Breast cancer is a malignant tumor that develops in the breast as a result of genetic changes in some set of breast cells, which begin to divide uncontrollably. Abnormal growth of breast cells occurs in both the breast duct and the mammary cells. This is the type of cancer that affects women the world over, with 1.38 million new cases and 458,000 deaths per year, according to the World Health Organization. The ratio in men and women is 1: 100 - that is, for every 100 women with breast cancer, a man will have the disease. In Brazil, the Ministry of Health estimates 52,680 new cases in a year, with an estimated risk of 52 cases per 100,000 women. According to data from the Brazilian Society of Mastology, about one in 12 women will have a breast tumor until they are 90 years old. According to INCA, it represents, in 2016, 28.1% of all women's cancers.
Types
There are several types and subtypes of breast cancer. In general, the diagnosis takes into account some criteria: whether or not the tumor is invasive, its type histological type, immunohistochemical evaluation and its stage (extension):
Invasive or non-invasive tumor
Noninvasive breast cancer, also called in situ cancer, is one that is contained somewhere in the breast without spreading to other organs - the lining of the tumor does not break, and cancer cells are concentrated within that nodule. The invasive type happens when this membrane ruptures and cancer cells invade other parts of the body. All in situ cancer has the potential to become an invader.
Immunohistochemical evaluation
Also called IQH, the immunohistochemical evaluation for breast cancer assesses whether that tumor has so-called hormone receptors. Approximately 65 to 70% of breast cancers have these receptors, which are a kind of anchorage for a particular hormone. There are three types of hormone receptors: estrogen, progesterone, and HER-2. These receptors cause the particular hormone to be attracted to the tumor, binding to the receptor and causing that malignant cell to divide, aggravating the disease.
Progesterone and estrogen are hormones that normally circulate in our body, which can bind to the hormone receptors of breast cancer, when available. HER-2 (acronym for human epidermal growth factor receptor 2) is a gene that can be found in all cells of the human body, which helps the cell in the processes of cell division. The HER-2 gene causes the cell to produce a protein called HER-2 protein, which sits on the surface of cells. From time to time, the HER-2 protein sends signals to the cell nucleus, warning that the time has come for cell division. In the breast, each cell has two copies of the HER-2 gene, which contribute to the normal functioning of these cells. However, in some patients the appearance of a large number of HER-2 genes occurs within the cells of the breast. With the increase in the number of HER-2 genes in the nucleus, the number of HER-2 receptors on the cell surface will also be increased.
Histological type of breast cancer
The histological type is like the name and surname of the cancer. Histological types are divided into several subtypes, according to factors such as the presence or absence of hormone receptors and tumor extension. The most basic types of breast cancer are:
Carcinoma ductus in situ: is the most common type of non-invasive breast cancer. It affects the ducts of the breast, which are the channels that conduct milk. It does not invade other tissues or spread through the bloodstream, the lining of the tumor does not rupture, and cancer cells are concentrated within that lump but may be multifocal, meaning there may be multiple outbreaks of this neoplasm in the same breast. It is characterized by the presence of one or more hormone receptors on the surface of the cells. All breast cancer in situ has the potential to become an invader.
Invasive ductal carcinoma: it also affects the ducts of the breast, and is characterized by a tumor that can invade surrounding tissues. Invasive ductal cancer accounts for 65-85% of invasive breast cancers. This carcinoma can grow locally or spread to other organs through veins and lymphatic vessels. It is characterized by the presence of one or more hormone receptors on the surface of the cells.
Lobular carcinoma in situ: it originates in the cells of the mammary lobes and does not have the capacity of invasion of adjacent tissues. It is often multifocal. Lobular carcinoma in situ accounts for 2 to 6% of cases of breast cancer.
Invasive Lobular Carcinoma: It is also born of the mammary lobes and is the second most common type. Invasive lobular carcinoma can invade other tissues and grow locally or spread. It usually has estrogen and progesterone receptors on the surface of the cells, but rarely the HER-2 protein. It is more likely to affect both breasts.
Inflammatory carcinoma: rarely presents hormonal receptors, and may be called triple negative. It is the most aggressive form of breast cancer - and also the rarest. Inflammatory carcinoma presents as an inflammation in the breast and often has a large extent. It also starts in the glands that produce milk. The chances of it spreading to other parts of the body and producing metastases are great.
