Tyumen Doctor on Breast Cancer, Nipple Piercing, and Breast Health

In 2022, the World Health Organization recognized breast cancer as the most common cancer in women. That same year, approximately 670,000 people died from it. Many fear this disease, but it is far from the only breast issue one may encounter.

Natalia Krechetova has been working as an oncologist-mammologist for 19 years. She currently practices at the NEO-Clinic medical center. We asked her the most important questions about breasts: we talked about cancer, pierced nipples, and how poorly cleaned teeth can lead to nipple inflammation. Read all about it in the extensive interview with 72.RU.

When to See a Mammologist and Why It«s Hard to Get an Appointment

— What issues do Tyumen residents come to an oncologist-mammologist with?

— Most often, it«s some kind of lump in the breast that a woman finds herself. It can also be pain sensations, such as a burning feeling or just discomfort, when she can»t sleep or lie down, she feels somehow uneasy. There can also be discharge from the breast.

Or it might be that nothing bothers you, but a gynecologist or endocrinologist refers you to me for a consultation. A separate category is girls who are planning a pregnancy, or those who want to undergo plastic surgery.

— How often should one see a mammologist and starting from what age?

— You should come for a preventive check-up once a year. And, of course, more often if something is bothering you. Usually, up to 18 years old, a pediatrician conducts the examination, but adult patients come to me.

— At what age should one start monitoring breast health in general?

— Breast glands in girls begin to develop at 12–13 years old. From this point, if there are no complaints, the mother should gradually teach the girl to perform self-examination. If there are complaints, then it«s worth seeing a doctor.

— About self-examination: how often should it be done?

— It is done once a month to know what your breast looks like normally. There are various videos and brochures dedicated to self-examination. Briefly: you need to look at yourself in the mirror, raise your arms up and down, palpate the breast standing and lying down. Be sure to pay attention to the condition of the nipples and the presence of discharge — they are easily noticed by the state of the underwear. If a woman has a regular cycle, this should be done after the menstrual discharge ends.

This is very important, I constantly say during appointments, since it is believed that most often women find lumps on their own, then sexual partners, and only after them — doctors during medical check-ups.

— We have received complaints that it is difficult to see a mammologist at a polyclinic. Why is that? Is it a rare specialization?

— When I started working, there were six of us in the city. Now practically every center has a mammologist. So I don«t know what this is related to. I can assume that a mammologist is primarily an oncologist. To get the specialization, you need to go through many stages, participate in surgeries, see the deaths of adults and children.

My professional activity also began in an oncology dispensary, and in a psychological sense, it is heavy work. I am sometimes invited to work, and I answer: «Thank you, I»ll just come for tea.« Because we are getting older, we have families, children. And I, for example, cannot be in the children»s department. It«s calmer here.

At the same time, I adore my specialty. There couldn«t be anything better.

Is It Safe to Pierce Nipples and Is Breastfeeding Beneficial

— There is a lot of talk about properly fitted underwear. How can it affect breast health?

— There is an influence. Underwear should be fitted by size, by the width of the chest. I am against push-ups, bras with underwires, and various synthetic fabrics. Specifically about underwires: they can cause lymphostasis, as they are located in areas of vessels where lymph flows.

When a woman walks with breast pain all week, it«s not very pleasant. Now there are many companies that consult oncologists and create series of underwear that can, so to speak, prevent cancer, help during premenstrual syndrome.

I am also often asked if it«s okay to go without underwear. Like, they read an article that if you go without it, pathology can appear. Actually, that»s nonsense. Is it comfortable to wear underwear? Please. Is it uncomfortable to wear underwear? Also please.

— Do breast shape and size somehow affect its health?

— Size absolutely does not affect health at all. The same with shape and symmetry. People are generally asymmetrical, so the right and left breasts can differ, and that«s normal. We can talk about pathology only if in some short period, over two or three weeks, the breast size changes sharply.

Often this becomes a cause of complexes. Certainly during an appointment, someone will come and say: «My breasts are asymmetrical, don»t pay attention.« I usually reply: »If we undress in the clinic now, you«ll see — everyone will have the same as you.»

