GREATER practical and financial help for parents is on the cards now that a new 'family law' has passed its second reading in the Council of Ministers, with extended maternity and paternity pay, protected time...
Spain marks International Breast Cancer Day
20/10/2019
WHEREVER you are in the world, you will probably have seen pink loops somewhere in the run-up to this weekend, and may have watched a sponsored run cut through your town with everyone dressed in pink – yesterday (Saturday) was International Breast Cancer Day and, in Spain, it had made headline news on almost every level.
Locally, because of fun runs and other activities to raise money for breast cancer care and research, and nationally, with everyone from sports teams to shopkeepers wearing pink.
Real Madrid Basket, defending champions of the Endesa League, played Galicia-based team Obradoiro yesterday in the fifth day of the ACB – and Obradoiro wore pink versions of their uniforms for the game, before signing them and putting them up for auction with all proceeds going to the Association Against Metastatic Breast Cancer.
Fans can buy their own (second picture) for as long as stocks last for between €36 and €50.
The Spanish national football team, known as La Roja ('The Reds'), became La Rosa, or 'The Pinks' for International Breast Cancer Day when they trained at the Friends Arena in Solna ahead of their match against Sweden which, they hope, will seal their place in the UEFA Euro for next year – a competition they won twice on the trot in 2008 and 2012, with a World Cup in between.
One in every eight will be diagnosed – but nearly nine in 10 will survive
It has not all been about raising awareness, though. Whilst this is important – anyone who finds signs they are not comfortable with should go straight to their GP, who will refer them for tests, and should never ignore it on the basis that it 'might be nothing' – research and improving diagnosis are behind many of the nationwide events to mark the occasion.
Thanks to better diagnostic techniques and women being less reticent about being checked out if they are suspicious, a huge number of cases of breast cancer are found in time, meaning they can be successfully treated and, in nearly 90% of cases, completely cured.
As many as one in eight women worldwide will be diagnosed with breast cancer at some point in their lives, and of these, eight in 10 at least will make a full recovery, according to latest statistics.
Men can also get breast cancer, although they account for fewer than 1% of the total – this said, among that 1% is R&B singer Beyoncé's father, the star has just announced.
Research mostly depends upon charities
Corporate support is crucial to the battle against breast cancer or, at least, the quest for it to one day be no more than a temporary and non-life-threatening health condition with few or no side effects of the disease or treatment.
Mindful of this, Spain's richest man, Inditex founder Amancio Ortega has donated 23 latest-generation diagnostic devices to hospitals across the Madrid region, of which 18 will be in use before the end of this year and the remaining five some time in 2020.
They include 13 high-performance lineal accelerators (third picture), five image-based machines – three 4D CAT scanners, an MRI scanner and a PET scanner, the latter being the most thorough but typically the most expensive – plus five sets of treatment equipment for brachytherapy, which is where radiation emitters are fitted inside the tumour, a common practice with prostate cancer.
The equipment has been supplied by the Amancio Ortega Foundation, the charitable wing of the Inditex clothing empire – whose star brand is Zara – and, in fact, a huge amount of key research into treatment and early diagnosis owes its existence to charities; the biggest nationwide is the AECC, which offers all-round care, prevention advice and support as well as carrying out research.
Another of these vital organisations is the GEICAM Group, Spain's largest breast cancer research charity and one that has been running for 20 years, with over 800 specialists giving up part of their time to volunteer in its laboratories.
Volunteers and 'completely independent research'
This 'enormous altruistic labour', as Dr Eva Carrasco, scientific and general director of GEICAM and medical oncologist by profession, calls it, helps support clinical trials, which are not only essential for newly-created drugs reaching the mainstream market, but are often a source of hope, sometimes the last hope, for patients who have exhausted all treatment possibilities.
Head of clinical operations Dr Gema Sanz (on the left in picture four) says participants in GEICAM's clinical trials are often patients who 'seek access to drugs that are not yet commercialised' and, in doing so, 'help create a body of evidence for future patients'.
