Breast cancer is one of the diseases that can affect women from almost every age group and ranks first among the cancers encountered in women. When the global incidence of cancer is examined, it can be seen that this type of cancer, which is most common in women, affected 2,088,849 women as of 2018, the rate of breast cancer among the cancers seen in women is more than 25 percent, that is, 1 out of every 4 women diagnosed with cancer is diagnosed with breast cancer. Again, according to the 2018 global cancer incidence results, breast cancer ranks first among cancer diseases that cause death in women with a rate of 15 percent. Early diagnosis factor is critically important in the fight against this type of cancer, which has a significant impact on public health. In order for the disease to be recognized at an early stage, it is very important to fully recognize the disease, to have complete information about the common signs and symptoms, and to diagnose the disease with mammography at the right time.
What is Breast Cancer?
Breast cancer can be briefly called as the uncontrolled proliferation of cells and cell groups in the breast tissue and the emergence of cancerous cell structures after this proliferation. With this uncontrolled proliferation, which is often seen in the mammary ducts or mammary glands, mass and similar structures form in the breast, and then cancer cells, which continue to multiply rapidly, usually adhere to the surrounding tissues and grow in a certain area. This mass, which can be detected by physical examination from the outside, is much easier to detect in breast cancer than lung, liver, stomach and similar organ cancers, making it easier to diagnose and effectively treat at an early stage. Therefore, this method, called breast self-examination, is of critical importance in the fight against breast cancer. Regular mammograms are required for breast cancer. These scans are definitely included in the check-up packages created for women over the age of 40.
Breast Cancer Symptoms
Breast cancer can progress insidiously without showing any symptoms for many years, and different findings can be detected according to the stages of the disease:
Breast Mass
The presence of a palpable mass in the breast is one of the most important symptoms of breast cancer. The mass can be felt in the axillary area called the armpit, or it can occur in the milk ducts or breast tissue. These hard lesions, which are usually painless, are seen as one of the first signs of breast cancer and it is recommended to apply detailed imaging methods with physician control.
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Nipple Discharge
Breast discharge may occur due to various conditions such as hormonal, periodic or infection. Considering the amount, density, color and frequency of the discharge, it is determined whether it is associated with breast cancer. Nipple discharge that occurs with breast cancer; It is usually in the form of bloody, spontaneous discharge from a single breast.
Breast Shape Disorder
The mass that occurs in the breast tissue usually grows rapidly and may cause deformity in the breast. Especially the size and shape differences between the two breasts should bring to mind the presence of a breast cancer-related mass.
Change in Breast Skin
Thickening of the breast skin, appearance of cellulite, superficial wounds called ulceration, edema and regional pits due to edema, erythematous or eczematous differentiations may occur.
Nipple Withdrawal
Depending on the location of the mass in the breast tissue, symptoms such as recession or dimpling on the nipple may occur. Deeper located breast tumors attach to the structure defined as Cooper’s ligament and the nipple is pulled inward by stretching this ligament. This finding usually occurs in the later stages of the disease or in the presence of very large masses.
What Causes Breast Cancer?
Breast cancer is very rare in men compared to women. However, when the disease develops, its course may be faster and worse than breast cancer seen in women. 1 out of every 100 breast cancers occurs in men. Although the exact cause of breast cancer is not known; Many factors can be mentioned such as heredity, diet, socioeconomic status, menstrual status, births, birth control pills.
The incidence of breast cancer increases with age. The risk of breast cancer, which is most common between the ages of 50 and 70, is increased when there is a family history of breast cancer. When a mother or sibling has breast cancer, the risk of the disease increases 3 times. Therefore, people with a family history of breast cancer should have frequent check-ups, especially at the age of 40. People with mutations in the BRCA1 and BRCA2 genes are at higher risk of developing both breast and ovarian cancer. Using hormone drugs for more than 5 years during menopause is also one of the factors that increase the risk of breast cancer.
What Are the Stages of Breast Cancer?
While breast cancer is a very common and rapidly progressing cancer, it can be treated very effectively and successfully when diagnosed at an early stage. In the first stage of cancer, the tumor tissue in the breast is less than 2 centimeters in diameter. There is no lymph node enlargement in the armpit area. In this period, which is defined as stage 1, the survival rate after 5 years is 98 percent in people who are diagnosed and treated. The period when the diameter of the mass is larger than 2 centimeters is defined as stage 2, at this stage, enlargement of the lymph nodes may or may not be seen. In the period called stage 3, the diameter of the tumor tissue exceeded 5 centimeters, and lymph enlargement in the armpit became evident. In breast cancer patients diagnosed at this stage, the survival rate drops by half in the 5-year period after treatment, to a rate of 50.6 percent.
Since early diagnosis is critical in the fight against breast cancer, it is extremely important to have information about cancer stages, to detect the mass at the earliest stage by performing regular breast self-examination, to consult a physician at the right time and to use advanced imaging techniques such as mammography.
How is Breast Self Examination Performed?