Paget's disease is a type of breast cancer that affects the areola or nipples, which can affect both at the same time. It accounts for 0.5 to 4.3% of all cases of breast carcinoma, being carried a rarer form. It is characterized by changes in the skin of the nipple, such as crusts and inflammation - however, it can also be asymptomatic. There are two theories to explain the origin of Paget's disease of the breast: tumor cells can grow in the mammary ducts and progress toward the epidermis of the nipple, or the tumor cells develop already in the terminal portion of the ducts at the junction with the epidermis .
Staging breast cancer
Breast cancer is divided into four stages or stages, depending on the extent of the disease, ranging from 0 to 4:
Stage 0: Cancer cells are still contained in the ducts, so the problem is almost always curable
Stage 1: Tumor less than 2 cm, without involvement of the axilla lymphatic glands
Stage 3: nodule more than 5 cm that can reach neighboring structures, such as muscle and skin, as well as lymph glands. But there is still no indication that cancer has spread through the body
Stage 4: Tumors of any size with metastases and, generally, there is involvement of the lymph glands. In Brazil about 60 to 70% of cases are diagnosed in stage 3 or 4.
Risk factors
The main risk factors for breast cancer are:
Family history
The criteria for identifying the genetic risk for the disease are:
Two or more first-degree relatives with breast cancer
A first degree relative and two or more second or third degree relatives with the disease
Two first-degree relatives with this type of cancer, one of whom had the disease before 45 years
A first-degree relative with bilateral breast cancer
A first-degree relative with the disease and one or more relatives with ovarian cancer
A second or third degree relative with breast cancer and two or more with ovarian cancer
Three or more second or third degree relatives with the disease
And two second or third degree relatives with breast cancer and one or more with ovarian cancer.
Breastfeeding decreases risk of breast cancer
Age
Women between the ages of 40 and 69 are the main victims. This is because exposure to the hormone estrogen is at its peak with the advent of that age. From the age of 50, particularly, the risks enter an upward curve.
Early menstruation
The relationship with menstruation lies in the fact that it is at the beginning of this period that the woman's body starts to produce larger amounts of the hormone estrogen. This hormone in altered amounts facilitates the disordered proliferation of mammary cells, resulting in a tumor. The more intense and long-lasting the hormone action in breast cells, the greater the likelihood of a tumor. If the first menstrual period occurs around the age of 9 or 10, it is because the ovaries have intensified production of the hormone early, and so the body will be exposed to estrogen for longer in the course of life.
Late menopause
The logic in this case is the same as in the case above - while menstruation does not cease, the ovaries continue to produce estrogen, leaving the mammary glands more exposed to disordered cell growth.
Hormone replacement
Many women seek hormone replacement to lessen the symptoms of menopause. But this replacement - especially of steroids, like estrogen and progesterone - may increase the odds. At menopause, the tissues are even more sensitive to the action of estrogen, since the levels of this hormone are low due to the absence of its production by the ovary. As an alternative to hormone replacement, it is indicated the practice of physical exercises and a balanced diet.
High cholesterol
Cholesterol is the fat that serves as raw material for the manufacture of estrogen. That way, women who high cholesterol levels tend to produce this hormone in greater quantity, increasing the risk of breast cancer.
Obesity
Being overweight is a risk factor for breast cancer especially after menopause. This is because from that age the fatty tissue starts to act as a new hormone factory. Under the action of enzymes, the fat stored in the breasts, for example, is converted into estrogen. The alert is more serious for those with a body mass index (BMI) of 30 or above. A reduction of only 5% in weight would already halve the risk of developing some of the major types of the disease. The findings are from researchers at the Fred Hutchinson Prevention Center (USA), based on the assessment of data from 439 overweight women between 50 and 75 years of age.
Learn more: Regular mammography reduces risk of breast cancer
Absence of pregnancy
Women who have never had children are more likely due to lack of breastfeeding. When the woman breastfeeds, it stimulates the mammary glands and decreases the amount of hormones, such as estrogen, in your bloodstream.
