Breast cancer seen in one of every 8-10 women has been increasing in recent years. According to global statistics, the incidence of breast cancer is calculated around 40-50 in 100,000. According to US data, the probability of a woman developing breast cancer in her lifetime is expressed as 1/8. Although its incidence increases with advancing age, there are some ways to prevent breast cancer. The most important rule in breast cancer, which has a high chance of treatment with early diagnosis, is defined as recognizing the person’s own breast structure and knowing the risk.
What is Breast Cancer?
Breast cancer; It is a type of cancer that can develop with abnormal proliferation and uncontrolled growth of breast cells, especially in women. As the age progresses, the risk of breast cancer increases. The most important risk factor in breast cancer is being a woman. Especially long exposure to estrogen, also known as the female hormone, increases the risk of breast cancer. Menstruation before the age of 12 and entering menopause after the age of 55 increases the exposure to estrogen hormone. The risk of developing breast cancer is higher in people who have never gotten pregnant, those who are not breastfeeding, and those who use birth control pills for a long time in their reproductive years. There is also estrogen hormone in hormone therapy applied to relieve postmenopausal complaints. The longer these hormones are used, the greater the risk. Breast cancer is mostly seen in women aged 50 and over.
1 out of every 100 breast cancer cases is male
Although rare, breast cancer, especially in women, can also manifest itself in men. Approximately 1 out of every 100 breast cancers are seen in men. Although the signs and symptoms in women are the same; Because of not being aware of this issue, breast cancer in men is usually diagnosed at an advanced stage.
Pay attention to overweight and inactivity!
Breast cancer can be based on 5-10% of hereditary causes. The risk is higher in people with breast cancer in their family and first-degree relatives. Apart from this, alcohol consumption, excess weight, lack of physical activity are conditions that increase the risk of breast cancer. Radiation to the chest for different reasons at younger ages also increases the possibility of developing breast cancer.
Breast Cancer Risk Factors
- Be woman,
- Being between the ages of 50-70 and in the post-menopausal period,
- Having relatives with breast cancer in the family (on the mother or father’s side) (the closer the degree of kinship and the more relatives with breast cancer, the higher the risk).
- Having had breast cancer before,
- Early menstrual onset, late menopause,
- Never gave birth
- Having the first birth after the age of 30,
- Having given birth but not breastfeeding her baby,
- Long-term hormone therapy,
- Living in a modern city life environment,
- Smoking and using tobacco products,
- Obesity; gaining excess weight especially after menopause and consuming excessive amounts of foods rich in saturated fat,
- Lack of physical activity.
What are the Types of Breast Cancer?
There are various types of breast cancer. However, it is basically divided into two main groups; first, noninvasive, or in other words, in situ (non-spreading potential) and second, invasive (with spreading potential) group.
Cancers that do not spread (in situ) are also divided into two groups as “ductal carcinoma in situ” and “lobular carcinoma in situ”. Especially after the 1980s, with the prominence of screening mammography, the incidence of non-spreading (in situ) cancers in all breast biopsies increased from 1.4 percent to 10 percent, and the rate in all breast cancers from 5 percent to 15 percent. draws attention.
Classical lobular carcinoma in situ: An important finding that increases the risk of breast cancer 8-10 times in both breasts. In addition to close monitoring, some preventive medications can be given to such patients or surgical interventions such as removing both breast tissues (simple mastectomy) can be applied for protective purposes. Cosmetic results can be obtained with the addition of prosthesis and similar surgical reconstructive procedures with plastic surgery.
In situ ductal cancers (ICDC, intraductal cancer): It often does not show itself on examination. Symptom; Irregular small-sized calcification finding detected in mammography and / or (pleomorphic microcalcification) occurs in the form of upstream discharge from a bloody / transparent single channel. ISDK is considered as the transition from normal cells to potentially invasive cancer cells. Since it does not create mass, it is removed by wire or labeling with radioactive materials.
If breast cancer is in a single focal state, sufficient clean tissue is left around it. When radiotherapy (RT) is applied to the remaining breast tissue, the disease has a clinically good prognosis.
If it is commonly found in the breast, it is necessary to remove all breast tissue (simple mastectomy), with up to 100 percent complete recovery. In pure ICHD, involvement of the armpit lymph nodes is rarely encountered in 1-3 percent. For this reason, patients whose whole breast will be removed; In some types with worse characteristics (high grade, etc.), it may be necessary to remove the guard lymph nodes most likely to retain cancer cells in the armpit lymph nodes (sentinel lymph node biopsy).
