Women from all over the world come to Doctor Furkat Davronov in Zurich for a gynecological consultation. He believes that a woman’s health depends first of all on how the woman takes care of herself.
– Doctor Davronov, you have broad experience in the treatment of breast cancer. Who is mostly at risk of getting this disease?
– The risk factors for the development of breast cancer are excessive weight, alcohol, nicotine, lack of exercise, working with cancerogenic substances and an abnormal sleep cycle, so this includes people who work at night. Medical aspects, such as hormone therapy, are also important. The risk group includes women who did not breastfeed. When I get such a patient, first of all I ask her if she has any bad habits and if she exercises. If the woman is thirty to thirty-five years old, I remind her that if she wants to have a baby, now it is the best time to consider it.
– Is the age of a patient important?
– Women who are between 45 and 60 years old are more interested in their health, but they are also in the risk group for developing cancer. I think that these two factors balance each other out.
– Does the hereditary factor also play a role?
– Of course, especially if we speak about breast cancer. Around 10% of patients inherited this disease. These 10% of cases are the most severe. As a rule, the disease develops before a woman turns 35 and takes an aggressive form. In half of cases it is associated with the presence of genes that scientists already know: BRCA-1 and BRCA-2. You need to consult a gynecologist who will examine you and decide what the risk level is. However, even doctors do not always take this seriously! These are factors you need to pay attention to: if the family has had more than one case of breast cancer, ovarian cancer, or both. You sometimes have to excise the breast and ovaries to decrease the risk to a minimum. However, everything is of course very individual.
– How often would you recommend undergoing a preventive medical examination?
– In Switzerland the Krankenkasse, the national insurance system, pays for a preventive oncological examination once every three years (you need to take a sample from the vagina for it). The same happens in most other countries and medical insurance companies think that this is enough. However, any doctor would say that it is not. You need to come for an annual ultrasound examination of the ovaries, ulcers and breasts to detect cancer as early as possible. This is a minimum list of examinations. If the patient is in a risk group, then she should come every six months. Besides this, every woman should examine her breasts herself once a month. – Is mammography effective?
– Scientists have different opinions. On the one hand, it is a very significant and informative method that allows us to determine changes in the breasts quite precisely. On the other hand, it turns out that it does not help to decrease mortality and morbidity rates. Regular screening programs do not yield the expected results. The problem is also that doctors prescribe too many surgical procedures as a result of these screenings, though women could live without them until they turn one hundred years old. It is extremely important how qualified the doctor doing the treatment is. There is a hypothesis (though it is not fully confirmed yet) saying that mammography can provoke the development of cancer in women who are genetically predisposed to it, as additional irradiation can cause cell proliferation. It can be useful in certain cases for additional diagnostics, but I would not recommend mammography as part of an annual screening.
– All women have heard that hormonal drugs are associated with the risk of cancer development.
– This is true. If you take hormones for a long time, they can provoke the development of cancer. Unambiguous data show that women are in a risk group not only if they take hormonal drugs, but also in the case of a certain hormonal exposition: precocious menstruation, for example, or late menopause. It means that if a woman started to menstruate when she was ten years old and stopped when she was seventy years old, she would have a higher risk of developing breast cancer. American studies show that the statistics on this disease unambiguously correlate with the use of hormonal drugs in the USA. An advanced maternal age, if it is the first baby, is also a reason to be more careful about one’s health. I am talking not only about embryo transfer but also natural pregnancy, because women at the age of 35 – 40 get a small hormonal stimulation in some cases.
– What do you think about hormone replacement therapy during menopause, which has been getting more and more popular in recent years?
– I would like to stress here that it is a THERAPY. You should not treat hormones as a way to prolong youth and increase activity, though they can have this additional effect. However, it is necessary to understand that these products treat a certain condition. Many women do not feel much discomfort during the menopause and do not need the treatment. However, if quality of life decreases, you should consider therapy. I include here also problems with self-perception and the perception of the surrounding world as well as sexual problems. Loss of sexual desire, lack of interest in an active social life and a general sense of melancholy are all indications of the need for hormone therapy.
– Is there still a risk that this therapy will cause cancer in the future?
– The breast is the first organ to react to hormone replacement therapy. However, every coin has two sides. The other side is an improvement of the situation regarding cardio-vascular diseases. The main task of medicine is sustaining life, and statistically people die most often from cardio-vascular diseases. It is important to mention that if we start hormone treatment during the first five years after the beginning of menopause, we improve the condition of the cardiovascular system. If we start it later, ten years after the beginning for example, we increase the risk of thrombosis. Judge for yourself: a woman has suffered from a hormonal deficiency for five to eight years, which has caused changes in the condition of the vessels and provoked the development of cholesterol plaques. It is like trying to start a car that has been in the garage for ten years: something will break. That is why it is important to consult a doctor in any case. Any doctor will tell you that it is not enough just to prescribe hormone replacement therapy; you also need to change your lifestyle.
