Breast cancer is the most common type of cancer in women and the second most common cause of death after lung cancer, learn more about diagnosis and treatment methods in Turkey.
Breast cancer occurs when cells in your breast grow and divide out of control, creating a mass of tissue called a tumor, and your risk increases as you age and gain weight.
Signs of a breast tumor can include feeling a lump in the breast, changing its size, and seeing changes in the skin of the breasts.
Early detection is through a mammogram.
What is breast cancer?
Cells in the body normally divide and multiply only when new cells are needed.
Sometimes, uncontrolled cell division and growth occur, leading to the formation of a mass of tissue called a tumor.
If the cells that grow out of control are normal cells, the tumor is called benign (non-cancerous).
If the cells that grow out of control are abnormal and do not function like normal body cells, the tumor is called malignant (cancerous).
Similar to other types of cancer, breast cancer can invade and grow into surrounding tissues.
It can also spread to other parts of the body and form new tumors, a process called cancer cell migration.
Who gets breast cancer?
Breast cancer is the most common cancer among women worldwide.
Aging is the most common risk factor for breast cancer, with 66% of breast cancer patients being diagnosed after the age of 55.
In the United States, breast cancer is the second leading cause of death for women after lung cancer and is the leading cause of cancer death among women between the ages of 35 and 54.
Only 5 to 10% of these cancers occur in women who have a clear genetic predisposition to the disease.
The majority of them are sporadic, meaning there is no definitive genetic mutation.
Does breast cancer affect women of all races equally?
All women, especially as they age, are at risk of developing breast cancer.
The overall risk of breast cancer is not spread equally across racial groups, and risks vary across racial groups for different types of breast cancer.
Breast cancer death rates in the United States have decreased by 40% since 1989, but disparities persist and widen between non-Hispanic Black women and non-Hispanic White women.
Do benign breast tumors mean a higher risk of breast cancer?
Benign breast tumors rarely increase the risk of breast cancer (malignant tumors).
Some women develop lumps that appear on biopsy to be hyperplasia (excessive cell growth). This slightly increases the risk of cancer.
When a biopsy shows enlargement and abnormal cells, a condition called atypical hyperplasia, the risk of this cancer increases slightly.
What are the types of breast cancer?
The most common types are:
- Invasive ductal carcinoma:
This cancer starts in the milk ducts of the breast and then penetrates the wall of the duct and invades the tissues surrounding the breast.
This is the most common form of breast cancer, accounting for 80% of cases. - Ductal carcinoma in situ:
Ductal carcinoma in situ refers to the fact that the cancer has not spread beyond its point of origin.
In this case, the disease is confined to the milk ducts and has not invaded nearby breast tissue.
If left untreated, ductal carcinoma in situ can become an invasive cancer.
The importance of early detection is that it is almost always curable. - Invasive lobular carcinoma:
This cancer starts in the breast lobules where breast milk is produced but has spread to the tissues surrounding the breast.
Accounting for 10 to 15% of breast cancers, this cancer can be more difficult to diagnose with a mammogram. - Lobular carcinoma in situ:
It is a sign of cancer found only in the lobules of the breast.
It is not actual cancer, but it is a sign of an increased risk of developing later, possibly in both breasts or one.
Therefore, women with lobular carcinoma need to undergo clinical breast exams and mammograms.
What is invasive breast cancer?
Invasive breast cancer occurs when cells spread outside the ducts or lobules, these cells first invade the surrounding breast tissue, and can metastasize to the lymph nodes.
Can cancer form in other parts of the breast?
Cancers can also form in other parts of the breast, but these types of cancer are usually less common and can include:
- Angiosarcoma:
This type of cancer starts in the cells that make up the lining of blood vessels or lymphatic vessels.
These cancers can start in the breast tissue or skin of the breast, which is rare. - Inflammatory breast cancer:
This type of cancer is also rare and different from other types and is caused by cancer cells that block the lymphatic vessels of the skin, causing the breast to become swollen and red. - Paget’s disease of the breast:
Also known as Paget’s disease of the nipple, this cancer affects the skin of the nipple and areola (the skin around the nipple). - Phyllodes tumors:
These are rare and mostly non-cancerous lumps (benign tumors) and some are cancerous, these tumors start in the connective tissue of the breast, which is called the stroma.
What are the stages of breast cancer?
