It’s true that 2020 is a year that most would like to forget… and it’s not even over yet. There’s been fires, floods, pandemics, and riots, and that’s just in Australia. Globally we are facing a health crisis like no other and as a race, we have been stretched beyond our limits.
However, in between this global and national upheaval and our personal experience of pandemic life, there is a growing health concern that medical professionals are trying to combat. Australians are putting their own health at risk by postponing screenings, ignoring potential symptoms, and not seeking out medical help because of pandemic restrictions. We spoke to Medical Oncologist Dr Nicholas Zdenkowski to find out more.
How has COVID and the global pandemic ultimately impacted your work?
"Well, I have seen fewer referrals come through because patients are not going to the doctor as often at the moment. They're not having breast screening as they were closed during the peak COVID period and so there were fewer women being diagnosed with breast cancer. The women I did see, and the occasional man tended to have a large tumor that they could feel and have symptoms from, which tends to mean that it's at a more advanced stage. This also results in more treatment and a worse prognosis. That's our goal around screening; we want to diagnose cancer very early on before it can be felt and before it has reached the point where it's a significant threat to life."
Now that restrictions are easing are you seeing any new movements?
“Yes, now that screening is open again, we're starting to see a few more of those screen-detected patients coming through, but I still think that there are people who are avoiding seeing their doctor and avoiding going to screenings because they just feel like they can safely put it off.”
What do you say to patients to reassure them that it’s safe to attend their screenings?
“That it's important to be diagnosed as early as possible and that they can now safely go out and see their doctor if they feel an abnormality, if they've got some symptoms or if they just need to have their routine screening. They shouldn’t leave it for too long because the longer you leave it, the greater the likelihood of needing more surgery or potentially chemotherapy and of having a poor prognosis, if a cancer is diagnosed.”
What do you feel are some of the most common misconceptions about breast health and how can we change our attitudes towards this?
“Look, there are a lot of misconceptions about breast cancer; one is that stress causes cancer, which it doesn't, and we don't have any evidence to show that stress causes cancer. Another big one is that women assume that, the genetic component of breast cancer is the main cause; that if they don't have any family history that they're not at risk of breast cancer, which is not the case. Only 10% of breast cancers are due to a genetic abnormality and in only half of those cases – so 5% – we know the actual gene that has caused it. The majority of cases are actually sporadic breast cancers.”
Are there any other lifestyle factors women should be aware of?
“What women often don't realise is how much alcohol intake contributes to breast cancer, but we know that alcohol is a risk factor for breast cancer. There are clear studies showing that alcohol intake is associated with an increased number of women being diagnosed with breast cancer, and there is no safe level of alcohol intake. However, I don't think that that's completely pragmatic. I'll say to my patients, look, there is no completely safe level of alcohol intake, but the increased risk with, say, one drink per day, a couple of times a week is not enormous. And they'll make their own decision, depending on their own views and risk aversion. However, the risk increases with increasing amounts of alcohol on any one occasion. The other misconception is that many women do not realise how important exercise is for breast cancer prevention. Women who regularly exercise are less likely to experience breast cancer in the future. And by regular exercise, the guidelines say 30 minutes per day, five days per week of moderate-intensity exercise. So, it's a reasonable level of intensity.
If more women focused on those healthy lifestyle factors, then we'd have fewer women with breast cancer in Australia and around the world. Ideally, we want to prevent breast cancer. We don't want it to occur in the first place. And we've got lots of treatments that have improved the cure rates, but if we didn't have to use those treatments at all because breast cancer didn't occur in the first place, then that would be a much better outcome.”