Of course, there are cases where asymmetry is present from birth, one breast simply doesn«t develop, for example. Now plastic surgeons can correct all this. But such cases are not common.

— Another common complex arises in women with age, when breasts sag and become less firm. How to deal with this and is it necessary?

— You can accept it or not, but there«s nothing to be done. In any case, a woman, like a man, changes with age. Since a woman gets older and enters menopause, when the active production of female sex hormones stops, her breast tissue restructures and is replaced by fatty tissue.

Inevitably, the breast becomes less firm, softer, and more elastic. Probably, one should approach this issue calmly, what other options are there? You need to accept yourself. And try to maintain health: watch your diet, weight.

— Often women address the issue with plastic surgery. What is your attitude towards this?

— It has been proven that implants are not a cause of breast cancer. That is, it«s safe. But if you get implants, you need to keep in mind that they are foreign bodies in your organism. You need to get examined annually, do an MRI of the breasts. Then everything will be fine. I note that implants do not affect the doctor»s work in any way.

Now, specifically in my practice, I see a trend: women who once got implants are now coming for consultations before surgery to remove these implants. Fashion is cyclical, and now, I think, women have started to prefer more natural options. That«s probably good.

— What about pierced nipples — is that normal?

— But regarding piercing specifically in the nipple area, I am extremely negative. Patients who come to me often have reactions to the presence of metal jewelry in this area, such as inflammatory processes, purulent discharge, and so on.

We must remember that the nipple is still that part of the breast that enters the child«s oral cavity. Often girls who have had piercings end up having certain difficulties. The nipple can change shape, there can be scar changes. It»s worth thinking carefully about whether to get nipple piercing.

— Since we«re talking about breastfeeding, there is also an opinion that it somehow positively affects breast health. Is that true?

— In most cases, it does favorably affect the gland. Especially when a woman has benign mastopathies, cysts identified before childbirth.

Our hormonal background is such that after childbirth, during breastfeeding, hormones start to be produced that not only provide breast milk but suppress cysts, mastopathy can disappear too. It is also believed that during breastfeeding, the growth of fibroids and endometriosis is suppressed.

Unfortunately, there are also cases where tumors appear during breastfeeding. I believe it is not related to feeding — surely the formations were there before childbirth, but in the process, they turned malignant. After all, for the organism, this is a certain stress. Therefore, gynecologists have started sending women who are planning pregnancy to me for examination more often.

All About Breast Cancer

— They say that breast cancer is almost the most dangerous cancer. Is that true?

— It is definitely not the most aggressive type of tumor; it is well diagnosed and treatable, so here I don«t entirely agree. But it is very common worldwide and is the main cause of mortality in women — it is believed that every third woman has or will have breast cancer. Therefore, breast cancer attracts attention, even though it is not the most dangerous.

It might seem that breast cancer has become more common. Actually, examinations have just become more accessible, and it is found more often in time.

— Is it difficult to diagnose breast cancer?

— Breasts are external organs, and most often women find a tumor literally at the first stage. Moreover, women go to doctors more often and get examined, do mammography, and so on.

— What symptoms should raise concern?

— Most often, cancer starts with a lump that doesn«t hurt or bother. Sometimes there are forms of cancer where the breast burns, becomes red, hurts, and swells. A woman might think she has, as they say, caught a chill. But always remember that there are also cancers that do not start with a lump.

There are also forms where everything in the breast is soft and fine, but in the armpit area, lumps also appear. More often, this is just a sign of lymph node inflammation, but sometimes it can be a manifestation of more aggressive cancer. In any case, it«s better to come and dispel your doubts, because it can be completely different from what is written on the internet.

— What about treatment in Tyumen?

— If this disease is found early, it is very treatable. Those women in whom I have detected oncology most often recover and return to me — just to talk or get checked again.

Now there are many varieties of treatment. Surgical, radiation, drug, hormonal, targeted therapy. Moreover, our region is distinguished by having an oncology center, and there are many opportunities there. But the queue is long, high workload.

— What if it«s a severe stage?

— The last stage can be very different. There can be metastases throughout the body, or it can be that the tumor is very small but close to the skin, and then the fourth stage is also assigned. Here, everything is very individual.