There are two types of staging systems for breast cancer, one is “anatomical staging” and the other is “predictive staging”.
Anatomical staging is determined by knowing the areas of the body where the breast cancer is located and helps in determining the most appropriate treatment.
Prognostic staging helps the specialized medical team predict the likelihood that a patient will be cured of breast cancer after proper treatment.
To better understand the stages, read the following article
Symptoms and causes of breast cancer
What are the causes of breast cancer?
It is not yet known what causes this type of cancer, but several risk factors increase the likelihood of developing breast cancer. A woman’s age, certain genetic factors, family medical history, personal health history, diet, and genetics increase the risk of developing breast cancer.
What are the risk factors for breast cancer?
These factors increase the likelihood of cancer, although finding all of them doesn’t mean you’ll inevitably get cancer.
Controllable risk factors for breast cancer
- Alcohol consumption: The amount of alcohol consumed increases the risk of this cancer.
- Excess body weight: Obesity is a risk factor for breast cancer. It is important to eat a healthy diet and exercise.
- Breast implants (breast augmentation): Breast augmentation with silicone breast implants and the resulting scarring makes it difficult to recognize cancerous tissue.
- A rare cancer called implant-associated large cell lymphoma (ALCL) can also form.
- Lack of lactation: Not breastfeeding may increase the risk of this cancer.
- Use of hormonal medications: This includes the use of post-menopausal hormone therapy and contraceptive medications.
Uncontrollable risk factors for breast cancer
- Gender: Breast cancer is more common in women, although men can be affected.
- High-density breast tissue: Dense breasts are more prone to cancer and also make it harder to see tumors during mammograms.
- Reproductive factors: These include starting menstruation early in life (before the age of 12), entering menopause after the age of 55, not having children, or having the first child after the age of 30.
- Aging: Most people affected are over 55 years old.
- Radiation exposure: This type of cancer can result from exposure to X-rays during an endoscopy procedure or a standard chest X-ray.
- Having a family history of breast cancer or having genetic mutations associated with certain types of breast cancer:
Having a first-degree relative with breast cancer (mother, sister, daughter, father, brother, son) poses an increased risk of developing breast cancer.
In terms of genetic mutations, these mutations in the genetic material include genes such as BRCA1 and BRCA2. - History of breast cancer: Your risk is higher if you have a history and/or other types of benign breast tumors such as lobular carcinoma in situ, atypical hyperplasia, or ductal carcinoma in situ.
- Diethylstilbestrol (DES) exposure: DES was prescribed to some pregnant women in the United States during 1940-1971. Ingestion of DES has been linked to cancer.
What are the warning signs of breast cancer?
- Discovery of a lump or thickening in or near the breast or under the armpit that persists during the menstrual cycle.
- Lump, which may look as small as a pea.
- Change in the shape, size, or contour of the breast.
- Bloody or clear liquid discharge from the nipple.
- Change in the shape or texture of the skin of the breast or nipple (dimpled, wrinkled, scale,y or inflamed)
- Redness of the skin on the breast or nipple
- An area that is distinctly different from any other area of the breasts.
- Solid area under the skin.
These changes can be found during monthly breast self-exams. By performing a breast self-exam, you can recognize normal monthly changes in your breasts.
Breast self-examination should be done at the same time each month, three to five days after your period ends.
If you’re menopausal, do the exam on the same day each month.
Diagnostics and tests
How is breast cancer diagnosed?
During a regular physical exam, your doctor will ask for one or more of the following:
Breast examination
During a breast exam, your doctor will carefully feel the tumor and surrounding tissue.
Breast cancer usually feels different (in size, texture, and movement) than benign lumps.
Mammography
A mammogram can provide important information about breast mass.
Ultrasound imaging
This test uses sound waves to reveal the nature of a breast lump – whether it’s a fluid-filled cyst (non-cancerous) or a solid mass (which may or may not be cancerous).
It can be done in conjunction with a mammogram.
Based on the results of these tests, your doctor may order a biopsy to obtain a sample of cells or tissue from the breast lump.
Biopsies are performed using surgery or needles.
After the sample is taken, it is sent to a lab where a pathologist – a doctor who specializes in diagnosing abnormal tissue changes – views the sample under a microscope and looks for abnormal cell shapes or growth patterns.
When cancer cells are present, a pathologist can often tell the type of cancer (ductal or lobular) and whether it has spread outside the ducts or lobules (invasive).