– Women are also afraid of hormonal drugs because they do not want to gain weight. Can this happen?
– Yes, you will gain weight if you take the medications and do not do anything else. Hormonal therapy is additional energy. Just imagine that you turned on the light at home even though there is already daylight outside. You should use this opportunity! Exercise, try to be sexually active if possible, go out and work on yourself. You will have enough energy. If you take hormones and stay passive, the therapy will not be effective.
– What drugs does replacement therapy include?
– It includes drugs that have two hormones – estrogen and gestagen – and estrogen-only drugs. If the woman has her womb preserved, it means in most cases she will be treated with two hormones. Hormone therapy should not be onesided. If the woman takes only estrogen, it can provoke the development of cancer, and so it is necessary to suppress this with gestagen. You can achieve very good results if you prescribe a gel, but only in post-hysterectomy patients.
– Nowadays we often see advertisements for bioidentical hormones. What are they good for?
– This term can delude you. It is not the case that one pharmacy sells good “bioidentical” hormones, and all the other pharmacies sell some dangerous chemical concoctions. Nowadays you mostly have bioidentical hormones on the market, though it is not always noted on the package.
– Let’s go back to early detection of oncological diseases. You have already spoken about the breast, but what about other types of cancer? Is early detection possible?
– You can detect almost all diseases at an early stage, but people should pay attention to any changes in their bodies themselves, as our body talks to us! A study has shown that all women with ovarian cancer had had systematic problems with the intestine (bloating, constipation, diarrhea) for a year before they got the diagnosis, but they did not take them seriously. You need to remember that the most widespread oncological disease in men, and the second most widespread one in women (after breast cancer), is colorectal cancer. That is why all women, after they have turned fifty, should regularly undergo intestinal colonoscopy, and if they have any problems then they should start to undergo it after they have turned forty. This is a very reliable and informative method.
– Besides consulting gynecologists and mammologists?
– In Germany, Switzerland and Austria the gynecologist examines the breasts and only in some cases do you have to go to a special center. Soon after graduation, I chose to specialize in gynecology and after six or seven years I moved to Europe, where I once again completed a residency in gynecology – in breasts, actually (a subspecialization of a gynecologist). In Russia, surgeons and mammologists deal with breasts. In Europe, gynecologists can also specialize in senology that studies breast pathologies not associated with malignant tumors.
– Let’s imagine that we have a diagnosis, and it is oncology. What should we do?
– The whole world treats oncological diseases according to well-defined protocols and programs. Here in Switzerland we usually organize a consultation of surgeons, oncologists, radiologists, pathologists and psychotherapists. It can also include a doctor who advises the patient and knows his medical history, even if the doctor is from another clinic. They create a detailed treatment plan together. It is not some unique event; we have such consultations once a week, and big medical centers organize them twice a week.
I had a patient who was diagnosed with uterine cancer three weeks before her honeymoon. I told her: do not cancel it as, after we start the treat ment, she will not be able to go anywhere for a year. Our task is not just to treat the patient, but to help the patient have a normal life.
– Could you tell us more, please, about treatment protocols?
– We have five main channels: surgical therapy, chemotherapy, radiotherapy, immunotherapy with the help of antibodies and hormone therapy, and, more specifically, anti-hormone therapy – the suppression of hormones. Oncological treatment is similar to a search through the best recipes: doctors should decide if they need to use every method or only some of them, and in which order. Even now it happens that surgeries are done without histology. This should never happen! Everything is very individual, and one case is never the same as another case. Surgeries can work to different extents and with different planning. Biological features of the tumor are important: if it reacts to antibodies and hormones, and what kind of a structure it has. However, these are all details. The most important thing is to remember that a doctor can not change a person’s life. The doctor should be attentive to the patient, diagnose and treat a disease and, also very important, give recommendations on lifestyle. If patients follow these recommendations, they will certainly prolong their life and stay young, beautiful and healthy.
In 1989 he graduated from the Samarkand State Medical University with a degree in obstetrics and gynecology. In 2000 he moved to Germany, where he took a postgraduate degree at one of the best European universities, the University of Cologne. He then worked in the Center for Treatment of Breast Cancer in Solingen. Nowadays he works with the Privatklinik Bethanien and also has his own B3 practice in the center of Zurich on Bahnhofplatz. He is a member of the Swiss Medical Association of Gynecological Oncology and Senology and is the Chairman of the Association of Russian-Speaking Doctors in Switzerland.