Perhaps one of the important achievements of today’s medicine is the reduction of the taboo of talking about a number of diseases, including cancer. Recently, social media accounts of those who did not have cancer, but had a high risk of it – and they underwent preventive surgery. Such people are called previvors – “survivors in advance”, in contrast to survivors – already survivors of cancer and its treatment. Active precursors are not only the stars of the level of Angelina Jolie, but also ordinary women who blog, popular social media accounts and participate in television talk shows dedicated to the prevention of cancer, primarily breast cancer. We tried to figure out why they talk about themselves and how it can help others.
Forty years ago, the very word “cancer” was pronounced in a whisper, and there were no months of awareness and multi-colored ribbons as symbols of the fight against tumors. That all changed in 1974 when US First Lady Betty Ford spoke openly about breast cancer and mastectomy – and revolutionized the way cancer stigmatized. People who have survived a malignant tumor more and more often do not hesitate to talk about the disease itself, its treatment and the difficulties they had to go through. On the one hand, it can help other patients with the same diseases, on the other hand, it can increase awareness, force someone else to see a doctor for examination, or understand what a sick loved one is experiencing.
Many types of cancer, especially if identified in a timely manner, are well cured, and the word itself is no longer an unambiguous death sentence – but, nevertheless, it causes fear and at first shocking. In addition to the disease and treatment itself, which often gives serious side effects, we have to solve a variety of problems: financial ones due to expensive treatment or disability, and psychological ones like depression and anxiety. Relatives and friends often do not know how to behave, how and what to talk about with a person who has been diagnosed with cancer. This is a time when family support is critical – and, unfortunately, at this moment, many families do not pass the test of strength.
As science advanced, it became clear that some people have a higher risk of certain tumors – this can be determined by studying heredity and environmental factors and performing genetic analysis. For example, women who have close relatives with breast cancer are shown to be tested for the BRCA1 and BRCA2 mutations. The presence of BRCA1 increases the risk of breast cancer up to 55-65% (and according to some sources – up to 87%), and such patients can be recommended preventive removal of the mammary glands – as, for example, Angelina Jolie did. Perhaps the actress has become the most famous “previor”, but the “survivors in advance” movement appeared earlier. After preventive surgeries, many women talk about their experiences, including misunderstanding on the part of friends, and that they still made the right decision.
Those who have done a preventive mastectomy get both “paranoia” and “hypochondria”, and the removal of the breast for cancer prevention is compared even with the removal of the eye to prevent cataracts
Of course, with respect to other types of cancer, you can take certain measures: quit smoking, lead a healthy lifestyle, and be examined as often as possible. But with a high genetic predisposition, each such examination is a fear that doctors will find a tumor. For most types of dangerous tumors, preventive surgery is not available: you cannot remove a healthy person’s lungs, liver or colon to prevent cancer – for those who have a very high risk of breast cancer, surgery can completely prevent it – and move on with peace of mind. Therefore, the precursors are primarily women who have undergone prophylactic mastectomy.
On instagram Paige Moore sixteen thousand people signed – and she says that doubted his choice and upset, but now convinced of the correctness of the decision. She learned about the harmful mutation at 22, and was offered several options, including enhanced surveillance, in which an MRI and other examinations are required every six months. Sounds easy, but, on the said Page, when you have the highest risk of breast cancer, this strategy turns into a daily fear: “You wake up and think that today you will develop cancer.” Therefore, she chose a different approach – surgery. Stephanie, who also underwent preventive mastectomy, argues in her blog that it is not life that “happens to us,” but that we can actively build it in many ways. If you have a high risk of breast cancer, then a mastectomy will most likely have to be done sometime; then you have to live the rest of your life in fear of cancer recurrence – and probably die from it.
It would seem that the ability to prevent a terrible disease is the most important achievement of science, but the previors are often criticized. According to Dina Roth Port, author of the book Previvors, some women breast cancer survivors find the prevention movement offensive and distracting. Those who have done a preventive mastectomy get both “paranoia” and “hypochondria”, and the removal of the breast for cancer prevention is compared even with the removal of the eye to prevent cataracts – an obvious exaggeration, because the absence of a mammary gland and an eye is clearly associated with different quality of life. Hardly anyone is happy about the prospect of breast removal – but there are no other methods of prevention with the same effectiveness yet. BRCA mutations also increase the risk of ovarian cancer, so in some cases preventive surgery is performed to remove them – which is also often condemned.