Crucially, as a charity staffed entirely by volunteers, GEICAM's research is not commissioned by any pharmaceutical company and is able to be totally independent. Whilst ethical practices in science dictate that research should never be influenced by finances, the recognised reality is that studies which find pharmaceutical solutions not to be effective often do not see the light of day.
“Even though what you're essentially doing is research, it's always with the underlying objective of positioning a pharmaceutical drug,” explains Dr Carrasco (on the right in picture four).
“That's why, by volunteering for GEICAM, you're taking part in academic investigations that are purely and simply for the benefit of the patient and nobody else – you're carrying out as many studies as you possibly can, studies which nobody else would ever do, let alone the industry itself.”
Despite not paying salaries, GEICAM's work still costs millions of euros every year, and it relies entirely on donations.
The cost of survival
As well as finding solutions to breast cancer, GEICAM seeks to find treatment with 'the fewest possible side-effects and after-effects'.
This is crucial, since, although early-stage breast cancer may leave no real traces behind once cured, later-stage cases do, even if they do not recur: an estimated 47% of non-retired women who have to undergo a mastectomy are unable to return to their jobs, say figures released by the Social Security Institute.
They are typically those who have had lymph nodes removed at the same time, which can leave them with a swollen or painful arm – and, according to the Spanish Association of Breast Cancer Surgeons, those who most commonly have to give up work as a result, or find some other way of earning a living, are shop assistants, hairdressers, cleaners, factory workers, carers, nurses, or anyone else whose job means working with their hands or at least a minimum of physical effort, such as lifting, or repetitive arm movements.
They can take up to a year off work with pay, which can then be extended upon review to up to another six months, giving them time to either see whether their condition improves or they can find work that does not aggravate it; if neither is the case, they will need to apply for permanent disability status.
Clearly, these scenarios are far from ideal either for the State or the patient; it's a cost to the former, and what the latter actually earns in disability falls a long way short of a living wage, and even of the minimum wage. To this end, research that allows women to be treated successfully but with as little lasting damage as possible is an investment across the board.
The future: 'Liquid' biopsies, immunotherapy and genetics
Research to date is focusing on the 'liquid biopsy', or blood tests to ascertain the genetic makeup of tumours and detect a return of the disease long before visible signs are available. The traditional biopsy method takes a sample of the tumour to analyse, but different genetic mutations may be present in different parts of the tumour, which may be missed and therefore not targeted in specific treatment. Genetic research into all types of cancer is, therefore, one of the hottest topics at present, since it allows treatment to be fine-tuned to what is essentially as diverse in each person as their fingerprint.
Immunotherapy is another key area, and one which GEICAM is focusing on along with genetic platforms and the liquid biopsy: strengthening the immune system so it recognises a tumour as a 'foreign body' and fights it is the premise behind immunotherapy, although at the moment, very few results have been reached showing it works well with breast cancer. In theory, however, the basis for it is a logical one, according to Dr Sanz and Dr Carrasco, meaning it needs to be explored in full.
And according to the Clara Campal Integral Oncology Centre, part of the HM Hospitals Research Foundation – known as HM-CIOCC and with branches in Madrid, Barcelona and Santiago de Compostela (Galicia) – immunotherapy is starting to show positive results in women with the 'triple negative' strain of breast cancer, a subtype which, until now, has been 'seriously lacking in innovative treatment methods', says Dr Joan Albanell of the Barcelona laboratory.
It is also prolonging life in women with metastatic breast cancer by slowing down the spread of the disease.
Prevention through screening: An age issue
With over 26,000 cases of breast cancer diagnosed in Spain every year, of which over 99% are in women, the HM-CIOCC wants to see an overhaul in routine screening programmes, since it has been proven these save lives.
At the moment, each of Spain's 17 autonomously-governed regions has its own criteria for breast cancer screening, with the most 'generous' offering automatic bi-annual mammograms (fifth picture) to all women aged 45 to 69 inclusive.
But some do not start screening until age 50 or even 55, some stop at 65, and some do both.