Ductal carcinoma, which develops in the cells lining the breast ducts that carry milk out of the nipple, is the most common type of breast cancer. This is differentiated according to its spreading feature: It is known that ductal carcinoma is in in situ form if it has no spreading feature, and invasive form if there is a potential to spread.
Cancer that develops from the milk-producing glands (lobule) is called lobular carcinoma. Lobular carcinoma is divided into two according to its spread. If there is no spreading feature, it is in invasive form if there is a potential to spread in situ.
Breast Cancer Symptoms
It takes a long time before a cancerous cell in the breast forms a tumor and is understood by a specialist during the examination or becomes apparent on radiological examination. Women are usually at least 1 cm. They can detect a mass that has reached its size by manual control method.
Today, most of the symptoms of breast cancer are found by the person himself. Cancerous masses are relatively hard, with irregular edges, the surface looks rough and cannot be moved comfortably within the breast tissue.
The symptoms of breast cancer are;
- A palpable hardness or mass in the breast,
- Asymmetry between two breasts,
- Inward pulling on the nipple or breast skin,
- Redness, wound, eczema, crusting, cracking in the breast,
- Appearance similar to orange peel on the breast skin,
- Shape or direction change in the nipple,
- Unusual swelling or size increase in the breast,
- Different types of pain that can be seen in the breast during menstrual periods,
- Discharge from the nipple; especially in pink, red color,
- Stiffness, swelling or mass in the armpit.
- If the cancer has metastasized to distant organs, these spreads rarely constitute the first finding of breast cancer. The regions where breast cancer spreads frequently are the hip and spine bones, and the lung and liver.
Mammography provides early diagnosis chance
Early diagnosis is essential in breast cancer treatment; Because the success rate of treatments in the early stages of the disease is quite high. For this, after the age of 20, a doctor should be checked every 3 years. After the age of 40, an annual doctor’s examination and an annual mammography examination must be performed. Mammography ensures that breast cancer is detected at an early stage. It is not exposed to excessive radiation by making it annually. Compression applied to the breast during mammography does not lead to cancer development.
Breast Cancer Stages
As in all other cancers, staging in breast cancer is an indispensable element in planning the treatment to be performed. Accordingly, each stage describes the stage of the disease described below.
Stage 0 (carcinoma in situ)
Cancer cells both have not gained the potential to spread and are completely confined to the breast.
Cancer cells have gained the potential to spread, but are smaller than 2 cm and are completely confined to the breast.
There is no tumor in the breast, but cancer has spread to the armpit lymph nodes. Or
a) Tumor 2 cm. or may have spread to smaller and armpit lymph nodes.
b) The tumor is larger than 2 cm but smaller than 5 cm and has not spread to the armpit lymph nodes.
The tumor is larger than 2 cm but smaller than 5 cm and has spread to the armpit lymph nodes or the tumor is larger than 5 cm but has not spread to the armpit lymph nodes.
a) There is no tumor in the breast or
b) Tumor in the breast is 2 cm or less, or
c) The tumor is larger than 2 cm but smaller than 5 cm or
d) It is larger than 5 cm. In addition, the cancer may either involve the armpit lymph nodes attached to each other or have spread to lymph nodes near the rib cage.
The tumor can be of any size and the cancer may have spread to the chest wall and / or breast skin and spread to the armpit lymph nodes adhered to each other or to lymph nodes near the rib cage bone.
There may be no signs of cancer in the breast, or the tumor may be of any size and have spread to the chest wall and / or breast skin. In addition, cancer may have spread to lymph nodes under or above the collarbone or armpit lymph nodes or lymph nodes near the rib cage bone.
Stage IIIC breast cancer is being studied in operable and inoperable stages:
In the operable stage, there are 10 or more lymph node involvement in breast cancer. The involved lymph nodes are either under the collarbone or are lymph nodes near the armpit and rib cage.
In the inoperable stage, the cancer has spread to the lymph nodes above the collarbone.
Cancer cells have spread to distant organs in the body (bone, liver, lung, brain).
Determining the stage of the disease in breast cancer also plays an important role in planning the treatment to be applied. The treatment plan created by determining the stage of the disease increases the success rate.