It turns out that conversations about mastectomy easily move from the plane of medical advances to the plane of objectification – and doubting a woman’s choice to remove her breasts, those around them essentially condemn the previors for putting health and life above beauty standards. Compare: people at high risk of melanoma who give up the beach, do not go out without sunscreen and prophylactically remove suspicious moles , also a kind of predominant, but they are not criticized publicly. Is it possible to condemn women who do not want to repeat the path of their mothers and grandmothers or leave their children too early? Of course, the decision must be balanced and well-grounded, it must be made by a woman together with a doctor – but whatever this decision may be, it deserves respect. The openness of the previors, their stories about their experiences, including the reactions of others, help to normalize the situation and tell those who are faced with a choice that they are not alone.
Why do we need the fat inside of us
We are all used to looking for answers to most of our questions online. In this series of articles, we ask just such questions – burning, unexpected or common – to professionals in a variety of fields.
The study of fat and its functions is an important medical trend in recent times. Even 25-30 years ago, fat was considered a passive tissue, which simply stores energy, but in the early nineties, scientific work appeared that proved that adipose tissue is the most important endocrine organ . And of course, this triggered an avalanche of new research: pathophysiologists , biologists and endocrinologists from all over the world began to study what fat is and how it affects the neuroendocrine system. Interest in the topic was fueled by the fact that, according to the UN , up to a third of the world’s population suffers from some degree of obesity. All these people are at risk for diseases that obesity can provoke, which means that it is important to know as much as possible about the effect of adipose tissue on the development of any pathologies.
Candidate of Medical Sciences, Endocrinologist at the Marina Ryabus Clinic
Adipose tissue is a type of connective tissue; it consists of fat cells, or adipocytes, which store energy and secrete various substances, including hormones. This means that adipose tissue performs a lot of tasks in our body and it is largely thanks to it that it functions as it should. The main function of fat is energy. Triglycerides, a component of adipose tissue, release a colossal amount of energy when broken down: twice as much as carbohydrates. The average adult has about fifteen kilograms of adipose tissue, or about 110 thousand kilocalories. This reserve is enough to live for two months, burning 2 thousand kilocalories a day.
Another function of fat is thermal insulation. Everything is clear here: the fat layer helps us not to lose too much heat at low temperatures. That is why the representatives of the northern peoples have a fat layer on average thicker than that of the southern ones. The next function of fat is supporting. This means that all our organs, such as the heart and even large vessels, are partially or completely surrounded by fatty tissue. This, on the one hand, helps to fix the organs in the “right” places, and on the other hand, it protects them from damage if we hit or someone attacks us. That’s all with obvious functions, we pass to more subtle matters.
An important function of adipose tissue is regulatory. Fat cells are involved in hematopoiesis: they are part of the bone marrow, form the microenvironment of erythrocytes, leukocytes and platelets and provide them with nutrients while they develop. Another function, which I would like to talk about separately, is immune. The cells of our immune system have receptors that “read” the structures of dangerous microbes – in response, the system produces protective components, including cytokines and chemokines , which direct the process of fighting infection. Several years ago, the same receptors were found in fat cells.
Another non-obvious function of fat is depositing: adipose tissue accumulates not only energy, but also some fat-soluble vitamins (A, D, E, K), and also serves as a large depot of steroid hormones, especially estrogens. In addition, it contains a supply of water (yes, not only in camels, but also in humans), which means that a deficiency of adipose tissue will immediately lead, for example, to dehydration and aging of the skin.
Both the lack of adipose tissue and its excess are equally dangerous for the body.
Now we finally come to the most interesting function of fat – the endocrine function . As I said, modern science considers adipose tissue to be a separate peripheral endocrine organ. In women, it is, among other things, a source of an enzyme called aromatase, thanks to which our body synthesizes estrogens from androgens (I think it is unnecessary to talk about estrogens for the female body). Also, adipocytes from adipose tissue produce leptin, which is necessary for puberty and for maintaining reproductive function. By the way, in patients with amenorrhea , that is, the absence of menstruation, due to too strong physical exertion, the level of leptin falls, and its secretion is impaired. And in normal women, serum leptin levels are 40% higher than in men.