Dr Eva Ciruelos says these need to be streamlined so their availability is less of a postcode lottery.
In the Comunidad Valenciana, activist and cancer survivor María Ferrer, from Jávea (Alicante province), presented a petition with over 200,000 signatures to the regional health authority calling for routine mammograms to be given from age 30 in patients with a family history.
These authorities discussed reducing the minimum age to 40, and then decided there was no 'scientific basis' for changing it.
María Ferrer disagrees: having been churning it over since her own mother died in her 30s from breast cancer, she decided to buy herself peace of mind by paying for a private mammogram when she was 42 – and this revealed she, too, had breast cancer.
If she had waited until she was 45 to start routine screening, she says, she 'would not be alive today'.
Generally, mammograms are considered ineffective below the age of 45, since breast tissue is too dense to detect tumours; however, younger women can be given an ultrasound instead.
Whilst the routine testing is not yet available for women aged 44 or less, or 70 or more, anyone who has a family history or is at all concerned for any other reason can and should ask their GP for a test referral, and in the event of physical changes or any case of a female relative being diagnosed – even as much as four generations back – this will always be granted.
“A human perspective”
Happily, much has changed since, decades ago, women were afraid to report unusual physical signs to their GP in case they were dismissed as 'overreacting', but the HM-CIOCC still stresses the need for oncologists and family doctors to continue working on communication. Dr Mercedes Herrero, from the Madrid branch, says: “I think practically every woman has thought at least once in her life that she might have breast cancer. I hear about it from them every day in my surgery. It's because of the frequency of it, and the campaigns staged to increase visibility.
“All of them have had a close experience of some description with the disease, but they also know that the prognosis these days is very good, with very high survival rates and good quality of life.
“But they also complain that all this good news is trivialising breast cancer.
“They want to see greater social sensitivity, and greater sensitivity on the part of companies, when it comes to getting on with their daily lives.
“We as professionals need to make an effort to translate our knowledge into clear, jargon-free language, because women are demanding accessible, realistic and complete information, empathy, and a human perspective.
“We need to look at their eyes, not at our computers.”
Related Topics
WHEREVER you are in the world, you will probably have seen pink loops somewhere in the run-up to this weekend, and may have watched a sponsored run cut through your town with everyone dressed in pink – yesterday (Saturday) was International Breast Cancer Day and, in Spain, it had made headline news on almost every level.
Locally, because of fun runs and other activities to raise money for breast cancer care and research, and nationally, with everyone from sports teams to shopkeepers wearing pink.
Real Madrid Basket, defending champions of the Endesa League, played Galicia-based team Obradoiro yesterday in the fifth day of the ACB – and Obradoiro wore pink versions of their uniforms for the game, before signing them and putting them up for auction with all proceeds going to the Association Against Metastatic Breast Cancer.
Fans can buy their own (second picture) for as long as stocks last for between €36 and €50.
The Spanish national football team, known as La Roja ('The Reds'), became La Rosa, or 'The Pinks' for International Breast Cancer Day when they trained at the Friends Arena in Solna ahead of their match against Sweden which, they hope, will seal their place in the UEFA Euro for next year – a competition they won twice on the trot in 2008 and 2012, with a World Cup in between.
One in every eight will be diagnosed – but nearly nine in 10 will survive
It has not all been about raising awareness, though. Whilst this is important – anyone who finds signs they are not comfortable with should go straight to their GP, who will refer them for tests, and should never ignore it on the basis that it 'might be nothing' – research and improving diagnosis are behind many of the nationwide events to mark the occasion.
Thanks to better diagnostic techniques and women being less reticent about being checked out if they are suspicious, a huge number of cases of breast cancer are found in time, meaning they can be successfully treated and, in nearly 90% of cases, completely cured.
As many as one in eight women worldwide will be diagnosed with breast cancer at some point in their lives, and of these, eight in 10 at least will make a full recovery, according to latest statistics.
Men can also get breast cancer, although they account for fewer than 1% of the total – this said, among that 1% is R&B singer Beyoncé's father, the star has just announced.