For breast self-examination, first of all, the menstrual cycle should be followed correctly. The first day of each monthly cycle is considered day 1. a day is set between the 5th day and the 14th day after today. This day should always be preferred for breast examination. For example, if the 9th day after the onset of bleeding was selected for the first examination in that month’s menstrual calendar, 9 days from the beginning of the menstrual bleeding should be counted in the same way in the other months and the examination should be repeated on that day. If the person is in the menopause period, he can choose a certain day of each month for breast self-exam.
The clothes on the upper part of the body should be completely removed before the examination, the arms should be lifted up in order in front of the mirror and the findings such as protrusion in the breast tissue, tension, retraction on the nipple, scar, color change should be evaluated and both breasts should be compared in terms of all these features.
In the next step, the arms should be extended forward and it should be evaluated whether there is a shape change between both breasts in this position. Afterwards, the mirror image of the breasts should be checked by positioning the hands at waist level and keeping the shoulders in an upright position. After these stages, the manual inspection method should be applied. The breast to be examined, and the right breast, the right arm should be bent at the elbow and placed on the head, and the second, third and fourth fingertips of the left hand should be moved around the breast tissue with circular movements. Then, the breast tissue should be evaluated with the fingertips of the right hand. Approximately 90% of the masses detected in the breast are sebaceous gland-like formations that do not have pathological features, but in any case, a physician’s examination and detailed imaging methods such as mammography should be applied.
When should a mammogram be done?
Today, mammography is still considered the gold standard for the diagnosis of breast cancer, but in order to detect a breast mass at an early stage and to determine the need for mammography, every woman should take care to perform a regular breast self-examination once a month.
For women aged 20-40, if there is no risk factor, a detailed physician examination every 3 years is sufficient. If there is a history of breast cancer in the family or in one of the first-degree relatives, the risk of developing breast cancer increases 3 times. Therefore, women in the risk group may need close follow-up in line with the physician’s recommendation.
Being over the age of 40 is one of the important factors that directly increase the risk of breast cancer. This type of cancer, which can be seen in women of all age groups from the age of 20, is most common between the ages of 45-60. Therefore, it is recommended that all women from the age of 40 have a breast examination once a year.
Having at least one digital mammogram between the ages of 35-40 provides a much more accurate assessment of the person’s examinations in the following years. The first mammogram and simultaneous detailed breast examination are very helpful in determining how the follow-up will take place between the ages of 40-45. After the age of 45, mammography is recommended once a year.
For this reason, it is critical for every woman over the age of 20 to regularly perform breast self-examination and to participate in mammography screenings at intervals appropriate for her age and health status, even if there are no signs of breast cancer. In order to detect possible cancer at an early stage and to benefit from successful treatment opportunities, do your breast examination without neglecting it between routine checkups.
Early Detection Methods in Breast Cancer
- Breast self checks
- annual mammogram
- Medical examination
- genetic tests
Breast examination is very important in terms of preventing breast cancer and catching breast cancer at an early stage. When breast cancer is a small mass in the breast, it can be treated with close to 100 percent success with timely intervention. Another feature that distinguishes breast cancer from other cancers is that it can be evaluated in “cancer screening programs”. Therefore, women who do not have any breast-related complaints or lumps should pay attention to screening methods.
Breast Cancer Diagnosis and Treatment
In recent years, important developments and new treatment possibilities in the treatment of breast cancer; reveals that the disease can be completely eliminated with early diagnosis and treatment.
Today, significant advances in breast cancer treatment and new treatment options have made the diagnosis and treatment of the disease easier and more successful. The priority in the treatment of breast cancer is the treatment and practices aimed at protecting the breast. In breast cancer that is caught at an early stage, without breast loss, the spread of the disease can be determined in advance with advanced techniques, and precautions can be taken and the tumor can be directly intervened. In cases where the breast needs to be surgically removed in advanced breast cancer, breast reconstruction (a new breast) can be applied with plastic surgery techniques. With early diagnosis, breast cancer can be cured at a rate close to 100 percent.
Breast cancer treatment varies according to the stage of the disease. In Stage 0, there is no need for post-operative chemotherapy treatment, and radiotherapy is often added to the treatment. Since the mass is small in stages I and II, it is decided whether or not to apply chemotherapy after surgery. In stage III, first chemotherapy treatment is applied, then the patient is taken to surgery. In stage IV, if the cancer has not spread to too many parts of the body, surgery can be considered. However, if the cancer spread is high, surgery alone is not recommended, chemotherapy and sometimes radiotherapy treatment is applied. Breast cancer-specific vaccines are also expected to be used in treatment in the near future.
Surgical Methods
Removing the tumor so that it does not remain behind and removing the lymph nodes completely in cases that spread to the armpit is the primary goal in breast cancer surgery.
Mastectomy
Simple mastectomy: This procedure is also called a total mastectomy. The entire breast, including the nipples, is removed, but not the axillary lymph nodes or the muscle tissues under the breast. This method is not preferred much nowadays.
Skin-sparing mastectomy: During surgery, the breast can be reconstructed in some female patients. This procedure is described as a skin-sparing mastectomy, leaving most of the skin above the breast (including the nipple (areola) and nipple) untouched.
