2020-25 OUR ACTIVITIES

Este será nuestro año, hemos demostrado que cabe una nueva manera de enseñar a diagnosticar tempranamente el cáncer de Seno. Seguimos revisando los 3 pilares de la llamada "Prevención del cáncer de Seno" y los adaptamos a nuestra realidad, la cual a su vez es la realidad latinoamericana como podrán leer hoy. Estamos comprometidos como nunca con lo que hacemos y ya veremos nuestro recorrido. Nuestro lema para este año además de ENSEÑAR A ENSEÑAR es que VAMOS ADONDE OTROS NO VAN y así hemos ido a sitios impensables de nuestra geografía , como hace 1 mes al Caquetá, a una región donde no iba una brigada médica hacia 20 años debido a la violencia. Tenemos la ventaja del apoyo de las FFMM y policía .

Seguimos convencidos que las soluciones al problema social del diagnóstico temprano del Cáncer de Seno deben acomodarse con el contexto de cada región que visitamos. Las estadísticas siguen mostrando que nuestra población objeto siguen siendo las mujeres post menopaúsicas, pero sin abandonar la enseñanza en las mujeres jóvenes convencidos que si les quitamos el miedo y las empoderamos tempranamente del cuidado de sus senos, cuando lleguen a las edades de riesgo tendremos mujeres sin temor, expertas en el autoexamen, atentas a las lesiones mas tempranas como encontrar una masa del tamaño de un frijol y motivada a enseñar a otras mujeres, tal como hemos evidenciado después de incluir por ejemplo adolescentes de los colegios enseñándoles primero porque duele un Seno, como examinar y conocer su Seno y conocer que buscamos como la lesión palpable mas temprana del cáncer...

. La ruta de atención del cáncer de Seno seguirá siendo nuestra guía, pero según la situación y contexto local en ocasiones seguiremos abordando casos clínicos avanzados con soporte provisional de Tamoxifen cuando veamos que la atención está muy demorada, de acuerdo con la experiencia que adquirimos desde la pandemia y que compartimos con colegas de España. No podemos irnos a dormir tranquilos sin hacer alguna acción sobre esas mujeres que no serán atendidas en los dos meses siguientes ideales debido a las distancias, los costos y los problemas cuando se desplazan y regresan a zonas de violencia por ejemplo.

Seguiremos innovando en la manera de enseñar, a adolescentes, mujeres jóvenes, hombres y mujeres de la comunidad, médicos , enfermeras y demas personal de salud, en especial nuestras promotoras que se han convertido en las personas que mas buscan mujeres con cáncer en esos sitios impensables de nuestra geografía y las cuales tienen "teléfono Rojo" para comunicarse directamente con nosotros.

Insistiremos en la formación de nuestros médicos jóvenes, desde mejorarles su motivación por realizar el año rural CON PASION. Sabemos que el 70 % de los médicos que termina su carrera piensan que el año rural es una pérdida de tiempo....así y sin herramientas adecuadas para acomodarse al contexto del la región adonde irán, los pone en una situación de desmotivación que hemos visto en todos los municipios que hemos visitado.

Con mucho orgullo en la Universidad Militar Nueva Granada logramos aumentar el índice de jóvenes que quieren hacer su año rural. Es resultado de un programa que en tal sentido comenzamos hace 2 años y ve ya sus frutos en la motivación.

Seguiremos con nuestro curso de pregrado de patología mamaria y rutas de atención del cáncer en la Universidad militar. Vamos por el cuarto curso y los médicos egresados con este curso han sido preferidos en EPS y otras instituciones dada la importancia de tener médicos generales preparados y con ganas de liderar estos programas. Además les hemos enseñado derechos de la mujer entre otros temas relacionados que no son habituales en los pensum universitarios.

Hemos participado enseñando la Ruta de atención a médicos de Gobernaciones y FFMM a punto de iniciar su año rural. En las encuestas precapacitación, se mantienen las estadísticas que demuestran que hay que mejorar la formación de estos. Solo el 38% conocen que la Mamografia obligatoria en Colombia es a los 50 años. Tienen miedo de actuar porque no conocen bien por ejemplo la clasificación Birads y la RIA. Remiten aun muchas mujeres con patologías o síntomas que debieran saber manejar bien y que al no hacerlo se convierten en barreras para que una mujer insatisfecha regrese cuando su síntoma es una lesión sospechosa, por ejemplo indolora. (ver nuestro articulo pagina inicio)

Nuestro pais está abordando un plan de choque, pero su movilización principal será en zonas de mayor incidencia como Atlántico. Nosotros seguiremos yendo a muchos sitios lejanos porque una mujer no es un numero, es una persona que tiene detrás una familia, un trabajo , una VIDA. Somos conscientes de su papel en la economía, tal como lo definió la Reunión ASIA PACIFICO de 2019, MUJERES SANAS ECONOMIAS SANAS.