Risk injuries
Having already presented some type of breast alteration not related to breast cancer can also increase the chances of the onset of tumors. Thus, small cysts or calcifications found in the breast, although benign, should be followed closely.
Anterior breast tumor
Patients who have had breast cancer are more likely to have another tumor - in this case it is called a relapsed cancer or a recurrence.
Symptoms
Symptoms of Breast Cancer
The symptoms of breast cancer vary depending on the size and stage of the tumor. Most tumors of the breast, when initial, have no symptoms.
If the tumor is already visible by the touch of the finger, it is a sign that it has about 1 cm³ - which is already a very large lesion. It is therefore important to take preventive exams (such as mammography) at the appropriate age before the onset of this and any other symptom of breast cancer.
See the other possible signs of breast cancer:
Redness in the skin, swelling or
Changes in the shape of the nipples and breasts, especially recent changes, is possible until one breast is different from the other
Nodules in the armpit
Dark discharge coming out of the nipple
Wrinkled skin, like an orange peel
In advanced stages, the breast can open a wound.
Diagnostic and Exams
Diagnosis of Breast Cancer
In addition to mammography, MRI, ultrasound, and other imaging tests that can be done to identify a suspected breast cancer change, a biopsy of the tissue collected from the breast is necessary. In this biopsy material, the medical team identifies whether the cells are tumorous or not. If the diagnosis is made, doctors will study the hormone receptors to see if that tumor expresses any or not, besides its histological classification. Treatment will be determined by the presence or absence of these receptors in the malignant cell as well as the prognosis of the patient.
At the medical appointment
Arriving at the office with suspected mammography for breast cancer, the doctor will ask about your family history of the disease, age, date of onset of menstruation, if you are already in menopause and other issues related to risk factors. Then he will do the mammogram and biopsy to find the diagnosis.
Learn more: Mammography detects breast cancer
If you have already received the diagnosis, it is important to take all your doubts to the doctor and not let anything escape. Here are some tips to get the most out of your query:
If you do not understand the doctor, ask him to repeat it in simpler terms or by drawing
Take a notebook for the consultation and write down the most important points and to take notes
If you would like more information about your case, ask your doctor to list books, websites, or articles
Prefer to take a companion to help in the assimilation of new information.
Here's a list of important questions to ask at the consultation:
Where is the disease at this time and what is its extent?
Is my cancer hormone receptor positive or negative?
Is my cancer HER-2 positive or negative?
What are the treatment options and how do they work?
What are the most common and least common side effects of treatment?
How will this treatment benefit me?
Can I avoid the discomforts of treatment? As?
What is the expected duration of treatment?
Will I need to see a doctor and have tests done during the treatment? What exams will be needed?
Will I need to be hospitalized?
Do I need to follow a specific diet?
Can I do breast reconstruction? How will my mom stay?
Can I have lymphedema? What are the odds?
Will my cancer return? What are the odds?
Who should I call if I have questions or problems regarding treatment?
When you finish, what are the next steps?
Do I have other concomitant illnesses that affect my ability to tolerate treatments?
Are there any special recommendations for this moment?
Treatment and Care
Breast Cancer Treatment
There are several treatments for breast cancer, which can be combined or not. All cancer should be removed with surgery, which can remove part of the breast or all of it - however, in some cases it may be that the surgery is combined with other treatments.
What will determine the choice of treatment is the presence or absence of hormone receptors, the staging of the tumor, whether the diagnosis is already metastasized or not.
Another determining factor for the treatment is the patient and what their state of health and time of life. Treating the picture in a healthy, 45-year-old woman is completely different from taking treatment in an 80-year-old woman and related diseases - even though the type and extent of cancer are exactly the same. In this case, the impact of treatments and whether they will interfere with the patient's quality of life should be taken into account. The treatments are divided between local therapy and systemic therapy:
Local Breast Cancer Therapy
Locally treated breast cancer will undergo partial or complete surgery followed by radiation therapy:
Surgery: it is the oldest treatment modality. When the tumor is at an early stage, withdrawal is easier and with less breast compromise
Radiation therapy: therapy that uses ionizing radiation at the site of the tumor. It is widely used for tumors that have not yet spread and not metastases, for which it is not necessary to remove a large part of the breast. Radiation therapy can also be used in cases where breast cancer can not be completely removed with surgery, or when you want to decrease the risk of the tumor growing again. It lasts approximately one month.