Radical Mastectomy: In this large-scale surgery, the entire breast, armpit glands and pectoral (chest wall) muscles under the breast are removed. Radical mastectomy is a technique that has been used quite frequently in the past.
Breast Conserving Surgery
When breast cancer is detected early, the most affected part of the breast is removed, but the part to be removed depends on the size and location of the tumor and other factors. In lumpectomy, only the mass in the breast and surrounding tissues are removed. Radiotherapy is a treatment technique applied after lumpectomy. If the patient will also receive adjuvant chemotherapy, radiotherapy is usually delayed until chemotherapy treatment is completed. In quadranectomy, one quarter of the breast is removed, and radiotherapy is usually given after surgery. Again, in this method, radiotherapy is delayed if chemotherapy is to be given.
Lymph Node Surgery
In order to detect the spread of breast cancer to the axillary lymph nodes, one or more lymph nodes are taken and examined under a microscope. This important examination is done to determine the staging of the cancer, the treatment method and its results. If cancer cells are found in the lymph nodes, there is a good chance that the cancer has spread to other parts of the body through the bloodstream. The presence of cancer cells in the lymph nodes under the arm is important in deciding what kind of treatment to apply after surgery, if necessary.
Radiotherapy Treatment
With radiotherapy in breast cancer, it is aimed to destroy cancer cells that may remain with the beam given to the armpit and breast area after surgery. In the treatment of breast cancer, radiotherapy is applied to protect the remaining breast tissue, especially in patients with a high risk of regeneration and breast-conserving surgery. In the fight against breast cancer, TrueBeam STx and Elekta Versa devices play an important role as beam technology.
Thanks to these technologies, only cancerous cells are focused on in radiation oncology applications in the field of breast cancer and damage to healthy cells is prevented.
Drug Treatments
Chemotherapy
Chemotherapy in breast cancer is mostly done after surgery. Although no cancerous cells remain after the operation, chemotherapy can be continued as a preventive measure.
Hormonotherapy
The aim of hormone therapy is to reduce the hormone amount of the cancer patient in cases of breast cancer sensitive to female hormones. Some cancer cells sensitive to estrogen hormone grow and multiply faster. This treatment technique prevents the development of cancer by eliminating the effect of estrogen.
Smart Medicines
Breast cancer requires individual and tumor-specific treatment with different treatment strategies. Previously, there were no options other than classical chemotherapy drugs and hormone treatments, but today, the combination of newer and more effective chemotherapy drugs, targeted smart drugs that can be taken intravenously and orally, and new hormonal therapy drugs lead to successful results.
Frequently asked Questions
It is possible for a palpable mass in the breast to be a cyst or a solid mass. The most common masses in the breast are fibroadenoma and fibrocysts. Breast masses, which are seen in the form of coins, are benign tumors that do not turn into cancer. Women cannot understand whether these masses they notice during breast self-check are breast cancer or a harmless fibroadenoma mass. Especially in women under the age of 30, fibroadenomas due to hormonal changes are very common. The character of the mass in the breast is understood by breast ultrasound. Therefore, women should see a specialist doctor as soon as they notice a change or mass in their breasts. An idea of the mass in the breast can be obtained with breast ultrasound and, if necessary, mammography.
If breast pain is felt in both breasts, it is primarily a sign of hormonal changes and the menstrual cycle. In addition, fibroadenoma and fibro cyst can also cause pain in the breast. Breast pain may develop due to hormonal changes in pregnant women and due to breastfeeding in lactating women. In advanced stages of breast cancer, edema due to the growth of the tumor and pain in the breast may occur, but breast pain is not considered a symptom of breast cancer.
When a difference or change in the breast is felt during breast self-exam, a specialist doctor should be consulted without delay. This mass needs to be diagnosed by investigating what it is.
8 out of 10 masses diagnosed with breast cancer may be benign. There may be non-cancerous masses called cysts, fibroadenoma, and fibrocystic masses that can be seen in middle age.
Exercise strengthens your immune system and helps you keep your weight under control. A woman who exercises as little as three hours a week, or about 30 minutes a day, may have a reduced risk of breast cancer.
Breast examination should be done 4-5 days after the end of the menstrual period.
After the age of 25-26, have your annual routine ultrasound follow-ups. The age of first mammography in genetic breast cancers is 26. If you are at familial risk of breast cancer, you should be followed up with mammography after the age of 32-34.
No cancer is contagious. Having cancer in many members of a family may cause this misconception. A person cannot transmit cancer to another person, but viruses are among the causes of some cancers such as cervix and liver cancer.
Particular attention should be paid to consuming fresh fruits and vegetables rich in vitamins A and C. It is necessary to stay away from animal fats, to prefer mostly pulpy foods, to stay away from cigarettes and alcohol, and not to gain too much weight. the use of preventive drugs in women at high risk of breast cancer, or the evacuation of both breasts and breast reconstruction with silicone or one’s own tissue. Breast cancer risks can be reduced by measures such as not using tablets, creams and gels sold under the name of ‘breast enlargement’ sold in the market.
Choose the sport that suits you in daily life. For many people, the sport that can be done is regular and brisk walking. However, group or solo exercises such as swimming, cycling, pilates, yoga can be preferred.