Tests, such as hormone receptors (estrogen and progesterone) and human epidermal growth factor receptor (HER2/neu) tests, can show whether hormones or growth factors are helping the cancer grow.
If the test results show a positive test, the cancer is more likely to respond to hormone therapy or antibody therapy.
These treatments prevent the cancer from accessing estrogen and thus cause the cancer to shrink in size.
Other diagnostic tests in Turkey
A range of other authorization methods:
Scintimammography
A technique in which a contrast agent is injected into a vein in the arm. An image of the breast is taken with a special camera that detects the rays (gamma rays) emitted by this substance. Cancer cells, which have more blood vessels than benign tissue, emit more of the dye and the overall image appears brighter.
Positron emission tomography (PET) scanning:
A technique that measures the signal from injected radioactive material that migrates into rapidly dividing cancer cells.
Magnetic resonance imaging (MRI):
A device that produces crystal-clear images of the human body without X-rays, so it’s safe for pregnant women.
Breast cancer treatment in Turkey
If breast cancer is diagnosed, the medical team will develop a treatment plan to eradicate it, to minimize the chance of recurrence, as well as to minimize the chance of the cancer spreading beyond the breast.
The type of treatment recommended depends on the size and location of the tumor in the breast, the results of laboratory tests performed on the cancer cells, and the stage or extent of the disease.
Breast cancer treatments are localized or systemic.
Localized treatments (such as surgery and radiation therapy) are used to remove, destroy, or control cancer cells.
Systemic treatments (chemotherapy and hormone therapy) are used to destroy or control cancer cells throughout the body.
Mastectomy surgery:
Breast-conserving surgery involves removing the cancerous portion of the breast and the surrounding area of normal tissue while striving to preserve the breast’s nearly normal appearance. This procedure is often called a lumpectomy, also referred to as a partial mastectomy.
Usually, it is followed by radiation therapy to treat the remaining breast tissue.
Most women with a small tumor in its early stages are excellent candidates for this method.
Mastectomy (removal of the entire breast) is also an option.
But today’s mastectomy procedures are not the radical mastectomies of old.
Radical mastectomies were extensive procedures that involved the removal of breast tissue, skin, and chest wall muscles.
Today, in Turkey, mastectomy procedures typically do not remove muscle, and for many women, mastectomy is accompanied by either immediate or delayed breast reconstruction.
What happens after localized breast cancer treatment?
After localized therapy for breast cancer, the treatment team will determine the likelihood of the cancer returning outside the breast
. Your oncologist may recommend tamoxifen, anastrozole (ARIMIDEX®), or chemotherapy.
These treatments are used in addition to, but not as a substitute for, localized breast cancer treatment with surgery or radiation.
After breast cancer treatment, women must continue to have monthly breast exams.
Regular checkups will help you detect relapse early.
Breast screening after breast cancer treatment
- After surgery
The incision line (scar) may be thick, raised, red and possibly painful for several months after surgery. Remember to examine the entire incision line.
If there is redness in areas away from the scar, contact your doctor.
- After breast reconstruction
After breast reconstruction, a breast exam of the reconstructed breast is performed in exactly the same way as for a natural breast.
If an implant was used for reconstruction, press firmly inward at the edges of the implant to feel the ribs underneath.
If your own tissue was used for reconstruction, you may naturally feel some numbness in the breasts.
- After radiation therapy
After radiation therapy, you may notice some changes in your breast tissue. Your breast may look red or burned and may be irritated or inflamed.
Once treatment is discontinued, the redness will disappear, and the breast will be less inflamed or irritated.
Sometimes, the skin can become more inflamed for a few days after treatment and then gradually improve after a few weeks.
During radiation therapy, monthly self-examinations should continue for the irradiated breast as well as the other breast.
If you notice any new developments, contact your doctor.
Most breast tumors (about 80 percent) are benign. However, self-examination may lead you to early detection of a new or relapsed cancer. The earlier the diagnosis, the better the chances of successful treatment.
Prevention
How can I protect myself from getting breast cancer?
Follow these three steps for early detection:
Get a mammogram: The American Cancer Society recommends getting a mammogram every year after age 40.
Check your breasts every month after age 20. You will recognize the contours of your breasts and be more attentive to changes.
Have a breast exam with your doctor at least once every three years after age 20, and every year after age 40.
