The sentence that gives the title to this article was, in fact, the sentence that ended the interview that Dr. Emília Vieira gave to Maxima, in a mixture of warning and demystification of a problem that is still taboo. The cancer surgeon is a doctor at the Santa Maria Hospital in Lisbon, where she is also president of the Amigas do Peito Association, which provides various forms of help to women who suffer or have the disease. The book you just released – What do I do? I have breast cancer (Book Sphere) – it brings together a series of questions that the doctor has been confronted with by her patients for over 30 years working in this area. We talked about how more and more cases of the disease appear, but also about all the innovation that exists today; the importance of age and incidence in men; different ways in which women view disease, prevention and the importance of lifestyle.
What led you to write this book and release it now?
The fact that it is now is because October is a worldwide month dedicated to breast cancer. This book is the answer to many questions that have been asked of me during these years and I think that in our literary world linked to breast cancer, a practical, accessible, easy-to-understand guide that was not very technical and could, somehow enlighten the sick.
Are these questions asked by your patients?
Exactly. I have more than 30 years of practice and during these years we are asking the most frequently asked questions. I drew on these questions and organized them with some chronology before the disease.
For you, the theme of breast cancer is a daily affair. How can you balance the normality of the theme in your daily life with the personalized attention each patient needs?
This balance is achieved in more than one way. I often get sick when they have only one suspicion. Then, while I ask for the tests that will confirm the diagnosis, I will soon get to know the patient and understand how I can later give this diagnosis. Often the patient comes to us already with the diagnosis, either for a second opinion or to start treatment. And by then they have their "heads made" already, as some say the "death sentence." Then we have to demystify this idea. I often say that we have to thank each day for the place and time we were born and lived, which is a great innovation and research in terms of breast cancer. We have a longer life expectancy and a better hope of healing than we previously had. What I am trying to instill is that having a serious condition, such as breast cancer, is a treatable situation. It will be a tough situation for a few months or a year or two, but then it will stabilize. It is not a death sentence. I try to give them hope and say that I will accompany them through this difficult period. That helps them somehow, and the fact that I say and demonstrate that they can be watched later and that it will be a situation to monitor the quiet also.
In 30 years of experience do you notice much evolution in treatments? Do you confirm that it is one of the most evolving forms of cancer in treatment in recent years?
I confirm and there has been so much research because it is the most common cancer in women. There are new drugs, each time the surgery is less radical … In terms of mortality, since the 80s, has dropped by about 25%. That's what the statistics tell us. But it is also true that statistics predict that by 2050, probably one in three women will have breast cancer. This is the most common cancer, but it is not the one that kills the most, which remains the lung. We have a lot of innovation in terms of breast cancer and it is increasingly becoming a chronic disease. So we now have a new class, breast cancer survivors, women who are free of the disease, although they need closer surveillance.
Why is there an increasing incidence of this disease?
There is no answer. Of course today can be the lifestyle. When buying a chicken from the supermarket we don't know what growth factors led to it, and today lettuce grows in one week when it should grow in three weeks. I wonder why? Because there are so many elements that are stimulating carcinogenic factors, as well as pesticides, that somehow disturb the stability of our cells. (Cancer) increasingly appears, but not only breast, all kinds of cancers.
What scares people the most about the disease awareness process and treatments?
If people are very young, what frightens them most is that they may not raise their children. If you are older you are likely to suffer from the disease. The breast is an element of the woman that identifies her as such. Any amputation of this organ is somehow forever etched. I have women who even with breast reconstruction feel a little amputated in their feminism. It is an organ with a great symbolism for the woman.
How important are other people (family and friends) in the whole process.
I think it is fundamental.
How does a doctor recommend that people around you get involved in the process?
No doubt! Although not all women react the same way and there are many who try to let no one know. They even try to deny their own family what they have, sometimes because they don't want the family to be worried, sometimes because having cancer is still a stigma. But family support is very important in the stability of a patient who is going through a cancer process. Just like friends.
It is not as taboo a disease as it was a few years ago. Does the fact that well-known guys share their cases help?
It certainly helps, but I must say that while there are some public figures who share, many more do not share. There is still taboo and a certain stigma. In the last century we had tuberculosis, nor was it said to be tuberculosis. Right now is cancer, which in some situations is a stigma. Especially in people of working age, there is some ostracism in some types of jobs for some women. While there are patients' rights that imply the right to work improvement, we are increasingly dealing with younger women who have complicated situations in their workplaces. The (medical) leave may not exceed three years and the option is to continue working or change work. Although there is a growing awareness of this disease, there are still very uncomfortable situations.
Is there a before and after disease? That is, is it possible for a person to be as he was before his illness, or does the process undoubtedly change people?
I think that in the face of such a disease, women are left with other life concepts. Most women feel that the disease has matured them and they give more importance to the little things that are really important. Few women do not view the disease in this way and have a riot. There are women who never forgive their illness for life, but most even see it as a growth.
Do you think women are increasingly concerned about prevention, or only think about it when they have to deal with it?
There are still women who don't want to think about it. Anyway, I do a lot of health fairs and clinical screenings, talk to a lot of women, and there's no doubt that more and more younger women are becoming aware of prevention and interested in it. This is also why tumors are picked up earlier each time. We cannot prevent cancer, what we can do is find it early. At the health fairs I'm going to now, I also have men who want to talk to me and want to be watched. We must not forget that 1% of breast cancers affect men.
How does a man recognize a breast cancer case?
There is no prevention in the case of men. It is very simple for a man who does not have a mammary gland but has a small nipple to notice if there is any change from one (chest) to the other. Some men don't even know they can get breast cancer, others spend months watching, and when they go to the doctor it's a little bit advanced, so although the cancers that appear in men are the same as those in women – they're from same type and treat the same way – they usually come to us a little more advanced than in the case of women.
What are the essential steps that all women should take to prevent?
We have to have the healthiest life possible, because if we can't know when a cancer comes along, we need to be as high as possible with our immunity. We have to have a healthy, healthy life, not smoking, not drinking, exercising, avoiding foods we know are most susceptible to treatment before we eat them. But if you ask me how you can do this in the world we live in, I understand.
We also know that we can only prevent early detection and we detect it by mammography and ultrasound. And breast self-examination, which is about knowing our body. If one breast is different from another we have to go to the doctor and see what happens to her. The mammogram should be done annually or every two years and the radiologist checks for lesions that are not yet palpable and may already be suspected. As for the first mammogram, if a patient is asymptomatic and has no family history of breast cancer, she should have her first mammogram at age 40 …
. (tagsToTranslate) Health (t) Breast Cancer (t) Emília Vieira (t) Prevention (t) October