Al compararnos con los modelos oficiales clásicos de diagnóstico temprano y tamizaje , donde los 12 signos de cáncer que debe buscar una mujer no son comprendidos, donde el porcentaje de mujeres que se realizan el autoexamen a un año después de haber sido entrenadas sigue siendo muy bajo , 21 a 24% , con hallazgos mas dramáticos como el del grupo de Antioqueño que evaluó 800 mujeres entrenadas en Boyacá un año después y solo 24% de realizaban el autoexamen pero de este porcentaje solo el 6% lo hacía bien. El miedo a conocer sus senos es grave. Siempre que empezamos una capacitación preguntamos al auditorio, de mujeres médicas, ejecutivas o población general, quienes se hacen el examen con juicio, periódicamente y no sobrepasa el 15% las mujeres que levantan la mano. PERO NUESTRA ESTRATEGIA DE CAPACITACION ESTA FUNCIONANDO. A 1 año el 74% de nuestras mujeres saben que tienen que buscar en sus senos... esto entre otros datos es muy motivador.

Seguiremos buscando tecnologías que podamos usar en nuestros viajes. Este será el año de la MAMOGRAFIA POR LUMINISCENCIA y al ecografía portátil con IA. Ya tuvimos nuestras experiencias y han sido exitosas. Esto es muy motivador porque ya tenemos algún instrumento que en sitios muy distantes nos permita una orientación diagnóstica sobre un hallazgo, donde antes solo contábamos con la clínica.

Nuestra ultima meta para este año es comunicar, dar a conocer nuestra experiencia, porque ya es evaluable, ya muestra resultados y creemos que podemos aportar una experiencia útil a nuestras instituciones de salud publicas y privadas comprometidas con la lucha contra el cáncer de Seno. No lo hicimos antes porque sabíamos que era una "herejía" cambiar la forma como se enseñan los signos del cáncer, sabíamos que para cambiar la manera de enseñar el autoexamen desde como garantizar la privacidad, debíamos primero probar y lo hemos hecho por varios años y nos ha ido muy bien. Pero somos conscientes que debemos unirnos con todos aquellos comprometidos en esta lucha ... Aquí estamos, solo garantizamos pasión en lo que hacemos y si hacemos las cosas bien los resultados estarán bien también.

OUR LETTER FOR 2025

This will be our year, we have shown that there is a new way to teach how to diagnose breast cancer early. We continue to review the 3 pillars of the so-called "Breast Cancer Prevention" and adapt them to our reality, which in turn is the Latin American reality as you can read today. We are committed like never before to what we do and we will see our journey. Our motto for this year, in addition to TEACHING TO TEACH, is that WE GO WHERE OTHERS DON'T GO and so we have gone to unthinkable places in our geography, like 1 month ago to Caquetá, to a region where a medical brigade had not gone for 20 years due to the violence. We have the advantage of the support of the FFMM and police.

We remain convinced that solutions to the social problem of early diagnosis of Breast Cancer must be accommodated with the context of each region we visit. The statistics continue to show that our target population continues to be post-menopausal women, but without abandoning the teaching of young women, convinced that if we remove their fear and empower them early to care for their breasts, when they reach the age of risk we will have women without fear, experts in self-examination, attentive to the earliest lesions such as finding a mass the size of a bean and motivated to teach other women, as we have shown after including, for example, adolescents from schools, teaching them first why a breast hurts. , how to examine and know your breast and know what we look for as the earliest palpable lesion of cancer...

. The breast cancer care route will continue to be our guide, but depending on the situation and local context, we will sometimes continue to address advanced clinical cases with provisional Tamoxifen support when we see that care is too delayed, in accordance with the experience we have acquired since pandemic and that we share with colleagues from Spain. We cannot go to sleep peacefully without taking some action on those women who will not be attended to in the ideal next two months due to the distances, costs and problems when they travel and return to areas of violence, for example.

We will continue to innovate in the way we teach adolescents, young women, men and women in the community, doctors, nurses and other health personnel, especially our promoters who have become the people who most search for women with cancer in those places. unthinkable in our geography and which have a "Red Telephone" to communicate directly with us.

We will insist on the training of our young doctors, from improving their motivation to carry out the rural year WITH PASSION. We know that 70% of doctors who finish their degree think that the rural year is a waste of time....and without adequate tools to adapt to the context of the region where they will go, it puts them in a situation of demotivation that we have seen in all the municipalities we have visited.

