Your children's health and HPV. Episode 60

Monika Rachtan
Hi, Monika Rachtan. I would like to welcome you to another episode of the programme "Po Pierwsze Pacjent". It's already been a year, as it's June, since the Ministry of Health introduced free HPV vaccination for girls and boys aged 12-13. Around 200,000 children have now been vaccinated over the past year. Have we passed the test on prevention? This is what I will be asking Professor Mariusz Bidzinski today. Good morning, and welcome, Professor.

Mariusz Bidziński
Good morning, Madam Editor, good morning to you.

Monika Rachtan
Parents still believe that vaccinating their child against HPV is somehow a sign that they are encouraging their child to be promiscuous. Can we clarify this issue at the outset once and for all?

Mariusz Bidziński
In general, we can say that health is a very delicate matter, and all kinds of preventive action, and the vaccine is primary prevention. It is an investment in health. It must be made clear that we must appreciate that there is a whole range of products that allow us to guard against all kinds of health problems. Today, HPV vaccination is not just a vaccine against cervical cancer, as is generally accepted, but HPV is also a cancer. It is also the cause of other cancers, including male cancers.

Monika Rachtan
What are the cancers?

Mariusz Bidziński
Anal cancers, penile cancers, head and neck cancers. There is really a whole range of cancers that are caused by HPV. The most common, of course, and the first such element to be introduced into the system, one might say, was vaccination against HPV infection on the cervix. And here, indeed, in 2006, some countries introduced this vaccine as a kind of product to reduce the risk of cervical cancer, because there are really millions of women around the world who get cervical cancer. This mainly affects the African population. It affects countries with low socio-economic status. But it does and therefore it is a very serious problem in the public health system. And today this so-called prevention project is extremely effective. We have evidence, and it is very clear evidence, that millions of women and men have not had cancer or pre-cancer problems thanks to these vaccinations. Therefore, in short, we can say that this is an absolutely excellent tool which gives us a very high guarantee that neither our son nor our daughter will become ill in the future.

Mariusz Bidziński
I will say more, these vaccinations, which are prophylactic vaccinations, are also applied today to women who have already been in contact with the virus. By doing so, we can raise the immune value of the body and cause potentially subsequent infections not to be active or to be eliminated by our immune system at a very early stage.
Monika Rachtan
So it's that not only girls and boys aged 12-13 are candidates for vaccination, but any de facto person, be they 17-year-olds, 25-year-olds or 30-year-olds should think about HPV vaccination?

Mariusz Bidziński
Yes, and today we can say that people who have not yet started an intimate life are the best candidates for not having come into contact with viruses yet. These antibodies provide a very high guarantee that contact with the virus will not cause any consequences in the body. However, for people who have already come into contact with the virus, and these are older people, this does not mean that the preventive element will not work. It will work a little less actively, but it will still work. Today, it is thought that people up to the age of 45 should still consider this concept. Of course, on a system-wide basis, we focus most on the youngest age groups. Although vaccines are more or less dedicated to people in both the male and female adolescent population from 9 to 14 years of age. The fact that today, in our reality, we have singled out two cohorts, namely 12- and 13-year-olds, but this does not mean that in a short while we will not vaccinate 14- and 15-year-olds and so on. The amount of these vaccines that have been ordered is so sufficient that it seems that we will be extending this element of the age groups up to probably 18 years of age, because this is how the project is prepared at the moment. And these vaccines can also be used free of charge for people up to the age of 18.

Monika Rachtan
But just because the Ministry of Health's programme currently does not yet cover these age groups, this does not mean that parents cannot decide for themselves that they want to vaccinate their child and go to a doctor, be it a paediatrician, a family doctor or a gynaecologist's office. Can such a vaccine be given, Professor?

Mariusz Bidziński
Yes, theoretically, the best solution is nevertheless systemic action. Action through family medicine is the best, i.e. both paediatricians and family doctors are the group that is most privileged to spread activity. Which is not to say that other medical groups can't do it, but the system tends to be directed towards the so-called public medicine system, and the other groups in the non-public system are only some fragment of the activity. But I don't see why people who go to a gynaecologist or a doctor who works in a non-public health service cannot be vaccinated.