Without adipose tissue, our body simply will not work: it is responsible for reproductive function and puberty, for immunity and hematopoiesis, it serves as fuel for basic metabolic processes, protects us from mechanical damage and hypothermia. Does this mean that the more adipose tissue in the body, the better? Of course not. Both the lack of adipose tissue and its excess are equally dangerous for the body. There are studies showing a direct link between imbalance of adipose tissue in any direction and a decrease in life expectancy, so it is very important to monitor the percentage of adipose tissue in the body and how it is distributed.
It should be understood that the rate of fat content in the male and female body is different: women should have 5-10% more fat. There are also differences in the properties of adipose tissue and how it is distributed. Firstly, in men, fat is denser, while in women it is loose, so cellulite is more common in them (strictly speaking, it can generally be considered a secondary sexual characteristic). Secondly, in men, adipose tissue is distributed more or less evenly throughout the body, and in women it is deposited in the mammary glands, in the pelvis and hips. In case of violations, adipose tissue can begin to be deposited in characteristic places, for example, on the anterior abdominal wall. It is this variant of obesity that doctors consider the most dangerous: it is directly related to the development of diabetes mellitus, atherosclerosis, arterial hypertension, some malignant tumors, myocardial infarctions, strokes and a great variety of other pathologies.
Another extremely unfavorable type of obesity is abdominal-visceral, that is, when adipose tissue is deposited around the internal organs and disrupts their work. Both of these types are found in women who gain weight with age. With the onset of menopause, the body begins to produce less sex hormones in the ovaries. In order to somehow compensate for the deficiency of estrogens, adipose tissue is taken for their increased production – and immediately begins to grow under their influence, that is, we find ourselves in a vicious circle. Moreover, the problem here is not only obesity, but also that estrogens, which are produced by adipose tissue in perimenopause, can trigger pathological processes in tissues, for example, endometrial hyperplasia or breast cancer.
The more stable the weight, the better for the skin, back, joints and the whole body as a whole.
With age, metabolic processes slow down. This means that a number of enzymes are still produced in our country, but the same amount is no longer consumed. The easiest way to spend them is to digest food, and the body tells you to “increase your appetite.” As a result, the woman begins to gain weight, but often does not notice that she has begun to eat more. The same danger, by the way, lies in wait for those who start drinking hormonal contraceptives: any change in hormonal levels temporarily affects appetite, so in the first months of taking COCs it is better to monitor the amount eaten. Of course, you will not get better from the pills themselves – this is a myth. But you can look at food with different eyes – this is reality. Weight gain during menopause or while taking HA is not the norm, even if you are far from obesity. The more stable the weight, the better for your skin, back, joints and the whole body in general.
Determining the optimal balance of adipose tissue in the body is not easy. Previously, almost the only way was to calculate BMI, that is, body mass index, but this method has a lot of disadvantages. First, it does not take into account either the age or gender of a person, although, logically, BMI in men should be higher than in women, and BMI in young people should be higher than in older people. In addition, the average BMI values do not depend on the country, and if, for example, the indicators recommended by the WHO are applied in Russia, it will turn out that more than half of the population suffers from overweight. In addition, the formula for calculating BMI is completely unsuitable for people who are seriously involved in sports. There are a lot of sports, the requirements for athletes are completely different, and they rarely fit into the average indicators: the BMI of rhythmic gymnasts, for example, is close to the mark “pronounced deficit”, and the BMI of weightlifters is obese, while both are completely healthy. Therefore, any calculation of the optimal weight and percentage of adipose tissue in professional athletes is an individual and empirical question.
One of the most reliable today ways to understand the optimal balance of adipose tissue in the body is the bioimpedance method, which is based on the bioelectrical resistance of tissues. With its help, we can find out not only the percentage of adipose tissue, but also how it is distributed. This is important for early diagnosis of endocrine disorders, which are characterized by excess body fat in certain areas. This study is quite simple, and it is done in a number of clinics. In addition, another method has recently been described to study the balance and distribution of fat using a three-dimensional scanner or computed tomography. The indicator that he measures is called BVI (that is, Body Volume Index, or body volume index).
But even without a three-dimensional scanner, with bioimpedance equipment, it is possible to accurately determine the optimal balance of body fat. In addition, there are formulas for the thickness of the fat fold, the ratio of the circumference and line of the pelvis, waist and height, waist and arm, waist and leg. Together, this allows you to make accurate and, most importantly, individual calculations. Although here it is necessary to make a reservation that the feelings of the patient himself play an important role. For example, if, according to all calculations, the optimal weight of a person is 60 kg, and he feels better at 54, and analyzes confirm that he is healthy, it is not a fact that he should gain weight.