Systemic therapy of breast cancer
The systemic treatment is made with a set that medicines that will be infused orally or directly into the bloodstream. In both cases, the treatment is not done locally - that is, the drug will circulate throughout the body, including where the tumor is. There are three types of systemic therapy:
Chemotherapy: treatment that uses oral or intravenous medications, with the aim of destroying, controlling or inhibiting the growth of diseased cells. Chemo can be done before or after surgery, and the treatment period varies according to the breast cancer and the patient
Hormone therapy: aims to prevent the action of hormones that cause cancer cells to grow. Hormone therapy, therefore, can only be used in patients who have at least one hormone receptor in their tumor. This therapy is usually done orally, and the drugs act by blocking or suppressing the effects of the hormone on the affected organ
Immunotherapy: Also known as anti-HER-2 therapy, this modality consists of drugs that block specific targets of certain proteins or mechanism of cell division present only in tumor cells or preferentially present in tumor cells. These are medicines usually given orally. When the tumor expresses the HER-2 protein in large amounts, for example, drugs are used that will specifically destroy those cells. There are other cellular proteins or processes that can accentuate the tumor and intensify its growth, and the targeted therapy drugs will act at these specific points.
If the tumor has a large extent, the doctor may recommend a systemic therapy initially to reduce the size of the breast cancer and thus perform partial surgery. If the cancer has metastases, systemic therapy is also indicated, since the drugs act in the whole body, finding foci of the tumor and eliminating. Treatment choice has to take into account disease curability and tolerance to treatment toxicity (some women may not be exposed to very severe treatments over a long period). Patients who have metastasized should undergo some systemic treatment for the rest of their lives, in addition to clinical follow-up.
Possible Complications
Among the complications is the relapse, which is the return of a tumor already treated. Breast cancer recurrence occurs within the first two to three years after tumor removal, so close follow-up is required at this time, with regular mammograms at six-month intervals or yearly more clinical analysis of the patient. The tumor can also invade other tissues and spread through the blood or lymphatic circulation, reaching other organs such as liver and bones - causing the so-called metastases. If the cancer is metastatic, the treatment should be systemic and also accompanied individually.
In addition, there are side effects of therapies. After surgery, it is necessary to follow up with a doctor and a physiotherapist to avoid breaking points and tissue necrosis - it is also important to maintain the hygiene of the place to avoid infections. Surgery also involves modification and can cause a number of psychological changes in the patient, in addition to the physical ones.
Hormone therapy may worsen menopausal symptoms, favor osteoporosis, increase the risk of thrombosis and clots in the legs - however, these side effects are rare and patients generally have a high tolerance for treatment.
During chemotherapy the woman can suffer oral infections, hair loss, diarrhea, nausea and low temporary immunity. Some chemotherapies can also affect cardiovascular health - so it is important to follow up with a cardiologist. The reproductive system can also be affected, so if you are of reproductive age and you want to have children, discuss with your doctor and partner the possibility of freezing eggs. Hair loss is the most common effect of chemotherapy and is not controllable - this is because the treatment will kill everything that is growing. That way, in addition to hair loss, you may notice the weaker nails as well.
Anti-HER-2 therapy has fewer side effects, but may induce a toxicity in the heart - so much care should be taken with the cardiologist if you choose this treatment. Monoclonal antibodies, binding to and specifically destroying cancer cells, are generally less toxic than conventional chemotherapies. Even so, it can generate effects like shortness of breath, heat sensation, drop in blood pressure and flushing. Immediately notify the team that is attending to the signs of these symptoms. These effects usually decrease in later administrations. Radiation therapy can cause tiredness and light skin burns that return to normal with the end of therapy.
Living together (prognosis)
Expectations
The greatest chance of cure is through early diagnosis. A tumor diagnosed at stage 0 or 1 has a 90% chance of cure. Stage 3 or 4 breast cancer has a 30-40% chance of total cure. But this is no reason to give up or feel that your case has no cure - with proper treatment and willpower, the whole obstacle is pierced. Even cancers in more advanced stages can respond well to the treatment and can be operated and removed completely. That's why it's important to talk to your doctor and always look for new ways to deal with the disease.