Monika Rachtan
HPV is not just cervical cancer. It is also cancers that affect men more often. Head and neck cancers, anal cancer. This is what the professor said. Approximately how many people a year in Poland die from all these cancers? If I remember correctly, cervical cancer is about four thousand women a year. And if we also expand on these other cancer groups, how many deaths could we avoid if we had a fully vaccinated population?

Mariusz Bidziński
I do not want to talk about certain data here due to the fact that our National Cancer Registry presents these data. Today I can only say as regards gynaecological cancers, mainly cervical cancers. We have at the moment 1,600 deaths a year from cervical cancer, so you can say, it is not a small number. As far as head and neck cancer and anal cancer are concerned, I cannot present exact figures today, because I do not want to speculate here, but I think it is another 2 000 to 3 000 people, so I assume that about 5 000 people a year could be saved from the fatal consequences of infection.

Monika Rachtan
I said 4,000 deaths from cervical cancer, but I think it was about incidence, right?

Mariusz Bidziński
The incidence is lower. At the moment we have about 2,600 cases and 1,500 deaths from cervical cancer. But I would still like to emphasise one thing. We, in 2006, introduced a so-called population-based prevention programme, which is a structured programme. Eighteen years have theoretically passed, and today we should be far closer to being in the race with France and Italy, and we are racing on with Macedonia and Albania. We can say that the efficiency of this project is not so great. It needs to be remodelled. You really need to go back to a system that will be a compulsory system. In short, non-opportunistic, that is, someone who wants to take a test for themselves. We have to say that these are things that arise at least from the fact that our actions must be oriented towards population health. In short, if we have excellent preventive tools, let us use them. I think that today, for example, occupational medicine should require people who are applying for a job to present the tests that they need in order to take action to get a job. The same applies to family medicine, which should be very interested in making the system work smoothly and consistently. Today, I repeat, we are given very precise tools that can effectively counter the effects of infection. However, we do not know how to use them. The system must be well prepared on the organisational side. The first thing is education. Then the introduction of a project which is organised in such a way that there is an element of a pathway which is implemented in this area, such as an active pathway, which means that we invite people who are in this so-called population group. We have these elements in this area organised in such a way that nobody wanders off. We can say that this is done in a constant and consistent way. We keep statistics, we have registers, we know who we have vaccinated, how many people are out of the system and every so often we evaluate whether the programme is progressing or whether we are starting to wade into so-called nothingness again. Therefore, I think that a very important thing is not only the question of availability of vaccine or medicine, but the organisation of the whole activity. Then we can count on effectiveness if it is really well organised and consistently conducted.


Monika Rachtan
Do you not have the impression, Professor, that at present in Poland no one is responsible for prevention, that everyone is responsible just a little bit, because primary care doctors do something and gynaecologists appeal to something. On the one hand, there are some promotional programmes of the National Health Fund, but in fact, if a patient is not so stubborn and does not go and find out on their own how to carry out these prophylactic tests, where they can be done, there is no single unit which would coordinate everything. So I guess what the professor said, that a well-written project of the whole prevention in the country, divided into different segments, is extremely necessary and should be introduced.

Mariusz Bidziński
I repeat, and I think you will agree with me, that in order to initiate any projects at all, there must first be a leader in this process. Today, in prevention, we have a number of institutions that are responsible for it. I would mention the Ministry of Health, the National Health Fund, the Chief Sanitary Inspectorate, local authorities, the Ministry of National Education, etc., etc. There are so many of these different institutions, it's just that it hasn't coalesced. There is no single leader who would actually carry out this project of preventive measures in a consistent manner, while at the same time setting out signposts, so to speak. Because we are not only talking about cancer prevention, but health prevention. Metabolic diseases, cardiovascular diseases. The whole prevention project involves a number of these so-called elements of different specialties. And there has to be a person in my view who will form, so to speak, a team to deal with this. One person who, in my opinion, should not only be substantive, but also politically strongly positioned, because these are decisions already at a level completely outside the Ministry of Health. I think these are decisions at the level of the Council of Ministers and, in my opinion, it has to be a person who will really be the designer and then the implementer of the whole system, and we are lacking this.

Monika Rachtan
Do you have any idea who this could be? Should it be some new entity?

