and other factors, the oncologist/surgeon will recommend a certain type of treatment. Generally, treatment consists of removing the tumor through surgery, systemic treatment (which treats cancer cells throughout the body – chemotherapy, hormone therapy, or targeted therapy), radiation therapy, and/or immunotherapy.
Medical team for breast cancer:
In the treatment of cancer you will need a team of doctors - which can be made up but does not necessarily consist of: a surgeon or oncologist/surgeon, the one who surgically treats breast cancer; an oncologist who will recommend chemotherapy or other drug treatments and supervise the course of treatment, a radiation therapist who will use radiation to treat the cancer, and possibly a reconstructive surgeon. Along with this medical team, your health will be monitored by nurses, psychologist, nutritionist, social workers, depending on the needs of each case. if you have received a cancer diagnosis, it is good to get a second opinion before starting treatment.
Cervical cancer diagnosis
Generally, the diagnosis of cervical cancer is made after a Pap test has shown the presence of abnormal cells. This test can be followed by an endocervical biopsy that will determine the nature of the cells and where they are located (colposcopy and cervical biopsy), conization and other investigations that determine the degree of spread of the disease and its stage (tomography, MRI, ultrasound, etc.).
Cervical cancer treatment
Surgical removal of portions of tissue affected by cancer cells is one of the standard methods of treatment. This can be done by conization, removal of the uterus and cervix (total hysterectomy), sometimes even a portion of the vagina (radical hysterectomy), depending on the portions of tissue affected. External or internal radiation therapy (when a radioactive substance is placed in or near abnormal cells) and chemotherapy, sometimes immunotherapy, complement surgery.
Medical team for cervical cancer:
As with any cancer treatment, the patient will need a team of doctors to recommend it and monitor progress. This can be made up of a gynecologist, an oncologist specialized in the treatment of cancers of the reproductive system, a radiotherapist, an oncologist who prescribes the treatment scheme (chemotherapy), a surgeon, but also assistants, psychologist, nutritionist, social worker, depending on the needs.
Treatment decisions
A second doctor's opinion is essential when a person is diagnosed with cancer.
Also, given the systemic treatment (chemotherapy) and the specificity of surgery in cases of cervical cancer, the fertility of people undergoing this treatment may be affected.
Discuss with your doctor what options are available to you if you want children after treatment ends. The treatment can also affect your sex life – you should talk to your doctor about the solutions available for this.
Some patients may enter clinical trials, having access to new methods of treatment – these are not necessarily suitable for every patient's situation. ask your doctors if the hospital where you are being treated does such studies or if they recommend that you join such a study.
if you also want to have alternative treatments, ask your doctor about the effectiveness of the type of treatment you want or how it interacts with the treatment already recommended by the medical team.
The patient navigator
Because in many cases doctors are overwhelmed by the number of patients and cannot provide everyone with answers to all questions, these needs are covered by a person who acts as a patient navigator. It directs diagnosed people to analyses, investigations, the most appropriate team, fills in the lack of communication with doctors, explaining the diagnosis, treatment, changes and conditions that the patient can expect during treatment in a way that everyone can understand. The profession of navigator was included in the Romanian nomenclature in 2016.
Side effects of treatments
Cancer treatments have serious and varied side effects, depending on the type of substances used. In general, a patient can expect mood swings, dehydration, eating problems, fatigue, fever, hair loss, infections caused by lowered immunity, muscle cramps, nausea and vomiting, pain, skin irritations, stool changes, weakness, sweating, sleep problems. Patients do not respond to treatment in the same way, so not every patient will be affected by all of these changes. at the same time, other reactions are possible. Each of these changes can be managed with the help of your doctor.
Some substances given during chemotherapy can have long-term effects on some organs. ask the doctor about these effects – in general, the treating doctor will recommend that patients on chemotherapy constantly check the functioning of the heart with an echocardiogram and an electrocardiogram.
IV. The rights of patients
Screening and diagnosis:
Any person insured in the national health insurance system has the right to medical investigations to determine whether or not he is suffering from cancer. The family doctor (under contract with CNAS) is the one who makes referrals to paraclinical medical services that are settled by CNAS, within the monthly budget limit. in the case of cancer diagnosis, these can be laboratory tests, pathological anatomy, medical radiology-imaging investigations and nuclear medicine.
Treatment:
The national oncology program offers insured patients drug treatment (cytostatics, immunomodulators, hormones, growth factors, etc.), monitoring of the evolution of the disease, radiotherapy during day hospitalization, surgery and reconstruction.