Living together / Prognosis
The prognosis of breast cancer depends on all characteristics of the tumor and patient, as well as the availability of appropriate drugs. In Brazil, HER2 therapy for metastatic disease, for example, is not yet available. In addition, 40% of women with cancer in general who need radiotherapy do not receive treatment because they do not have enough equipment in the country to meet the demand. This type of complication can worsen the prognosis of a patient, who is dependent on a waiting line or needs to enroll in international programs. There are mathematical models that help estimate the risk of relapse over the next ten years - but their results are not 100% correct or perfect. There are more modern methods that evaluate the patient's tumor in their genetic makeup individually. Based on the assessment of the patient's tumor genes an individualized prognosis and the benefit that any treatment will bring to the cure of breast cancer is made. However, these tests are more sophisticated and do not need to be sent out of the country for evaluation.
The treatment also involves a series of care and practices to minimize the effects of therapies:
How to minimize the adverse effects of chemotherapy?
Nausea and vomiting: Eat easily digested foods and talk to your oncologist about the need for antiemetics.
Plan feeding: Some people feel good eating before chemotherapy and others do not - in this case, the habit varies according to the need of the patient with breast cancer. However, you should always wait at least one hour after the session to consume any food or drink.
Eat Slowly: consume small meals five or six times a day instead of three large meals, avoiding ingesting fluids while you eat. This prevents nausea and vomiting.
Choose fresh foods and avoid consuming them too hot.
Avoid strong foods and beverages such as coffee, fish, onions and garlic. They also favor vomiting.
Care during radiation therapy
The radiotherapist and the nursing team should advise her on the specific care that should be taken during radiotherapy treatment. Such care varies greatly depending on the region being irradiated.
Skin: Wash the radiated skin with mild soap and warm water. Try not to scratch or rub the area.
Ointment: apply ointments or creams on the skin with medical approval.
Prefer comfortable and loose clothing and if possible cover the radiated area with light clothing.
More than living, the patient can live well, taking care of herself with care and attention. To help patients in this challenge, the multidisciplinary approach to breast cancer, with the support of dentists, nutritionists, physiotherapists, nurses, psychologists, physical trainers, etc., is increasingly common.
Physiotherapy for breast cancer
It promotes the functional independence of the patient, allowing her to perform the activities she wishes alone and without inconveniences. It provides pain relief and reduces the need for analgesics. Usually the treatment is indicated after the surgery.
Nutrition
Nutritional monitoring helps prevent weight loss and malnutrition during treatment. In addition, it helps the breast cancer patient to follow the correct dietary restrictions to avoid possible side effects of the treatment.
Physical exercises and breast cancer
Not important activity - what matters is practicing. Physical activity helps to "send" fatigue though, increases energy, disposition and self-esteem, and provides social interaction.
After surgery: Talk to your doctor about returning to physical activity. This varies according to the expected recovery time for each procedure and patient state.
Some patients may experience decreased immunity during treatment, which can lead to opportunistic infections. Therefore, swimming activities are not recommended - contact with pool water may favor infections.
If the idea is to attend a gym, opt for the activity supervised by a physical education professional. Report your case so that it indicates the most appropriate exercise series.
Sexuality and sensuality
During breast cancer treatment, several situations such as decreased libido, hormonal changes and emotional nuisances can directly influence your sexual behavior. It is important that you understand that these disorders are caused by the physical situations you are experiencing and do not have to see what you are in essence. Try to rescue in that period the sensuality that is in you - but everything in its time.
Talk to your partner: Talk about decreasing libido so that the person does not feel rejected and confused with their possible sexual disinterest. Open communication can help you find creative ways to awaken your libido.
Talk to your oncologist: Your doctor may prescribe medications to combat the side effects of treatment, which leads to sexual disinterest.
Talk to a psychologist: The professional can help by identifying and addressing the emotional obstacles that contribute to sexual disinterest.
