In oktober wordt wereldwijd aandacht gevraagd voor borstkanker. Deze negen feiten over het opsporen van borstkanker zijn nuttig om te weten.
1. Vroege ontdekking is van levensbelang
Er vroeg bij zijn is belangrijk. De volgende cijfers maken dat duidelijk. In 2015 werd in Nederland bij 14.449 vrouwen voor het eerst borstkanker vastgesteld. Van deze vrouwen was 9007 tussen de 50 en 74 jaar en 2517 75-plusser. Ook werd bij 2542 vrouwen borstkanker ‘in situ’ vastgesteld; dat is een voorstadium van borstkanker. Bij ongeveer 30 procent groeit borstkanker in situ uit tot borstkanker. Deze cijfers zijn afkomstig van de Nederlandse Kankerregistratie (NKR), een database die beheerd wordt door Integraal Kankercentrum Nederland (IKNL).
Het is moeilijk te zeggen wanneer iemand met borstkanker ‘genezen’ is, want ook na een behandeling bestaat het risico dat de ziekte terugkomt. Artsen spreken meestal van ‘overlevingskansen’. Bijvoorbeeld: je leeft na de diagnose waarschijnlijk nog minimaal vijf of tien jaar. Bij borstkanker is de kans op nog vijf jaar leven 85 procent en op nog tien jaar leven 76 procent.
De overlevingskansen zijn een stuk groter als de borstkanker vroeg ontdekt wordt. Als de borstkanker nog in het eerste stadium zit, is de kans op nog minimaal vijf jaar leven 94 procent. Als de borstkanker uitgezaaid is, is die kans 9 procent.
2. Het begint met zelfonderzoek
Je borsten goed kennen is essentieel. Dan merk je verdachte veranderingen sneller op. Doe een paar keer per jaar borstzelfonderzoek, op deze manier:
Bekijk voor de spiegel of je veranderingen ziet aan je tepels; in grootte, in vorm, aan de huid. Kijk wat je ziet als je je armen langs het lichaam houdt, en wat je ziet als je je handen achter je hoofd houdt.
Voel de tepels en het gebied rondom de tepels. De tepel moet soepel meegeven als je deze rustig een beetje naar voren trekt.
Voel je borsten zo zorgvuldig mogelijk. Bijvoorbeeld: rechterarm achter hoofd, linkerhand op rechterborst, en met de vingers drie verschillende bewegingen maken. Beweeg eerst van de rand van je borst naar de tepel, vervolgens van de onderrand van je borst naar de bovenrand en tot slot van de rand van je tepel naar de buitenranden van je borst. Herhaal de bewegingen drie keer.
3. Kleine veranderingen kunnen veel zeggen
Bij de volgende veranderingen is het verstandig om direct de huisarts te raadplegen:
een ongewoon knobbeltje in de borst
schilfering en roodheid van de tepel of kuiltje in de borst
sinds kort ingetrokken tepel, strengetje naar de tepel
vocht uit de tepel (bloederig, waterig, groen van kleur of melkachtig)
warm aanvoelende borst met een rode verkleuring van de huid
een slecht genezend plekje
pijnlijke, anders aanvoelende plek in de borst
zwelling in de oksel
4. Screening geeft geen 100 procent zekerheid
Het screenen op borstkanker gebeurt met röntgenfoto’s, de zogenoemde mammografie. Bij een verdachte afwijking word je voor vervolgonderzoek doorverwezen naar een ziekenhuis. Niet alle afwijkingen worden op de röntgenfoto’s ontdekt. Volgens het Rijksinstituut voor Volksgezondheid en Milieu (RIVM) worden 7 van de 10 gevallen van borstkanker bij het bevolkingsonderzoek ontdekt. 25 van de 1000 vrouwen krijgen bij het bevolkingsonderzoek te horen dat ze een verdachte afwijking hebben. Van die 25 vrouwen blijken er 7 daadwerkelijk borstkanker te hebben.
5. Discussie blijft over bevolkingsonderzoek
Vrouwen van 50 tot en met 75 jaar kunnen elke twee jaar meedoen aan het bevolkingsonderzoek borstkanker. Deelname heeft voor- en nadelen. De mammografie kan veel pijn doen. Een borst wordt platgedrukt tussen twee plexiglasplaten om van twee kanten een foto te kunnen maken. Dat voelt voor sommigen als een marteling. Volgens sommige onderzoekers werkt het bevolkingsonderzoek onnodige, ingrijpende behandelingen en schijnveiligheid in de hand.
Volgens het RIVM bewijst het bevolkingsonderzoek zijn waarde. Sinds 1990, toen het bevolkingsonderzoek werd ingesteld, is het aantal doden door borstkanker met een kwart gedaald. Een onderzoek uit 2015 lijkt erop te wijzen dat regelmatig een mammografie laten doen verstandig is. Onderzoekers van de International Agency for Research in Cancer, de in kanker gespecialiseerde afdeling van de Wereldgezondheidsorganisatie, vergeleken tientallen studies naar screeningsmethoden. Ze concludeerden dat vrouwen die regelmatig een mammografie laten doen, 40 procent minder kans hebben om te overlijden aan borstkanker.
6. Erfelijkheidsonderzoek kan nuttig zijn
Van alle vrouwen met borstkanker heeft ongeveer 5 tot 10 procent een erfelijke vorm. Wie erfelijk belast is met borstkanker, kan zich aanmelden voor onderzoek. Mogelijke aanwijzingen voor erfelijke belasting zijn onder meer als:
borst- en/of eierstokkanker bij meerdere familieleden voorkomt
een vrouw in de familie zowel borst- als eierstokkanker krijgt
een vrouw in de familie borstkanker heeft voor haar 40ste
in de familie prostaatkanker voorkomt onder de leeftijd van 60 jaar
in de familie een man is met borstkanker
Op www.brca.nl staat het volledige overzicht.
Bij erfelijkheidsonderzoek wordt de familiegeschiedenis in kaart gebracht en wordt DNA-onderzoek gedaan. Vrouwen die erfelijk belast zijn, komen in aanmerking voor extra screening. Vrouwen kunnen er ook voor kiezen beide borsten preventief te laten verwijderen.
7. Alleen screening met mammografie wordt vergoed
Meedoen aan het bevolkingsonderzoek is gratis. Als een huisarts of specialist de controle doet, vergoeden de meeste zorgverzekeraars dat vanuit de basisverzekering. De kosten gaan wel af van het eigen risico. Borstscreening met andere methoden dan de mammografie, zoals thermografie, wordt niet vergoed.
8. Thermografie is geen alternatief
Bij thermografie worden temperatuurverschillen in de huid zichtbaar gemaakt met infraroodopnamen. Volgens het RIVM kan thermografie niet gebruikt worden als screeningsmethode. Infrarood kan tumoren niet zichtbaar maken.
9. Mammografie wordt minder pijnlijk
Hoogleraar medische technologie Kees Grimbergen en emeritus hoogleraar radiologie Ard den Heeten van het Academisch Medisch Centrum in Amsterdam hebben een nieuwe techniek ontwikkeld voor borstkankeronderzoek. Het apparaat, de ‘mammograaf op maat’, berekent met hoeveel kracht de borst moet worden samengedrukt. Uit onderzoek van het AMC blijken vrouwen daardoor minder pijn te hebben, terwijl de foto’s net zo goed zijn. Het AMC gebruikt het apparaat al. Het zal nog wel enkele jaren duren voordat de mammograaf op maat in andere onderzoekscentra gebruikt kan worden.
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