Mariusz Bidziński
I think there are many women among politicians today. Women are more sensitive than men in this respect to the issue of health. Anyway, that is what the statistics show. So I think that within the various groups of politicians, especially those who have sometimes encountered health problems, there would certainly be someone who could be, one might say, the leader of this project. Of course, I am not going to mention any names, because, to tell the truth, I would not like to single anyone out or depreciate them in any way, but the fact is that we could certainly find people who, above all, have a willingness to act in this area, because this is very important. Also it seems to me that this is the form. First of all a leader who builds a team, a prepared project and then the actual implementation things which are checked, evaluated from time to time. It will indeed be a system which, if funds are found for it, because money is also important here. It will indeed be very, very, very, very helpful in the implementation of prevention programmes. Prevention, so to speak, because it seems to have changed its meaning today. Because, to tell the truth, today we treat prevention a little neglectfully. And this is a phenomenon we are witnessing, both among ourselves as doctors and those outside the profession. I always say, we wish for health. This health is very important, but do we respect this health? Do we take care of this health? I always say health is an investment. That is what is important today. If we talk about the fact that if health is lacking, all the other spells of life are gone. So let us really be proactive about it. And it is not only the system itself that we should build, but also each of us should remember that it is also in our hands this whole system. It will certainly function very well if the two links really want to come together.

Monika Rachtan
This is where the professor's appeal to the Ministry of Health and to those involved in health policy would be for such an influencer, I would say an influencer of prevention, to appear within the ranks of the Ministry of Health. However, I would like to remind you that it is education and listening to conversations such as the one we have had today that makes you a conversation partner with your doctor, that makes you understand the system better, and that makes you able to navigate it more effectively. It is worth investing in prevention, but in the beginning this education is extremely important and it is worth listening to experts such as the Professor, because it is a factual, reliable message which can actually give you knowledge which is in line with what today's medicine says. I would also like to return to prevention, because today we are talking about HPV, but in general we are also talking a great deal about prevention. Since 2006, there has been a prevention programme in Poland to protect women from developing cervical cancer. Could you please explain what exactly it consists of, how to use it and to whom it is dedicated?

Mariusz Bidziński
Was the project introduced, as the editor said, in 2006. It was dedicated to all Polish women aged 25-59 and once every three years. Every woman could have a cytological examination. Why once every three years? Because ladies were usually used to having a cytology once a year. It is natural that the process of developing cancer, or cancer from the moment of infection, is a multi-year process. Usually it is said 10 years, maybe eight, but it is not a matter of one or two years. Therefore, today we can say cytology. If there is even a first false negative, if we repeat it two more times, there will rarely be a situation of the type that these results will be false all the time. Therefore, it is possible to have a cytology once every three years, and this really does give a much, I repeat a very high guarantee that a woman will be diagnosed at the stage of very early, so to speak, still pre-cancerous changes. Because this is secondary prevention. I would like to emphasise once again and explain to you here that we have several types of prevention. Primary prevention, i.e. vaccination, means that our body does not become infected.

Mariusz Bidziński
In short, we are eliminating the causal factor. The secondary prophylaxis profile is already that element, one might say the next stage. The virus has entered the body, it has begun to tamper, so to speak, with our cellular elements. So it has created certain, so to speak, transformations in these cells. Specifically the cervixes, which have been altered. They have already changed in some way in the sense of before cancer, but not yet cancer. And we can capture this stage. Why is this stage so important? Because if it is a neoplastic change, it only affects the epithelium, we can tell. We are able to treat such a person with very conservative methods and give them a full guarantee of a cure.

Monika Rachtan
What methods are these?

Mariusz Bidziński
Usually these are methods, you could say minor procedures where we remove these cells. Whether it is a laser treatment or an excisional treatment, but it does not create certain elements that would, in the future, as it often concerns young women, hinder them in some way, such as getting pregnant, giving birth and so on. Therefore, this procedure is, firstly, from the point of view of its extent, small, but its effectiveness is one hundred per cent.

