Family physician Liva Maca and gynaecologist Karlina Elksne are talking with Skrinings.lv ambassador and obstetrics & gynaecology resident doctor Laura Luse.
Laura: Who is the first doctor a woman should turn to with breast related questions and complaints?
Liva: This is a debatable question. It depends on which doctor is currently the most available and who does the patient have a closer relationship with. In some of Latvia’s regions, for example, an obstetrics and gynaecology specialist is not always easily accessible, therefore turning to a family physician is the answer. I would recommend every woman to first reach out to a gynaecologist and then to a family physician, but if the current circumstances prohibit access to one or the other, consider an alternative. The topic of breast health and prophylaxis is collaborative in nature, requiring input from both women’s reproductive health specialists like us and, of course, the patient. Breast health is often referred to as quite an intimate subject, therefore I would like to emphasize that there is no place for shame in the process of reaching out to a family physician with questions about breast health. Even if the family physician might not feel completely competent in taking on the full responsibility, they will be able to forward you to the adequate specialist to conduct the necessary tests.
In short, regarding questions about breast health it is possible to consult both a family physician, a gynaecologist or a surgeon mammologist. At this point it is important to clarify that a mammologist is a medical doctor - surgeon that specialises in surgical interventions for oncological pathologies. A mammologist is usually not the first specialist to consult, as patients are only redirected to them if a breast cancer diagnosis has already been made or there are serious suspicions. All of the previously mentioned doctors, such as a family physician or a gynaecologist, are able to guide patients through the various diagnostic pathways prescribing the necessary examinations, including a breast ultrasound or an MRI.
Laura: Who should be the one to initiate the conversation about breast illness prevention? Should it be the doctor who begins by questioning about complaints or the last time a patient has had a screening? Or should the initiative rather stem from the patient?
Karlina: That definitely depends on the situation. If a woman comes in and says that she does not have any concerns and this is just a regular prophylactic check-up then the visit goes by much quicker and we have a lot of time to talk about additional preventative measures. I usually begin this conversation by asking a question about the family history, clarifying if anyone in the immediate family has had any breast illnesses. If breast-related pathologies run in the family, especially if a first-degree relative has had breast cancer, then I usually redirect them for an examination at the Institute of Hereditary Cancer. However, I have to acknowledge that usually women come in with complaints. Considering the limited time during a consultation it is rare that during these appointments we go in-depth into questions regarding all of the preventative breast health practices.
We certainly have to work harder towards prevention education so there are less incidences of disease, but unfortunately this is not always the reality. I would truly encourage all of the patients not to shy away from this conversation and be the ones to initiate it. I believe everyone has a responsibility for preserving and promoting their own health. As a society we no longer possess the passive Soviet time ideology, that sees the doctor equivalent to God carrying all of the responsibility. These days the responsibility for health lies in the hands of each individual. This is the modern approach. With this in mind I encourage everyone to read educational content, browse available resources online and of course it is worth mentioning the Latvian Centre for Disease Prevention and Control publications about breast health as an excellent source for deepening your knowledge. After this if any questions arise, you can and should bring them up to your doctor.
Laura: How often is it necessary to talk about breast illness prevention with your doctor?
Karlina: I would say once a year at your annual visit to the gynaecologist would be a fitting time to talk over preventive breast health practices with your doctor. I usually begin by asking a question of whether my patient regularly performs breast self-examinations. This question helps understand whether she knows how to correctly perform a self-examination, organically leading into other uncertainties relating to breast health and prophylaxis.
I would always suggest for a woman to “triple-check” when it comes to health and visit the specialist an extra time than regret not going at all. Even at times when the complaints seem insignificant it is better to remain certain, than wait for the development of serious “red flag” symptoms. This train of thought summarizes the importance and value of performing monthly breast self-examinations at home, because the purpose of prevention is not to suddenly find a large lump, but consistently track breast tissue changes at a particular day of the cycle in order to notice signs that were not present previously. Any sign that was not there just a month ago signals the need to book a visit to see a specialist and without causing any additional worry checking the meaning behind the change.
If a woman after the age of 40 comes in with complaints that I myself am not always able to detect, I directly forward her to receive a mammogram or an ultrasound. A mammogram or an ultrasound is a great tool that provides accurate results and confidence in diagnosing the signs that a gynaecologist is not fully capable of examining.
Laura: Here I would like to touch upon one of the main reasons why women do not attend mammogram screenings and that is the discomfort aspect experienced during the procedure. I would like to reassure people that they can approach the technical specialist performing the examination and talk through the steps of the process and adjust to the feelings of the patient to make the process a bit less worrisome.
Karlina: Quickly adding to this point I want to mention that currently there are new mammography machines with tomosynthesis that are a lot more gentle and sensitive, no longer applying significant pressure on the breast tissue. These machines are available across a variety of facilities, however currently these are limited to the Riga city region.
Laura: How would you evaluate the risk assessment test created by Skrinings.lv not only as a method of understanding the risks that women face in breast cancer development but as a tool that advocates for taking responsibility for your health and encourages people to begin a dialogue about prevention? Can a woman that has completed this risk assessment bring the results to her doctor?
Liva: Personally I believe the test that Skrinings.lv has created is a great starting point for a woman in her risk comprehension journey. Equally it serves as a good instrument for initiating a conversation about prophylaxis and health risk management. Regularly filling out the breast self-examination test offered by Skrinings.lv it is possible to follow along even the smallest changes which allows to detect and resolve suspicious symptoms early. A substantial part of the job of a physician is not only treating a disease but preventing it before its start. By educating people about particular risk factors we attempt to tackle the illness at its source. Therefore as a family physician the topic of breast cancer prevention is that much more important.
Laura: With our conversation coming to an end what would be your main pieces of advice, which you would like to pass on to the readers that sum up everything said about prevention, various breast health-related tests and self- examinations?
Liva: I would like to stress that it is better to visit the doctor an extra time rather than one time too little. Even if it is something small or a barely noticeable change, it is worth going to the doctor and making sure everything is under control rather than relying on personal assumptions and wishing for the best. In sum, fighting with an advanced illness is that much harder, therefore regularly going in for checkups and performing monthly self-examinations is critically important.
Karlina: I would like to pass on the message that breast cancer nowadays is not a lethal illness and is successfully treatable with the condition that it is detected at a relatively early stage. My main piece of advice is not to be afraid of doctor's visits and examinations because it continues to remain a significant barrier for women in performing preventive practices fuelled by fear and anxiety. I encourage every woman to be brave and take on the responsibility for her breast health, to proactively engage in preventive practices and to trust the doctor to discover illnesses early on. It is important not to shy away from this conversation, ask questions and address this problem head on, to have a fighting chance at solving it.
The full conversation is available to listen on the Skrinings.lv Facebook page. There you will find out more about genetic tests, breast examinations for women with breast implants and other detailed questions surrounding the topic of prevention.