Medical leave and allowance
The duration of granting leave and allowance for temporary incapacity for work is one year, with the right to extend up to one year and six months, by the social insurance expert doctor, within the last 2 years, for neoplasms. (cf. Emergency Ordinance no. 158/2005 on leave and social health insurance allowances).
The monthly gross amount of the allowance for temporary work incapacity caused by neoplasia is 100% of the established calculation base.
The attending physician is the one who prepares a report that will be sent to the medical expertise and work capacity recovery office. The attending physician in the specialized outpatient clinic or in the hospital extends the medical leave in successive stages of 30/31 days.
Patients' rights
"Patients have the right to the highest quality medical care available to society, in accordance with human, financial and material resources.", (Law no. 46/2003). Also, the patient has the right to be respected as a human person, without discrimination, to be informed about the available medical services and how to use them, to be informed about his state of health, the proposed interventions, the risks of each procedure, the alternatives to the proposed procedures.
The patient has the right, according to the law, to continuous medical care until his health condition improves or until he is cured.
The problems you may face
Given the limits of the budgets of the medical units and the congestion in the public health system, but also the urgency of the diagnosis, some patients may decide to carry out investigations in the private system, with their own funds. If this is unlikely, there are a number of organizations that can help financially or otherwise.
IV. Life after cancer:
Physical recovery
Because the treatment for the various types of cancer generally involves surgery, the end of the treatment also coincides with a recovery period. Often this means movement. In the case of breast cancer, because the lymph nodes in the armpit are also removed during the operation, but certain nerves are also sectioned, the movement in the respective hand can be affected, and the sensations are diverse. From tingling to a hollow feeling under the arm to difficulty raising the hand, the reactions are diverse, depending on the patient. Movement is essential for all these reactions. lymph node removal also comes with the risk of developing lymphedema (swelling of the limb, because the lymph no longer finds places to circulate through). In order for it to be prevented or kept under control, the exercises that a physiotherapist can prescribe, lymphatic drainage and the avoidance of repetitive activities (ironing clothes, washing windows) with the respective hand, any kind of injuries and the infections they can cause, and the avoidance of heavy lifting are essential. No more injections, no more blood draws, and no blood pressure taken from the affected hand. It is also important to wear a compression sleeve that facilitates lymph circulation.
Induced menopause
Chemotherapy and, in some cases, surgery for cervical cancer can also induce menopause. In the case of some breast cancers, menopause will be induced by medication. Such a menopause will generally have very obvious symptoms, from hot flashes to depressive states, insomnia, restlessness. This condition has several consequences – lack of sexual desire, decreased bone strength, vaginal dryness. For each of these problems there are solutions that you can discuss with your doctor or the gynecologist who supervises you.
Psychic recovery
Most patients who have gone through cancer treatment will benefit from the support of a psychologist, if they decide to turn to one. His help is indicated, especially because the experience I am going through is overwhelming. Each patient's reactions are different, but many will face fears, hopelessness, a sense of danger. Support from those around (children, family, friends) is very important, who should know very clearly what is happening to the person who has been diagnosed with cancer and is undergoing treatment. Also, to the extent possible, resuming some routines is also important - maintaining a healthy, but not tiring or stressful, level of activity. Walking, meditation or prayer can help, on a case-by-case basis. It is also very important to support the partner - in some countries, he can also go through psychological counseling, in order to be better prepared to face the transformations in the relationship.
Periodic analyzes and tests
As indicated by the doctor, the patient who has undergone cancer treatment will have to constantly monitor her health, in order to prevent a recurrence or to react in time if it occurs. It is your doctor who indicates the tests to be done and the periods in which they are carried out (in the first phase, at an interval of six months, then less often). In order for them to be done on time and without additional financial efforts, it is recommended to schedule them well in advance. otherwise, due to the limited amounts with which the insurance system operates, you will have to pay for these investigations.
Reconstruction and prostheses
The breast reconstruction subprogram after oncological conditions allows free breast reconstruction, if the therapeutic protocol does not establish that it is not indicated.
The doctor is the one who makes this recommendation - and a whole series of hospitals in Bucharest and in the country carry out the reconstruction. Also, patients who have suffered from breast cancer benefit from an external prosthesis and a bra, settled by the National Health Insurance Company. In order to benefit from them, patients must look for those providers who have a contract with CNAS, and have a medical recommendation, a copy of their identity document, employment certificate or pension slip, a standard application and a disability certificate (if applicable).
Note:
The present information comes from http://cnsmf.ro (National Center for Family Medicine Studies), http://screening. iarc.fr (International Agency for Research on Cancer), http://www.who.int (World Health Organization), https://www.cancer.org (American Cancer Society) and the Romanian legislation in the field of health.