Clinical breast exams can detect lumps that may not be detected by mammography.
Can exercise help reduce my risk of breast cancer?
Exercise is a big part of a healthy lifestyle.
It can also be a helpful way to reduce the risk of breast cancer in the post-menopausal years.
Women often gain weight during menopause.
People who have large amounts of body fat are more likely to develop breast cancer.
However, by reducing body fat through exercise, you may be able to reduce your risk of breast cancer.
The general recommendation for regular exercise is about 150 minutes each week. That means you work out for 30 minutes, five days each week.
However, doubling the amount of weekly exercise to 300 minutes (60 minutes, five days each week) can greatly benefit postmenopausal women.
Longer exercise duration allows you to burn more fat and improve heart and lung function.
The type of exercise you do can vary – the main goal is to get your heart rate up while exercising.
It is recommended that your heart rate rise by about 65 to 75% of your maximum heart rate during exercise.
You can find your maximum heart rate by subtracting your current age from 220. If you’re 65, for example, your maximum heart rate is 155.
Aerobic exercise is a great way to improve heart and lung function, as well as burn fat. Some aerobic exercises you can try include the following:
Walking/swimming/running/biking/dancing.
Choose an activity that you enjoy and want to do again and again.
The more you love your activity, the more likely you are to keep exercising day after day.
You don’t have to do the same activity for all 300 minutes of your weekly workout. You can mix it up and try different things throughout the week.
The important thing is to keep moving.
Remember that there are many benefits to incorporating more exercise into your weekly routine. Some of the benefits of aerobic exercise can include:
- Lower cholesterol and blood pressure.
- Increased stamina.
- Lose weight or maintain your current weight.
- Relieve tension.
- Good sleep.
Here’s an article that explains how to proceed after breast cancer
How do tamoxifen, raloxifene, anastrozole, and exemestane reduce the risk of breast cancer?
If you’re at increased risk of breast cancer, four medications – tamoxifen (Nolvadex®), raloxifene (Evista®), anastrozole (Arimidex®), and exemestane (Aromasin®) – may help reduce your risk.
These drugs work only to reduce the risk of developing a specific type of breast cancer called estrogen receptor-positive breast cancer.
This type of breast cancer accounts for about two-thirds of all breast cancers.
Tamoxifen and raloxifene are drugs called selective estrogen receptor modulators (SERMs).
These drugs work by blocking the effects of estrogen in breast tissue by binding to estrogen receptors in breast cells.
As SERMs bind to the receptors, estrogen is blocked from binding. Estrogen is the fuel that makes most breast cancer cells grow.
The use of these drugs prevents the development of estrogen receptor-positive breast cancer.
Anastrozole and exemestane fall into a class of drugs called aromatase inhibitors (AIs).
These drugs work by blocking the production of estrogen. Aromatase inhibitors do this by blocking the activity of an enzyme called aromatase, which is needed to make estrogen.
How much do tamoxifen and raloxifene reduce the risk of infection?
Multiple studies have shown that both tamoxifen and raloxifene can reduce the risk of estrogen receptor-positive breast cancer in healthy postmenopausal women at high risk for the disease.
Tamoxifen reduced the risk by 50 percent.
Raloxifene reduced the risk by 38 percent.
Overall, the combined results of these studies showed that taking tamoxifen or raloxifene daily for five years reduced the risk of breast cancer by at least one-third.
In one trial that directly compared tamoxifen with raloxifene, raloxifene was found to be slightly less effective than tamoxifen for preventing breast cancer.
Both tamoxifen and raloxifene are approved for use to reduce the risk of breast cancer in women at high risk of developing the disease.
Tamoxifen is approved for use in both premenopausal and postmenopausal women.
Raloxifene is only approved for use in postmenopausal women.
How much does anastrozole and exemestane reduce the risk of breast tumors?
Studies have shown that both anastrozole and exemestane can reduce the risk of breast tumors in postmenopausal women who are at increased risk for the disease.
In one large study, taking anastrozole for five years reduced the risk of estrogen receptor-positive breast cancer by 53 percent.
In another study, taking exemestane for three years reduced the risk of estrogen receptor-positive breast cancer by 65 percent.
The most common side effects of anastrozole and exemestane are joint pain, low bone density, and menopausal symptoms (such as hot flashes, night sweats, and vaginal dryness).
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