Monika Rachtan
HPV vaccination arrived in paediatricians' offices last year, on the first of June. The Ministry of Health made a gift to children, to their parents, and decided to reimburse these vaccinations. If you were to give us three arguments as to why every mum, every dad should take their 12- or 13-year-old by the hand and bring them to the paediatrician's surgery. And also perhaps you could tell us what such a procedure looks like. Is it something complicated, time-consuming so practically for parents?

Mariusz Bidziński
The first thing is that it is a bit inconvenient that you have to get a prescription first. This is a kind of element that actually gets in the way a little bit. We should have vaccination centres that are equipped with all these tools. And a person who is a 12/13 year old going there has the product ready on the spot, so to speak, and is vaccinated. Here a little bit this so-called system is more complicated, which results today that only 30% POZs have been, so to speak, interested in this project. But they these things are done administratively and I think that the simplification of this will be implemented soon. Why take a young person and vaccinate them? Just as we have eradicated many social diseases through vaccination, today we can say if we look at it from the point of view of saving a young person from the consequences of cancer, it seems to me that this is a very strong argument. Also, I am not hiding.

Monika Rachtan
Such life insurance, right?

Mariusz Bidziński
Life insurance, and beyond that, I also make no secret of the fact that this is a kind of building of such a health culture. It has to be said clearly that these factors today are so effective that it would be difficult to argue with the fact that it is safe, that it is effective. All over the world, statistics show that HPV vaccination is really an extremely safe vaccine. Our anti-vaccine campaigns, so to speak, which were indeed linked to at least the MRNA vaccine, which was at the time of covidu, were because this vaccine was very, shall we say, short studied. These were vaccinations that were driven primarily by epidemiological needs. This one, on the other hand, already has a huge history, so to speak. Besides, there is no virus there, there is only a viral protein, which is absolutely safe and does not cause any negative consequences in our bodies. The only thing that this protein causes is that our organism recognises this element and such a protein will be eliminated regardless of whether it is a virus or not.

Monika Rachtan
We are at the grey end when it comes to reimbursable HPV vaccination worldwide and in Europe. How many years has this vaccination been in place in some countries?

Mariusz Bidziński
Australia, for example, began vaccination in 2006, and it can be said that they are already at such a stage that, in fact, cervical cancer will cease to visit this population in any way in the next few seasons. Therefore, in short, I am convinced, and this is also shown by other statistics, Scandinavian ones, that the effectiveness of this is extremely high, provided that people take advantage of it.

Monika Rachtan
To whom it is dedicated.

Mariusz Bidziński
I am not looking at statistics today, because in our reality in the public system we have 20% of this so-called population stock vaccinated. This shows that this so-called promotion of these vaccinations, despite the fact that they are free, despite the fact that they are actually reimbursed, is not appropriate And today we can say that we need to change our habits, we need to prepare ourselves more for the fact that if we are given such a gift, it is worth taking advantage of it and it is really worth participating in this project. The number of cytologies, which is scandalously low, in my opinion today this so-called size of cytology is also not measured, because we are talking about the public system, which is reported. And how much is in the non-public system, we do not know. Today, if we were reporting cytology not from the level of offices, not from the level of so-called medical records, but from laboratories, this would show, for example, the Covid era, when these reports were very precise, very genuinely reliable, and we knew how many people had occurred, 61% had at least one dose of the Covid virus vaccine, so you could see that this mechanism worked then. Was he merely, just out of fear, so to speak? I do not know. It seems to me that the logistics of this whole process were better.

Monika Rachtan
It seems to me that when it comes to cancer, everyone says, it doesn't affect me. But during the Covid 19 pandemic, we have seen people die en masse from Covid 19 virus infection on television. We have seen our loved ones end up in hospital. We have seen our loved ones get sick for 3 weeks and not be able to get up. But when we see something, we find it easier to believe it when we are talking about such a big abstraction as cancer for many of us. And let me remind you that the data say that soon one in three Poles will be faced with cancer. Maybe it is already the case that every third Pole is in contact with cancer. There are six people in the studio, at this point it is two of us who are likely to have personal contact with cancer. It's not uncommon and that's something we should probably finally realise.