Breast Cancer Diagnosis Methods
Your physician will first perform a physical examination after listening to your and your family’s medical history. Later, imaging methods such as mammography or breast ultrasound, ductoscopy (examination of the milk ducts by entering very thin fiberoptic systems from the mouth of the nipple canal), ductography (or galactography, imaging by giving contrast material from the nipple), magnetic resonance imaging (MRI) may request examinations such as.
Considering the importance of early diagnosis and the possibility of screening in breast cancer, it can be said that the following measures are of great importance:
Breast Self Examination
Seventy percent of breast cancers are found while examining or examining their own breasts. That is why women after the age of 20; Once a month, they should observe their breasts, preferably in front of the mirror, and examine their breasts and armpits with their hands, preferably in the post-period period. If they notice any changes, they should consult a doctor as soon as possible.
The examination starts first in front of the mirror. Hands are placed on the waist to check whether the breasts are symmetrical or not. A visible mass is investigated in the breasts, it is checked for any depressions or color changes in the breast skin.
The same examinations are repeated by lifting the hands.
Then, inpatient examination begins. The examination starts from the right breast first. A small pillow is placed under the right shoulder-back for a more comfortable examination. The right hand is placed behind the head.
The examination is carried out with 2-3 fingertips of the left hand. It is checked whether there is any sensitivity or mass by circular movements in a clockwise direction, starting from the nipple area and pressing lightly on the breast tissue. After the whole breast is examined, the armpit is looked at. The left breast and armpit are evaluated similarly.
Even though she has no complaints about her breasts, every woman between the ages of 20-40 should be examined by a general surgeon every 3 years, and after the age of 40, once a year for a clinical breast examination.
Imaging methods: Breast imaging aims to detect breast cancer at the earliest stage possible. In parallel with the technological developments and especially the widespread use of screening mammography, there is a significant increase in breast cancer cases that can be detected by imaging methods even though it is not felt by hand.
Breast Cancer Treatment Methods
The chance of success in breast cancer treatment is directly related to how early the cancer is caught. When detected at an early stage, the 5-year survival rate can reach 96 percent.
Surgical treatment is the most important part of breast cancer treatment. The aim of the surgery is to remove the entire tumor from the body. Non-surgical treatment methods are aimed at preventing recurrence (recurrence) of the tumor or its spread to other organs. Basically, there are 3 types of surgery:
With the tumor, it is tried to remove the entire breast. In the same session or in the late period (1-2 years later) to the patient; New breasts can be made with silicone prosthesis or their own tissues.
It is a preferred method in cases where the entire breast tissue needs to be removed, but the breast skin can be protected. A cosmetic appearance is achieved by placing a silicone prosthesis into the skin instead of the removed tissue. It is especially preferred for risk-reducing breast surgeries (prophylactic mastectomy).
Breast Conserving Surgery
Surgical method in which only the tumor is removed with some normal breast tissue around it. This surgery has two purposes: First, leaving the breast in place and not spoiling the cosmetic appearance; Second, to ensure that the patient is physically and psychologically affected at a minimum level. Radiotherapy can be applied for 5-7 weeks after surgery.
In the last 20 years, there have been great changes in the surgical treatment of early stage breast cancer. As a result of studies involving thousands of patients and having a follow-up period of more than twenty years, it has been revealed that the survival rates obtained with the breast conserving surgery method are equivalent to mastectomy (removing the whole breast) in eligible patients.
Nowadays, in breast cancer surgeries, it is not necessary to remove the entire breast, except for some medical necessity. Breast is an important organ in women’s sexual identity and body perception.
With these surgical methods called partial mastectomy, lumpectomy, and quadrantectomy, women avoid unnecessary loss of their breasts.
However, in some patients, it may be necessary to remove the entire breast. In this case, surgery can be performed for breast repair and surgeons can create a breast that looks very similar to the natural breast.
Women with Symptoms in the Breast Should Consult a Doctor
Women who feel stiffness or any other symptom in the breast should consult their doctor immediately, even if the previous mammogram results are normal.
Is hair loss seen in breast cancer?
Cancer itself never causes hair loss. Hair loss may occur due to radiotherapy in cases where the drugs used in treatment and brain irradiation are required. However, with “smart drugs” that are becoming more and more common in breast cancer treatment, hair loss is no longer seen.