Caring for self-esteem
Hair loss and mastectomy are the most likely to affect the patient's self-esteem. Try not to surrender to those feelings and look for ways out of those nuisances that are small close to your quality of life and the struggle you are fighting. You can save the natural wigs to apply on a ponytail when hair regrows, or buy wigs and wear colored scarves, reflecting your personality. Look for other activities that make you feel good, like courses in an area you are interested in. Anything goes to regain self-confidence or else not let it go.
Managing feelings
Breast cancer can generate a lot of feelings, various ups and downs. This is all normal - the human being is full of emotions and illness can maximize this aspect. Understand that some days will be better than others, but do not let the more be installed. The important thing is that you do not despair in the midst of the feelings you experience. If you notice any sign of depression, such as deep sadness, lack of sleep and appetite, insecurity and dismay, talk to your oncologist about it. He may recommend a visit to the psychologist.
Impact of breast cancer in my life
Home: If you still do not share the tasks with your partner and children, this is the time to determine new roles. During treatment you may feel unwell, and all the support is important in that regard.
Work: If you feel willing and willing to work, go ahead - this will help maintain social conviviality and tie commitments to life that are not related to the tumor. However, at times you may feel weak and you may choose to leave work.
Financial life: your budget may be shaken in case you need to stop working, plus treatment expenses. Know that you can apply for sickness assistance and do not be ashamed if you need to ask for help from a close relative or friend. Review spending during this time is also essential.
Talking with Your Children
The best person to tell is you. Speak as fast as you can so as not to create an omission. Also, avoid omitting the word cancer or treating breast cancer as a taboo. This will only create fear around the disease
You do not need to tell details of the disease, but be prepared for questioning.
Explain the side effects of the treatment disease, which is normal for you to become more sad at some times, which is normal hair loss and other effects. This will avoid shocks.
Your children may exhibit behavioral and behavioral changes at school. It is important that the educator knows how to deal with this and is free to comment with you if something different happens.
If you feel the need, get support from a family psychologist.
Talking with your husband or partner
Your mate is the person who, like your children, will be closest to you right now. Talk frankly about the demands that will arise and ask for help in coping with the disease.
Breast Reconstruction
It can be performed in almost all patients, but there is difficulty in accessing SUS patients mainly due to economic factors. For those who do not have access, it is recommended the use of external prosthesis in order to balance some of the weight on the spine and mainly for aesthetic relief and greater freedom for the patient's clothing.
Prevention
Prevention
The prevention of breast cancer can be divided into primary and secondary: the first involves the adoption of healthy habits, and the second concerns the conduct of screening tests in order to make the diagnosis early:
Exercises
A study published in the Journal of the National Cancer Institute pointed out that adolescents practicing intense physical exercises decrease the chances of suffering from breast cancer in the adult stage by up to 23%. In this analysis, the practice of physical activity should begin around age 12 and last for at least ten years for protection against disease to be noticed. The exercises are able to reduce the levels of estrogen, hormone-related cancer risk. Exercise also decreases stress and helps weight control, which also influences the development of the tumor. It is important in cancer prevention and relapse prevention.
Breast-feeding
Women who breastfeed for at least six months are 5 percent less likely to develop the disease. When the woman breastfeeds, it stimulates the mammary glands and decreases the amount of hormones, such as estrogen, in your bloodstream.
Balanced diet
Maintaining a proper diet helps in controlling weight, preventing chronic diseases, and improves health as a whole. In addition, a healthy body works best by preventing the onset of tumors. Women who consume vegetables are often up to 45 percent less likely to develop breast cancer, according to a study by Boston University. Foods like broccoli, mustard, kale and green vegetables are rich in glucosinolates, which are amino acids with an important role in prevention and treatment.
Stress
Women who live a very hectic and stressful routine have almost double the chances of developing breast cancer when related to other risk factors. Breathing, meditation and relaxation techniques, practiced in Tai Chi and yoga, help control stress and anxiety.
Alcohol
Consuming only 14 grams of alcohol per day can increase the chances of breast cancer by 30%. The mechanism of action by which alcohol consumption increases this risk remains unknown, but we know that it influences the signaling pathways of estrogen.
Weight control
By achieving menopause, overweight or obese women are at greater risk of developing the tumor. What's more, excess weight still increases the chances of cancer being more aggressive.