Mariusz Bidziński
Can I say that I would like to disenchant this so-called cancer element. Because, to tell the truth, the word cancer or malignant tumour arouses horror. I make no secret of the fact that for us doctors, the important thing is to know when we are able to detect this disease. When we are able to diagnose. I have many of my patients, or rather patients, because I am a gynaecologist oncologist, who, thanks to the fact that they were actually diagnosed at a very early stage or at an early stage, are still alive today and are enjoying good health. So oncology is not just a string of failures. It is a very interesting discipline, which I can say I have been practising for many, many years, and I have the satisfaction of knowing that many people today have come to believe that it is possible to recover from cancer, provided we do not neglect it. And here is my appeal precisely to people who are listening, so that they really don't treat some of the symptoms like this, and it will go away on its own. If we really have a loss of weight, if we have a chronic cough, if we have stomach pains which do not really go away after the so-called first aid measures.

Mariusz Bidziński
However, let us nevertheless try not to underestimate certain things and to contact the doctor, to take that step forward, so that we can actually influence certain things. Today, we can say that oncology has really taken a giant step forward. Today, we have many treatment options, effective treatment, but on condition that the disease is detected early. There are preventive cancers, for example, cervical cancer, breast cancer and colorectal cancer, and if we used these tools today, there would really be far fewer of these diseases. And those who die might not exist at all.

Monika Rachtan
We very often complain in Poland about the health service. We say that the health service does not want to serve us, does not want to treat us. But many situations could be avoided if we respected our health more and performed preventive examinations. But it is also important to do the examinations themselves. However, it is important to start treatment when a worrying change occurs, when there is some indication that something is going on. However, it is important to dig deeper. To see a specialist, even to consult a second specialist, because a second opinion is nowadays practically the norm in medicine, and to undertake treatment, because, as the professor said, oncology today really does have excellent tools for radical treatment, in other words, for simply eliminating the cancer from our organism.

Mariusz Bidziński
The system of organisation that is being prepared, that is, the National Oncology Network, will also be a certain element, very important from the point of view of organisation for the patient. There, such a position of coordinator is being created. The coordinator will be that, so to speak.

Monika Rachtan
Paperclip.

Mariusz Bidziński
Such a jumper, i.e. the person who will guide this patient, just as it is in an airport, is the air traffic control tower, which actually guides the aircraft. It is not really a chaotic process, but it is a structured process and such a coordinator will make sure that certain things happen in a planned and consistent way. This is what is lacking today and, indeed, sometimes a person gets a result, but this result still has to be implemented by themselves. And this is, you could say, a very fractured model. In my opinion, this is also what sometimes causes people to lose trust in the system, because they say well, I go for a test, I get a bad result and what happens next? And they actually direct certain things themselves. That's not how it should be. It's just a question of preparing the process. My trust is, you could say, at a high level at the moment. If, in fact, I know that someone will take care of me, a professional will guide me through all these obstacles, that I will watch over it, I mean someone will watch over this process moving forward, in a specific direction.

Monika Rachtan
Yes, and coordinators are already increasingly present and working in Polish hospitals. We also featured coordinators from the Lower Silesian Centre for Oncology, Pulmonology and Haematology in our programme Po Pierwsze Pacjent. And if you feel like it, I invite you to recall the episode, or if you haven't seen it, to watch it. And just if you are even in the middle of treatment, ask your treating doctor your clinical oncologist if there is a coordinator on the particular ward and how you can benefit from their help. This really makes life easier because this coordinator knows exactly the pathway and knows which door to knock on. He knows which phone to call and the patient. This is especially true for elderly patients. He or she is guided by the hand through this whole diagnostic pathway, but this walk is much more pleasant in presence.

Mariusz Bidziński
It is safer above all. And there is actually an element of these organisational and logistical activities beyond the patient. He is under stress anyway. He really has to get used to the new situation. So if he has such a partner who realises certain things and suggests and organises them, this very clearly has a beneficial effect on the whole efficiency of the process.

Monika Rachtan
Is it true that doctors from abroad are coming to Poland to see what cervical cancer looks like?

Mariusz Bidziński
The question is an interesting one, to say the least, but I think it is a little overdue, so to speak. We can say today that in many countries this process, of course, of cervical cancer is still evident, both in France and Italy. Especially now that there is migration. We actually have a large number of people who have come to Europe from other continents. In fact, cases also occur in Sweden and Finland, where these prevention campaigns are very well developed, but undoubtedly on a much smaller scale than in Poland.

