Breathe
By Dr. Anel Arellano Tejeda
October was decreed by the World Health Organization (WHO) as Breast Cancer Awareness Month and in the spirit of using information as a weapon to empower women with knowledge about our bodies, our health and our happiness, I would like to share these lines with you.
There are dozens of taboos surrounding breast cancer, distorted realities due to statements poorly transmitted by word of mouth, lies that have been repeated so often that they are stored in the collective subconscious as harmful and dangerous absolute truths, irresponsible assertions of small-time informative programs and sadly, it hurts to say it as a doctor, butthere are also the irresponsible opinions of the same health personnel with archaic knowledge, who refuse to update their knowledge.
We drag the collateral damage of many centuries of ignorance of women's bodies, of the stigmas that surround our sexuality, of considering it a sin to touch us, to explore us, to know us and even to enjoy us, to be a woman is impudent, to be looked at by someone other than your husband is not for respectable ladies. On the other hand, there is also social inequality, that wall as tangible as it is unjust, built with endless columns of bricks of poverty, marginalization, discrimination and violence, where he who has can, andthe relationship between the satisfaction of needs is directly proportional to the economic resources you have. Let's add to this the fear of knowing (blessed ignorance that keeps us serene because not knowing allows us to continue with our normal life), as long as it is not absolutely evident that something is wrong, we prefer to be anesthetized in the reality that we want to fabricate, because when you really decide to know, you will probably not like what you are going to hear.
So all of this and whatever else that accumulates derives in the following 10 points, which are not the only ones, nor probably the most important, but to start getting into what we as women must know about our breasts, I think that for now they are more than enough. Well, may curiosity overwhelm you and may you decide to continue learning about this and all the topics that involve knowing about your body, from how to love it in an organic way, that is to say tangible, real, keep it healthy and safe, inside and out, but, above all, may sorority reach you so that every woman you have in your lives, you can pass on the information that, we do not know, probably will save her life.
The FIRST POINT touches on a painful truth, we must not forget it. The first cause of death of women in our country is breast cancer, it is the most frequent malignant tumor in Mexico and in the world, its increase is constant, a situation that besides alarming us, should put us in the context of informing and caring for ourselves. The incidence in our country is 39.5% and the mortality rate is 9.9 per 100,000 inhabitants, does that sound high? The problem is that we are 6 million 11 thousand 402 adult women most likely to suffer from it, nothing more and nothing less than 55% of the total population.
SECOND POINT. The mastography is the only imaging study that has been shown worldwide to reduce breast cancer mortality. For some patients painful, for all uncomfortable, it is a simple radiological study that consists in its most basic mode, 4 two-dimensional images, two of each breast and gives us a lot of information that before the sharp eyes of doctors specializing in breast imaging, can detect micro lesions that allow us to diagnose cancer in its earliest stages.
THIRD POINT. There is no doctor who knows everything and does everything, that only happens in TV series; with cancer we must speak from an interdisciplinary group of specialties that can diagnose it radiologically and histologically, provide clinical and surgical treatment to rehabilitate the body injured by a mastectomy and finally, in the ideal scenario, those who will reconstruct the neo-breast.
FOURTH POINT. As everything in this life, to be an expert in something, you have to study a lot and time also helps to generate experience, in many cases the costs do go hand in hand with quality and the medical field is no exception, we all have the freedom to take care of our health where our pocket allows it . Although the treatment of a cancer patient is fundamentally interdisciplinary, the only doctors empowered to evaluate and integrate a diagnosis with valuable imaging tools such as mastography and its variants, magnetic resonance imaging and breast ultrasound are Radiologists with high specialization in mammary gland and interventional procedures, who after 7 years of general medicine, 4 years of Diagnostic and Therapeutic Imaging, and 1 year of high specialty in Breast Radiology, devote much of the hours of his life to see radiological images, which trains and sharpens your eyesight to detect suspicious lesions. You have the right to demand that your study be evaluated and reported in a written report by a certified medical specialist and I strongly suggest that whoever performs your ultrasound also has this training.
FIFTH POINT. The mastography does not give cancer. I wanted to give another point to this unjustly hated character, the mastography study, although it uses ionizing radiation (X-rays) to be acquired the dose emanating from the equipment and absorbed by the mammary gland for the purpose of producing a digital image that will be transmitted to a screen for medical evaluation, is virtually harmless to her and the rest of the body (yes, including the thyroid). We receive more radiation on a summer afternoon where we decide to lie down for 3 hours in the sun hugging Acapulco or on a plane ride of more than 2 hours, than during the mastography, not to mention that in the ideal scenario it will only be performed once a year.