Research mostly depends upon charities
Corporate support is crucial to the battle against breast cancer or, at least, the quest for it to one day be no more than a temporary and non-life-threatening health condition with few or no side effects of the disease or treatment.
Mindful of this, Spain's richest man, Inditex founder Amancio Ortega has donated 23 latest-generation diagnostic devices to hospitals across the Madrid region, of which 18 will be in use before the end of this year and the remaining five some time in 2020.
They include 13 high-performance lineal accelerators (third picture), five image-based machines – three 4D CAT scanners, an MRI scanner and a PET scanner, the latter being the most thorough but typically the most expensive – plus five sets of treatment equipment for brachytherapy, which is where radiation emitters are fitted inside the tumour, a common practice with prostate cancer.
The equipment has been supplied by the Amancio Ortega Foundation, the charitable wing of the Inditex clothing empire – whose star brand is Zara – and, in fact, a huge amount of key research into treatment and early diagnosis owes its existence to charities; the biggest nationwide is the AECC, which offers all-round care, prevention advice and support as well as carrying out research.
Another of these vital organisations is the GEICAM Group, Spain's largest breast cancer research charity and one that has been running for 20 years, with over 800 specialists giving up part of their time to volunteer in its laboratories.
Volunteers and 'completely independent research'
This 'enormous altruistic labour', as Dr Eva Carrasco, scientific and general director of GEICAM and medical oncologist by profession, calls it, helps support clinical trials, which are not only essential for newly-created drugs reaching the mainstream market, but are often a source of hope, sometimes the last hope, for patients who have exhausted all treatment possibilities.
Head of clinical operations Dr Gema Sanz (on the left in picture four) says participants in GEICAM's clinical trials are often patients who 'seek access to drugs that are not yet commercialised' and, in doing so, 'help create a body of evidence for future patients'.
Crucially, as a charity staffed entirely by volunteers, GEICAM's research is not commissioned by any pharmaceutical company and is able to be totally independent. Whilst ethical practices in science dictate that research should never be influenced by finances, the recognised reality is that studies which find pharmaceutical solutions not to be effective often do not see the light of day.
“Even though what you're essentially doing is research, it's always with the underlying objective of positioning a pharmaceutical drug,” explains Dr Carrasco (on the right in picture four).
“That's why, by volunteering for GEICAM, you're taking part in academic investigations that are purely and simply for the benefit of the patient and nobody else – you're carrying out as many studies as you possibly can, studies which nobody else would ever do, let alone the industry itself.”
Despite not paying salaries, GEICAM's work still costs millions of euros every year, and it relies entirely on donations.
The cost of survival
As well as finding solutions to breast cancer, GEICAM seeks to find treatment with 'the fewest possible side-effects and after-effects'.
This is crucial, since, although early-stage breast cancer may leave no real traces behind once cured, later-stage cases do, even if they do not recur: an estimated 47% of non-retired women who have to undergo a mastectomy are unable to return to their jobs, say figures released by the Social Security Institute.
They are typically those who have had lymph nodes removed at the same time, which can leave them with a swollen or painful arm – and, according to the Spanish Association of Breast Cancer Surgeons, those who most commonly have to give up work as a result, or find some other way of earning a living, are shop assistants, hairdressers, cleaners, factory workers, carers, nurses, or anyone else whose job means working with their hands or at least a minimum of physical effort, such as lifting, or repetitive arm movements.
They can take up to a year off work with pay, which can then be extended upon review to up to another six months, giving them time to either see whether their condition improves or they can find work that does not aggravate it; if neither is the case, they will need to apply for permanent disability status.
Clearly, these scenarios are far from ideal either for the State or the patient; it's a cost to the former, and what the latter actually earns in disability falls a long way short of a living wage, and even of the minimum wage. To this end, research that allows women to be treated successfully but with as little lasting damage as possible is an investment across the board.