Monika Rachtan
The systemic changes that should take place to make HPV vaccination accessible have already been discussed by the professor. A few episodes ago, our guest on our programme was Piotr Merks, a pharmacist, with whom we talked about the morning-after pill. And on the internet, after that episode of the programme was published, there was a very big debate about whether pharmacists should dispense the pill, which is the case for girls aged 15. We are all familiar with this debate, by the way, as it is still going on on TV today. However, the professor said that there should be points in Poland where vaccinations can be carried out. He said that this does not necessarily have to be carried out at family doctors or paediatricians, but that these points could be used. Aren't you afraid, Professor, that this would again raise discussion between pharmacists and between the Ministry of Health, that at this point everyone would again want to take their hands off it, so that they wouldn't take responsibility for vaccinations. Especially as this is a very hot topic in Poland.

Mariusz Bidziński
I think that here a very important thing would be possibly whole processes within schools. School medicine is, of course, a very vestigial outline at the moment, but if we were to adopt such, I would say, joint action between the POZ authorities and schools in the regions, we are talking about local action at the moment. It doesn't have to be a central action. The central is to secure the product, whereas the organisation can actually be done in one's own area, If these so-called communities are actually, as in Wrocław well organised, it goes. And there is no reason for us to actually create some additional elements here that are actually tested. We have very effective tools today and some regions are showing that they have been able to introduce this. Therefore, let's use these models and there is no problem at all, only it has to be a really coherent project, and at the same time a project that will be really well prepared, so to speak, both organisationally and educationally, so that there are really as few people as possible contesting the project.
Monika Rachtan
Well. The Ministry of Health's educational campaign to promote HPV vaccination has been going on since that first June last year, for better or worse, but it is constantly appearing in the media. However, as we said at the beginning, the vaccination rate is not satisfactory, and many parents with whom I have spoken do not decide to vaccinate because they hear various things on the Internet about vaccines, that they can cause side effects, that, as I said at the very beginning of our conversation, they can predispose children to promiscuity. How do you convince these parents when it comes to safety? What are the other arguments to make them decide to go to the doctor and have their child vaccinated? Of course, probably systemic solutions and education, but we can't do that. I would very much like to reach out to people today who are listening to us and who are wondering, to convince them to go to the doctor.

Mariusz Bidziński
It is natural that it is difficult to take a single so-called step forward today. But the fact of the matter is that various facts, so to speak, are in the public so-called news. There is, of course, this so-called information, which I would call unsupported by any scientific evidence. All I can say is that both doctors and public figures should participate in this system. Just as today, we can say that the politicians who have inoculated themselves with the Covid vaccine have caused this acumen to grow.

Monika Rachtan
Yes, this is true.

Mariusz Bidziński
As they say, all hands on deck today. Everyone and influencers and those who have a big public perception should be great ambassadors. And besides, today I can say as a doctor working many years, I am absolutely convinced and if I had any doubts about the effectiveness of these projects, at the same time I would also see some inconsistency, I would certainly not allow myself to communicate this in such a studio and in public. I believe that if we want to live a long life without major problems, we should be proactive in this regard.

Monika Rachtan
Can any side effects occur after vaccination? If I go with my daughter, with my son for vaccination, is there anything I should look out for in the next 24 hours?

Mariusz Bidziński
These are only minor post-vaccination reactions. After any vaccine we can have a temperature, we can have a local skin reaction, while major problems have not been observed. There are statistics that show that the number of these so-called vaccination reactions is small, and they are of a very mild nature. Also, I have no doubt that this is nothing that could cause profound health consequences.

Monika Rachtan
We would like society as a whole to be convinced about vaccination and we would like all parents to make the decision to have their children vaccinated. But at what level should vaccination rates be so that we in Poland can slowly think that diseases caused by HPV will cease to exist?

Mariusz Bidziński
When it comes to prevention, those who are involved in it and have what is called 'deep knowledge' believe that 70% of the population, if they are active in prevention, we can build on that. In our national oncology strategy system, we have assumed that 60% girls and boys will be vaccinated by 2028. It seems to me that this threshold of 60% is such the lowest threshold to be vaccinated, because the transmissibility of these elements is an extremely important factor. If there are 60% boys and 60% girls, the chance of us transmitting this viral process to each other is negligible.