SIXTH POINT: Breast ultrasound does not replace mastography. And I know that with this statement a significant percentage of your breasts decide to take on a life of their own and hate me, but it is the reality. After the age of 40, mastography will be done annually, and many people eager for research have taken the trouble to study the diagnostic, therapeutic and economic benefits of performing this study at that time, after many international consensuses, and derived from the worrying statistics of incidence and mortality, this affirmation was reached. So the first step for all of us when we turn 40 is to undergo this annoying study, which lasts only a few minutes, but after a proper evaluation, it will give us at least a year of peace of mind. I insist, mastography is useful to diagnose certain things and if necessary we will use other tools such as ultrasound to finish characterizing others.
SEVENTH POINT. Breast cancer is not a pathology exclusive to women. Although it is true that the first and most determining risk factor for breast cancer is being a woman, men are not exempt from the possibility of presenting it, the incidence is low, only 1%, however, knowing that this possibility exists puts us on alert to identify that a symptom located in the mammary gland of a man (palpable mass, discharge from the nipple, skin changes) will imperatively require an imaging study to determine the picture of what is happening.
EIGHTH POINT. Not every palpable lump in your breasts is cancer, but if you wait just to touch, you will most likely get it. At this point I allude to the most famous campaign that invites women to self-explore, a subject on which I am more than in agreement, as long as we learn to do it. The high point is that they refer to it as an absolute assertion "touch yourself so that it does not touch you" and we do differ on this point.
We know that breast self-examination becomes more significant the more frequently a woman does it. It is recommended that it should always be done on the same day of the month, that is, 5 to 7 days after the last day of bleeding, so that the mammary gland is as little stimulated as possible by the hormonal cascade involved in the menstrual cycle. However, it is a two-edged sword, since it is difficult for patients to palpate lesions smaller than 3 centimeters, in the understanding that a palpable lesion may be malignant; if it reaches those dimensions, advanced cancer is already suggested. Therefore, I do not agree with the assertion of the campaign I quote.
The moral would be: "Join reinforcements" learn to palpate your breasts monthly, get used to go once a year with your gynecologist for a more advanced clinical examination and also perform routine studies annually that correspond to your age (for those under 40 years, breast ultrasound and for older, mastography) and that would be the perfect combo. However, this is not a recipe, each patient is different, above all, always the personalized opinion of your trusted doctor will give the most appropriate way for each woman.
NINTH POINT. A risk factor, by definition, is any trait, characteristic or exposure of an individual that increases his or her likelihood of suffering a disease or injury. Speaking of breast cancer some of the most significant risk factors for developing breast cancer are the following:
1.- Central obesity. High weight in postmenopausal patients generates a significant risk compared to thin patients.
2.- Height. Women over 175 cm have a 20% higher risk of breast cancer.
3.- High estrogen levels in the blood. This happens when we start menstruation very young and menopause comes late.
Dense breast. That is, white mass in the mastography, I do not omit to mention that cancer also looks white in the mastography, therefore, it is easily hidden before the expert eyes and even worse before the inexperienced ones.
Alcoholism. The risk increases when consumption is greater than 12 grams per day, and increases 10% for every 10 g/day, the risk increases even more if combined with the use of hormones.
6.- Family history of breast cancer. It especially jumps out at us when we remember cases of famous artists with direct genetic load through the BRCA 1 and BRCA 2 genes.
Do not forget that 80% of cancers are de novo, i.e., no family member has had cancer before. Which ones do you identify with?
TENTH POINT. The word prevention does not exist when we talk about breast cancer, we must begin to make it public knowledge that what we need to do in this country and around the world is, OPPORTUNATE DETECTION and this we will eventually achieve, demystifying the imaging studies endorsed by the FDA that help us to diagnose in earlier stages, revaluing the proper training of doctors who check and diagnose us, democratizing knowledge to women of all social strata, taking care of those who correspond to us in our environment always starting with ourselves and solidarity with social causes, the sea is vast because it does not belittle streams, there is no minor effort, everything adds up.