With great pride at the Nueva Granada Military University we managed to increase the rate of young people who want to do their rural year. It is the result of a program that we started in this sense 2 years ago and is already seeing its fruits in motivation.

We will continue with our undergraduate course in breast pathology and cancer care pathways at the Military University. We are in the fourth year and the doctors who graduated with this course have been preferred in EPS and other institutions given the importance of having general physicians prepared and willing to lead these programs. We have also taught them women's rights among other related topics that are not common in university curricula.

We have participated by teaching the Care Route to doctors from Governments and FFMM about to start their rural year. In pre-training surveys, statistics are maintained that show that their training must be improved. Only 38% know that mandatory Mammography in Colombia is at age 50. They are afraid to act because they do not know well, for example, the Birads classification and the RIA. They still refer many women with pathologies or symptoms that they should know how to manage well and that by not doing so become barriers for a dissatisfied woman to return when her symptom is a suspicious lesion, for example painless. (see our article home page)

Our country is addressing a shock plan, but its main mobilization will be in areas of greatest incidence such as the Atlantic. We will continue going to many distant places because a woman is not a number, she is a person who has a family, a job, a LIFE behind her. We are aware of her role in the economy, as defined by the 2019 ASIA PACIFIC Meeting, HEALTHY WOMEN HEALTHY ECONOMIES.

When compared to the classic official models of early diagnosis and screening, where the 12 signs of cancer that a woman should look for are not understood, where the percentage of women who perform self-examination one year after being trained remains very low. , 21 to 24%, with more dramatic findings such as that of the Antioqueño group that evaluated 800 trained women in Boyacá a year later and only 24% performed the self-examination but of this percentage only 6% did it well. The fear of knowing her breasts is serious. Whenever we start a training we ask the audience, whether women doctors, executives or the general population, who take the exam judiciously, periodically and no more than 15% of women raise their hands. BUT OUR TRAINING STRATEGY IS WORKING. After 1 year, 74% of our women know that they have to look at their breasts... this, among other data, is very motivating.

We will continue to look for technologies that we can use on our trips. This will be the year of LUMINESCENCE MAMMOGRAPHY and portable ultrasound with AI. We have already had our experiences and they have been successful. This is very motivating because we already have an instrument that in very distant places allows us diagnostic guidance on a finding, where before we only had the clinic.

Our last goal for this year is to communicate, to make our experience known, because it is already evaluable, it already shows results and we believe that we can provide useful experience to our public and private health institutions committed to the fight against breast cancer. We didn't do it before because we knew it was a "heresy" to change the way the signs of cancer are taught, we knew that to change the way we teach self-examination from how to guarantee privacy, we had to first try and we have done it for several years and We have done very well. But we are aware that we must unite with all those committed to this fight... Here we are, we only guarantee passion in what we do and if we do things well the results will be good too.

NUESTRAS ESTADISTICAS HASTA MARZO DE 2025

EL PROBLEMA SOCIAL DEL CANCER DE SENO ES LATINOAMERICANO

I had the honor of participating in this event that was broadcast to Ibero America with the support of

the Aesculap Foundation of Mexico , financed by Braun of Germany Etartu and the Mexican Association against Breast Cancer . Respecting cultural differences from how the Breast is called, mythology and beliefs, the conclusion of my presentation is that the social problem of Breast Cancer is a latinoamerican problem for which:

1. Most of the women arrive in advanced stages of the disease the first time, which has an impact on mortality, the radical nature of the surgery and treatment, self-esteem...

2. In Latin America, trained women who perform self-examination are very few, the percentage ranges from 21 to 29% where some jobs in Mexico show that maximum percentage. In countries like Cuba the percentage is 26%. But with an additional problem, in some Latin American works it is shown that only 10% of this percentage does it correctly.

3. A Mexican study suggested that the main reason for not doing a self-examination was forgetfulness, however, in our experience in more than 40,000 women, the main reason is fear followed by ignorance to interpret the findings.

4. Fear occurs because we have taught 12 warning signs that are mostly advanced Cancer, which from the point of view of a marketing expert SCARES WOMAN AND DOES NOT MOTIVATE HER TO GET EXAMINED.

5. HE HAS BEEN TAUGHT THINGS LIKE "Look in a mirror and look for dimples and orange skin."HOWEVER, THE MIRRORS IN THE FIELD ARE SMALL, THEY ARE OUTSIDE THE BATHROOM FOR EVERYONE'S USE AND AT A HEIGHT WHICH USUALLY IS NOT REACHED TO SEE A BREAST, ALSO THEY DON'T KNOW IT IS A DIMPLE AND THEY JUST WAIT FOR AN ORANGE SKIN TO WORRY ABOUT.