Monika Rachtan
On the occasion of our meeting, the professor is a gynaecologist, but he is also an oncologist. It is impossible not to ask about the prevention of precisely women, girls, because it is not only cervical cancer that threatens us. There are also other cancers that strictly affect women. Prevention, knowledge of one's own body, interest in one's health is extremely important, and in most cases, if we had such skills, which I am sure the professor will talk about in a moment, many cancers would be detected much earlier. I am of course referring to breast cancer, the main killer of women in our country.

Mariusz Bidziński
In truth, the first thing I would urge you to do is to establish your family pedigree. How many people in our family have had cancer? This is very important information. If there have been two or three people in the family with breast cancer, a man with bowel cancer or prostate cancer, then a window starts to open in the system that it could be cancer that has what is called a family genealogy. The incidence can pass from generation to generation. There are so-called high-risk families. In female cancers, both breast cancer and ovarian cancer are among such cancers, but this does not mean that mutations in genes, mainly BRCA1, BRCA2, do not also contribute to male cancers. Prostate cancers, pancreatic cancers can also be initiated by these mutations. In short, it is worth tracing your family lineage. It used to be that people were ashamed to talk about cancer. It was something shameful, like leprosy and so on. Whereas today we can say, more and more people are saying: no, I am not fighting cancer, I am living with cancer. Therefore, the family pedigree is very important. If we pass it on to the doctor, he may start to look at certain things differently, he puts the person in a group of low or high risk of contracting certain diseases, and this is a signal for the selection of diagnostic tools.

Monika Rachtan
Who to talk to? With the family doctor, with our gynaecologist? To whom to present this pedigree of ours?

Mariusz Bidziński
Every doctor should be the recipient of this. I make no secret of the fact that it is not common for doctors to ask for this kind of information. Therefore, we should have this information in our minds and pass it on. It can be a very important signal in the selection of diagnostic tools. Besides, breast cancer, it can be said that getting used to examining the breasts from puberty onwards should be a permanent element. Everyone, while bathing, can assess their body if it has changed in some way. Women look at their breasts, it is not a supernatural phenomenon. They look at the breasts and it is worth noting all sorts of symptoms. A change in the appearance of the breasts, a change in configuration, leakage from the breasts are all things that need to be checked by a doctor. The system is alert and signals problems quite early. On the other hand, the fact is that, unfortunately, some people think that it will pass on its own. If we are talking about such things, it is worth consulting a doctor.

Mariusz Bidziński
Also, mammography screening. We have lowered the limits of these examinations to 45-74 years of age. Women can have a mammogram once every two years. If we take advantage of this package on a regular basis, we should not have major problems with breast cancers, because they can be detected at a very early stage. They can be treated very sparingly and without fear of the disease progressing.

Monika Rachtan
How often should we perform the breast examination itself?

Mariusz Bidziński
In a woman who is menstruating, after menstruation such a breast examination is advisable. On the other hand, in a woman in menopause, once a month or when bathing. It is useful for a woman to touch her breasts to see if anything new has appeared.

Monika Rachtan
Breast examination can be done by husband, partner. Taking care of each other's health is extremely important. Today we talked about primary prevention, secondary prevention. I would like to remind our audience that taking care of yourself is not just about playing sports at the gym, it is not just about eating healthily, but above all about prevention, both primary and secondary. If you don't know what tests you should do, what tests are reimbursed to you, it is worth talking to your GP and taking advantage of what the system gives us free of charge. My guest today was Professor Mariusz Bidzinski. Thank you, Professor.

Mariusz Bidziński
Thank you very much. I would also like to add that what the editor said, taking care of your figure is also important, because a sporting mode, an active mode and avoiding stimulants are decalogues for preventing various diseases.

Monika Rachtan
Of course it is, but it can't be all that important to reach for these diagnostic tools, especially as they are at your fingertips. This was the 'First Patient' programme. My name is Monika Rachtan, thank you for your attention and I invite you to subscribe to the channel.