Do the mammogram
Most women should start mammograms every year after age 50, but for those who have a family history of breast cancer, the examination should begin 10 before the earliest case in the family. So if a close relative has had this type of cancer at 40, you need to start having mammograms every year from the age of 30. Getting mammograms annually at a suitable age can reduce death from breast cancer by as much as 30 percent, according to a study in the journal Radiology.
Breast cancer: mammography is an examination indicated for the detection of malignant nodules
More on Breast Cancer
Your rights
Professional rehabilitation: The Social Security service aims to readapt or re-educate the professional to return to work, with the supply of materials necessary for rehabilitation (such as fees for professional services and transportation and food aid). All Social Security policyholders are entitled to rehabilitation.
Sickness benefit: you will be entitled to the monthly benefit provided you stay for more than 15 days with incapacity for work certified by Social Security medical expertise and have contributed to the INSS for at least 12 months (although there are exceptions). Go personally or through a prosecutor to a Social Security agency, fill out the application, submit the required documentation and schedule the examination. The sickness benefit will no longer be paid when you recover your ability to work, or if the right reverts to disability retirement.
Disability Retirement: You will be entitled to the benefit if you are insured from Social Security and the expert finds that you are permanently disabled for work. As a rule, you must have contributed to the INSS for at least 12 months to obtain the benefit. Go personally or by proxy to a Social Security agency, fill out the application, submit the required documentation, and schedule the expertise. You can still apply for sickness insurance online, on the Social Security website or by the toll-free number 135.
Income tax exemption: You are entitled to exemption from income tax on amounts received as a pension, pension or retirement benefit, including supplements received from private entities and alimony, even if the illness was acquired after the granting of the retirement, pension or retirement. Look for the body responsible for the payment of retirement, pension or retirement and request the exemption from income tax that affects those income.
IPTU: There is no national legislation that guarantees the exemption of IPTU for people with certain pathologies, such as breast cancer, but since it is a municipal tax, some cities already guarantee exemption. Find out in the Finance Department of your municipality.
Breast reconstruction surgery: You have the right to perform repair surgery free of charge, both by the SUS and by the health plan. If you are being treated at the SUS, you must schedule your surgery on-site and, if you are not, go to a Basic Health Unit and request your referral to a specialized unit for breast reconstruction. For the Health Plan, consult an accredited surgeon.
Sharing experience
Loneliness can be a feeling that plagues the patient with breast cancer. But remember that you are not alone. Ask for help, share your experience, look for centers and places that do group therapy. Disseminate your knowledge and your fight against breast cancer and help break the stigma surrounding the disease. Encourage women to do the mammogram, talk to their friends and colleagues about the importance of the exam. Relate your experience to patient support entities or create a blog to share your questions with readers.
Common questions
What percentage of breast cancers occur because of the genetic mutation?
The general population has about 10 to 12% risk of developing the disease. According to the Brazilian Society of Mastology, the presence of the mutation among cases of breast cancer is around 5 to 10%, with 5% of all breast cancers being of women with the BRCA mutation. Therefore, the safest way to treat and prevent is to visit your mastologist, when indicated, and follow their guidelines.
Can a person who has a proven risk for breast cancer do a preventive mastectomy?
A woman at high risk may choose preventive mastectomy. Mammary preventive mastectomy consists of the removal of the internal breast region - that is, the mammary gland together with the mammary ducts - which are the places where a tumor can occur. With the removal of the inside of the breast, the risks of cancer reduce by up to 90%. The chances of cancer still exist because 10% of the breast tissue is preserved to nourish the skin, halo and nipple. In surgery, both breasts will be removed, hence the name of double preventive mastectomy.
There are also treatments that use so-called anti-hormones or hormone modulators, which inhibit the production of estrogen and prevent the breast cells from multiplying. This treatment, however, is only recommended for hormonal breast cancers - that is, what happens or can happen as a result of hormonal changes - not being indicated for people who have genetic risk, for example.
For patients at genetic risk, an alternative is to double the attention and follow-up of the breasts, starting for screening exams such as breast ultrasound and mammograms at shorter intervals every six months, for example, depending on what your consider it safer. The objective in this case is to identify the cancer at a very early stage and to start the appropriate treatment from this diagnosis.