For these and more reasons that we exposed, we demonstrate that a radical turn must be made in the way we teach to diagnose breast cancer early. Not to prevent it, to discover it in time, women should not be underestimated in what they can learn. When they find it, they think, for example, that they did not do what was necessary to "prevent" it, and that is not the objective. The marketing expert told me, "Doctor Castilla, what do you want, for your women to be mastologists or for them to free themselves and look for the tumor without fear when it is possible to detect it long before the 12 warning signs?" He was right and we changed the way of teaching both in the way of doing it and in the content. OUR OBJECTIVE IS NOT TO TRAIN BREASTMASTERS BUT WOMEN WHO ARE EMPOWERED BY THE CARE OF THEIR BREASTS.

We all know that the 3 pillars of early diagnosis of Cancer are:

1.MAMOGRAPHY. We already know that even if it is free in Latin America, many women have to pay for their transport tickets and travel with a companion for hours, often on difficult roads, and also many do not see the need because "they do not feel anything" (we do not teach them to do so). we are looking for is too small to be palpated...for example CONCLUSION MANY WOMEN WILL NOT ARRIVE EVEN FOR THE MAMMOGRAPHY

2. VISIT TO THE DOCTOR, today it is easier to get to the doctor in the cities. But in suburban and rural areas, women have a rural doctor, who is young and in our knowledge surveys does not have enough knowledge about breast diseases, which makes them a barrier for women to consult on time. . For example, as we have documented, a woman consults for pain, the doctor does not have the knowledge of her AND THE ATTITUDE TO TEACH WHY HER BREASTS HURT about her. The woman leaves with a vague explanation in the best of cases and formulated with an analgesic, for example acetaminophen. We have seen cases that when the doctor returns he says: "My wife, it wasn't acetaminophen, it's Dolex!" At the next consultation with another doctor, she orders an ultrasound that may not be possible and that would surely report a Fibrocystic Condition in most cases. When a lump appears that doesn't hurt, it may not come back because you're frustrated or simply don't pay attention to it until it becomes one of the warning signs. That is why we must change the way we educate our students in undergraduate.

3.The third pillar is SELF-EXAMINATION. We already know why they don't do it, but we definitely reevaluate and change the entire teaching strategy because IT IS THE BEST METHOD THAT CAN GUIDE A WOMAN WHEN THEY HAVE A SUSPICIOUS INJURY, It does not cover all manifestations of cancer, many will arrive despite the empowerment that let's care for your breasts in advanced stages of the disease. But many more, 80% or more will be able to detect the tumor when it barely measures 2.4 cm, which according to many evidence-based studies is the earliest that a woman can find in a breast of normal size by doing a judicious self-examination.

BUT WE LEARNED that for a woman to do a self-examination and empower herself in the care of her breasts, she must begin by teaching her why her breasts hurt, that she learn to interpret changes in consistency from a young age, that she not be scared by common secretions and many more aspects that a couple of years ago we began to teach in a simple way, as the marketing experts taught us, with direct messages, simple based on neurolinguistics, teaching rural doctors, nurses, promoters HOW THEY HAVE TO TEACH AND HOW TO CONVERT IN LEADERS BY EXAMPLE. They should not be afraid to teach women with simple messages, to commit themselves to their communities as we have been doing, educating a new generation of doctors in the municipalities where we have been, and above all our students from the NUEVA GRANADA MILITARY UNIVERSITY, who have participated in more than 7,000 screening consultations in the departments of Boyacá, Meta, Cundinamarca, Guaviare, Vichada and San Andrés, going to places where a specialist had never been, let alone a mastologist. Success is very satisfying. When asking the women we have trained what they should look for in the exam, they have answered 70% correctly. BUT ABOVE ALL THEY ARE NOT AFRAID... THAT IS THE MOST IMPORTANT THING because if a suspicious lesion is discovered in the middle of a jungle, they will not hesitate to consult in time and then we will see how the CANCER CARE ROUTE develops.

WE ARE LATIN AMERICA AND WE MUST EVALUATE HOW WE CAN IMPROVE THIS SITUATION. Many women are heads of families for many reasons, in our country sadly due to violence MAINLY, violence against women themselves, due to the loss of their partner due to drug trafficking or the guerrilla, among others.

We are also ready to receive support such as the one we have had from our University, the Military Forces and the work done with the Government of Cundinamarca and many municipalities.

WE ARE READY TO SHARE OUR EXPERIENCE AND OUR STRATEGY!!!

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