In the ISSSTE, my second home and beloved source of work, from the Medical Directorate where I currently live and which is headed by a great human being who decided from the genuine interest in the epidemiological problem we face and the moral dilemmas that support it, to give priority status to the Breast Cancer program, Dr. Ramiro Lopez Elizalde, who since the year 2022 has tirelessly supported the efforts of the team that allowed the purchase of diagnostic radiology tools with the latest technology throughout the country for the replacement of obsolete equipment. Ramiro López Elizalde, who since the year 2022 has tirelessly supported the efforts of the human team that allowed the purchase of radiodiagnostic tools with state-of-the-art technology throughout the country to replace obsolete equipment and equipment where it was not available, scoutings were carried out throughout the year so that such equipment would be placed in the ideal physical spaces, so that from January 2023 to date, 13 units have been adapted, installed and trained, placing 24 digital mastography equipment, 11 of them with stereotaxy and tomosynthesis, both modern diagnostic and interventional technologies. This is in addition to the 76 pre-existing functional units and the 15 in the current bidding process to be received in 2024, giving a total of 115 mastography units.
In a second scenario, we tried to have only one team of qualified personnel in these units, since different results cannot be obtained by performing the same processes, so that their unification at the national level will allow us to standardize the actions and make them reproducible, and from this measure the ideal operating team was broken down:
1.- Radiologists with high specialty in breast and interventional procedures, with the proper certifications by the Mexican board of radiology, which will undoubtedly boost the quality of diagnosis.
Radiological technicians, who have been progressively trained with courses in breast positioning. To date, 3 training courses of this type have been held, enabling the training of 34 colleagues throughout the country.
3.- Nurses, who play a role in accompanying the patients and whose participation is indispensable in the intervention procedures.
4.- Administrative personnel, for the management of appointment schedules that allow the maximum approach of the patient to the service, covering all the flanks of attention required by the patients.
With the addition of the equipment and the management of the positions of radiologists, the strategy started 6 years ago in the H.R Lic Adolfo Lopez Mateos Hospital was replicated, the Breast Cancer Detection and Diagnosis Centers, CDDCM, today there are 13, whose original and final purpose is to be the catalyzing enzyme that accelerates the process of care for patients with breast pathology, allowing them to be performed in a single place:
1. Screening and diagnostic mastographies
2. Complementary and Diagnostic Breast Ultrasounds
3. Ultrasound-guided biopsy and stereotaxy procedures
4. Revaluations of external studies performed by unqualified personnel.
This organization improved the effectiveness of the processes and above all has made patient care more accessible, allowing CDDCM medical centers to reduce diagnosis times from the national average of 60 days to a record time of 1 to 7 days from the time of the mastography to the performance of the biopsy.
The challenges identified now are to reduce the reading times of suspicious tissue samples, for this has been requested to the centers with higher productivity to strengthen pathology services, also the breast cancer program of the Medical Directorate of the ISSSTE, is working in parallel in the HISTOPATHOLOGICAL DIAGNOSIS CENTER OF CANCER OF WOMEN (CEDHCAM), which will be in Mexico City and will be equipped to process and read histological samples, until the immunohistochemistry of those that are positive is completed. This center is scheduled to open in the coming months and the biopsy units will be able to send their samples, so that the estimated reading times, which now total up to 35 days, will be reduced to a maximum of 12.
In this way, we will be able to guarantee OPPORTUNATE DETECTION in less time than the national average of any institution, committing ourselves to ensure that the next steps are directed to guarantee the entry to OPPORTUNE TREATMENT of the patients and, together with all the processes, the obtaining of national statistics, with which real measures of epidemiological impact on our target population can be generated, supported by scientific publications of the institute.
The achievements belong to all of us and the soul of the project is our patients.
*DRA. ANEL ARELLANO TEJEDA
Medical Surgeon by BENEMÉRITA UNIVERSIDAD AUTÓNOMA DE PUEBLA
Medical Specialist in Diagnostic and Therapeutic Imaging by UNIVERSIDAD NACIONAL AUTÓNOMA DE MÉXICO
Medical Radiologist with High Specialty in Radiology of the Mammary Gland and interventional procedures by UNIVERSIDAD NACIONAL AUTÓNOMA DE MÉXICO.
Accredited by the Mexican Council of Radiology and Imaging, CMRI.
Radiologist attached to the Radiology Department of H.RLic. Adolfo López Mateos H.RLic. 2017-2022
Adjunct Professor, Breast Gland Radiology and Interventional Procedures course from 2017-2023.
Professor of Imaging, School of Medicine, UNAM.
Head of the First Breast Cancer Detection and Diagnosis Center of the ISSSTE from 2017-2022.
Current National Head of the Department of Breast Cancer and Priority Program for Timely Detection in the Medical Directorate of ISSSTE.
The opinions expressed are the responsibility of the authors and are absolutely independent of the position and editorial line of the company. Opinion 51.
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