In any case, I always tell women that they need to be treated. There was a case where I thought the patient had a year left to live, and she has been running around for 18 years now, better than we do. The right attitude and sincere support from family and loved ones help a person. You need to trust them and the doctors, not read articles on the internet. And definitely be treated.

— Can breast cancer return?

— That sometimes happens. This summer, I had a patient who had a breast formation detected nine years ago. Now she had a formation in the second breast, but she was also treated well. Now she continues under observation.

— I heard there is some examination that can determine a predisposition to breast cancer. Can you tell about it?

— Yes, a special blood test is conducted that helps a woman understand if she has gene mutations responsible for breast cancer and ovarian cancer. On a paid basis, any woman can take it, but first and foremost, it is indicated for women who have cases of blood relatives with breast cancer and ovarian cancer.

For example, Angelina Jolie«s mother suffered from this disease, so she took such a test, found that she has gene mutations and a high probability of tumors. And, accordingly, she underwent necessary medical procedures to protect herself as much as possible.

— Our reader passed on a question: how realistic is it to see oncology at an early stage on a mammogram conducted during a medical check-up?

— In the last five to eight years, the level of mammography in city polyclinics has become very high. The only thing, I always tell patients: first, always do it on the 5th–12th day of the cycle and always take the storage device from the polyclinic on which the examination is recorded. Because, unfortunately, the description from the polyclinic does not always correspond to what is on the disk. Today, two women came to me whose description was one thing, but on the disk it was another.

Mastitis, Cysts, and Other Problems

— Besides cancer, there are other diseases. Let«s talk a bit about them too. What is a breast cyst and how can it harm?

— As in any other organ, a cyst in the breast is a capsule with fluid inside. In the breast, the appearance of a cyst is related to the expansion of a duct — a little tube through which milk goes towards the nipple. Most often, duct expansion is hormonal in nature — menstrual cycle irregularities, thyroid diseases, receiving hormone therapy.

By itself, a cyst almost never becomes malignant. There are rare cases where tumors begin to form in the cyst wall.

— What does mastitis look like and how dangerous is it?

— It is inflammation of the breast. Mastitis can be acute, chronic, lactational. Like any inflammation, mastitis is dangerous — if not helped in time, a person can even die.

Since mastitis develops very quickly, women often end up in surgery, where the breast has to be cut open, cleaned out, so mastitis needs to be taken very seriously.

— Is mastitis more common in breastfeeding mothers or is there no connection?

— Probably, the frequency is slightly higher, but I want to say that non-breastfeeding women also come with mastitis very often. Not always do women know that they have cysts in the breast that can become inflamed.

— What is mastopathy? How does it manifest and how is it treated?

— In simpler terms, it is a disruption in the structure of breast tissue or the appearance of some formations due to hormonal changes. These can be neoplasms that shouldn«t be there, pronounced tissue density.

Most often, women with mastopathy have some concomitant gynecological or endocrine diseases. Some types of mastopathy, for example, diffuse, can increase the risk of cancer.

— Is there anything unexpected that patients often come with?

— I have several girls who regularly came with nipple inflammation. This continued until I directly said that they need to take their sexual partner for teeth cleaning. Yes, the nipple has ducts through which infection can enter during kisses and caresses.

Sometimes women come with complaints of pain after a partner strongly squeezed the breast. But they usually go away on their own, so there«s no need to worry. Just need to be more careful.

This interview is a continuation of our series of conversations with Tyumen doctors. Here are the previous ones:

1. «Have Sex Until Your Last Breath»: A Big Conversation with a Gynecologist About HPV, Menopause, and Vaginal Size.

2. «A Girl Did a Kerosene Detox»: A Tyumen Endocrinologist on Ozempic, the Diabetes Epidemic, and Crazy Diets.

3. «It»s Unproductive to Feel Inferior About Penis Size«: A Conversation with a Tyumen Urologist About Prostate Cancer, Intercourse Duration, and Viagra.

4. »Cells Mutate in Everyone«: A Tyumen Doctor on One of the Most Insidious Cancers That Kills Millions;

5. »The Disease Doesn«t Choose by Gender or Status»: A Tyumen Venereologist on «Shameful» Infections and Protection from Them.