The future: 'Liquid' biopsies, immunotherapy and genetics
Research to date is focusing on the 'liquid biopsy', or blood tests to ascertain the genetic makeup of tumours and detect a return of the disease long before visible signs are available. The traditional biopsy method takes a sample of the tumour to analyse, but different genetic mutations may be present in different parts of the tumour, which may be missed and therefore not targeted in specific treatment. Genetic research into all types of cancer is, therefore, one of the hottest topics at present, since it allows treatment to be fine-tuned to what is essentially as diverse in each person as their fingerprint.
Immunotherapy is another key area, and one which GEICAM is focusing on along with genetic platforms and the liquid biopsy: strengthening the immune system so it recognises a tumour as a 'foreign body' and fights it is the premise behind immunotherapy, although at the moment, very few results have been reached showing it works well with breast cancer. In theory, however, the basis for it is a logical one, according to Dr Sanz and Dr Carrasco, meaning it needs to be explored in full.
And according to the Clara Campal Integral Oncology Centre, part of the HM Hospitals Research Foundation – known as HM-CIOCC and with branches in Madrid, Barcelona and Santiago de Compostela (Galicia) – immunotherapy is starting to show positive results in women with the 'triple negative' strain of breast cancer, a subtype which, until now, has been 'seriously lacking in innovative treatment methods', says Dr Joan Albanell of the Barcelona laboratory.
It is also prolonging life in women with metastatic breast cancer by slowing down the spread of the disease.
Prevention through screening: An age issue
With over 26,000 cases of breast cancer diagnosed in Spain every year, of which over 99% are in women, the HM-CIOCC wants to see an overhaul in routine screening programmes, since it has been proven these save lives.
At the moment, each of Spain's 17 autonomously-governed regions has its own criteria for breast cancer screening, with the most 'generous' offering automatic bi-annual mammograms (fifth picture) to all women aged 45 to 69 inclusive.
But some do not start screening until age 50 or even 55, some stop at 65, and some do both.
Dr Eva Ciruelos says these need to be streamlined so their availability is less of a postcode lottery.
In the Comunidad Valenciana, activist and cancer survivor María Ferrer, from Jávea (Alicante province), presented a petition with over 200,000 signatures to the regional health authority calling for routine mammograms to be given from age 30 in patients with a family history.
These authorities discussed reducing the minimum age to 40, and then decided there was no 'scientific basis' for changing it.
María Ferrer disagrees: having been churning it over since her own mother died in her 30s from breast cancer, she decided to buy herself peace of mind by paying for a private mammogram when she was 42 – and this revealed she, too, had breast cancer.
If she had waited until she was 45 to start routine screening, she says, she 'would not be alive today'.
Generally, mammograms are considered ineffective below the age of 45, since breast tissue is too dense to detect tumours; however, younger women can be given an ultrasound instead.
Whilst the routine testing is not yet available for women aged 44 or less, or 70 or more, anyone who has a family history or is at all concerned for any other reason can and should ask their GP for a test referral, and in the event of physical changes or any case of a female relative being diagnosed – even as much as four generations back – this will always be granted.
“A human perspective”
Happily, much has changed since, decades ago, women were afraid to report unusual physical signs to their GP in case they were dismissed as 'overreacting', but the HM-CIOCC still stresses the need for oncologists and family doctors to continue working on communication. Dr Mercedes Herrero, from the Madrid branch, says: “I think practically every woman has thought at least once in her life that she might have breast cancer. I hear about it from them every day in my surgery. It's because of the frequency of it, and the campaigns staged to increase visibility.
“All of them have had a close experience of some description with the disease, but they also know that the prognosis these days is very good, with very high survival rates and good quality of life.
“But they also complain that all this good news is trivialising breast cancer.
“They want to see greater social sensitivity, and greater sensitivity on the part of companies, when it comes to getting on with their daily lives.
“We as professionals need to make an effort to translate our knowledge into clear, jargon-free language, because women are demanding accessible, realistic and complete information, empathy, and a human perspective.
“We need to look at their eyes, not at our computers.”
Related Topics
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