Breast cancer is the most common type of cancer in women and the second most common cause of death after lung cancer. Find out more details about the methods of diagnosis and treatment in Turkey.
Breast cancer occurs when cells in your breast grow and divide in an uncontrollable way, creating a mass of tissue called a tumor. Your risk of developing it increases as you age and as you gain weight.
Signs of a breast lump can include feeling a lump in the breast, changing its size, and seeing changes in the skin of the breasts.
Early detection is done by performing a mammogram.
What is breast cancer?
Cells in the body normally divide and reproduce only when new cells are needed.
Sometimes, cells divide and grow out of control, resulting in 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).
But 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 tissue.
It can also metastasize 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 type of cancer among women in the world.
Age is the most common risk factor for developing 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, It is the leading cause of cancer death among women between the ages of 35 and 54.
Only 5 to 10% of breast cancers occur in women who have a clear genetic predisposition to the disease.
The majority of breast cancer cases are random, sporadic, which means Absence of a critical 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 between ethnic groups, and the risks vary between ethnic groups for different types of breast cancer.
Breast cancer mortality rates in the United States have fallen by 40% since 1989, but disparities persist and widen between non-Hispanic black women and non-Hispanic white women.
Does the appearance of benign breast tumors mean that the risk of developing breast cancer is higher?
Benign breast tumors rarely increase the risk of breast cancer (malignancy).
Some women have lumps that are the result of their biopsy (excessive cell growth). This condition slightly increases the risk of developing cancer.
When the biopsy shows enlargement and abnormal cells, a condition called atypical hyperplasia, the risk of breast cancer increases somewhat.
What are the types of breast cancer?
The most common types of breast cancer are:
Invasive ductal carcinoma:
This cancer begins 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:
In early stage ductal carcinoma, the term “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 invasive.
The importance of early detection is that it is almost always curable.
Invasive lobular carcinoma:
This cancer begins in the breast lobules where breast milk is produced, but spreads to the tissues surrounding the breast.
Representing 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's not true cancer, but it's a sign of an increased risk of developing breast cancer later, possibly in both or one breast.
Thus, it is important for women with lobular carcinoma to have 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 surrounding breast tissue and can travel 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 begins in the cells that make up the lining of blood vessels or lymphatic vessels.
These cancers can start in the breast tissue or the skin of the breast and this is rare.
And inflammatory breast cancer:
This type of cancer is also rare and different from other types of breast cancer and is caused by cancer cells that block the lymphatic vessels of the skin, causing swelling and redness in the breast.
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 most are lumps that are not cancerous (benign tumors) and some are cancerous. These tumors begin in the connective tissue of the breast, which is called the stroma.
What are the stages of breast cancer?
There are two types of classification systems for breast cancer, one is the “anatomical classification” and the other is the “predictive classification”.
The anatomical stage is determined by knowing the areas of the body in which breast cancer is located and helps determine the most appropriate treatment.
Predictive classification helps the medical team predict the likelihood that a patient will be cured of breast cancer after appropriate treatment.
To better understand the stages of breast cancer Read the next article
Breast cancer symptoms and causes
What are the causes of breast cancer?
Practically, it is not yet known what causes this type of cancerHowever, there are many risk factors that increase the risk of developing breast cancer, as a woman's age, certain genetic factors, family medical history, personal health history, and diet are at risk of developing breast cancer.
What are the risk factors for breast cancer?
As these factors increase the likelihood of developing cancer, although finding all of them does not mean that you will have cancer.
Controllable risk factors for breast cancer
alcohol consumptionWhich increases the risk of breast cancer by increasing the amount of alcohol consumed.
Increase in body weightObesity is a risk factor for breast cancer. As it is important to eat a healthy diet and exercise commitment.
Breast implants (breast augmentation): Breast augmentation using silicone and the formation of scars resulting from the operation make it difficult to distinguish the formed cancerous tissue.
A rare cancer called transplant-associated anaplastic large cell lymphoma (ALCL) can also form.
not breastfeedingNot breast-feeding may increase the risk of breast cancer.
Use of hormonal drugsThis includes the use of postmenopausal hormone therapy and contraceptive medications.
Uncontrollable risk factors for breast cancer
Gender: Breast cancer is more common in women, although it can occur in men.
Dense breast tissue: Dense breasts are more likely to develop cancer and also make it difficult to see tumors during mammograms.
reproductive factors: They include starting menstruation early in life (before age 12), entering menopause after age 55, not having children, or having their first child after age 30.
aging Most of the affected people are over 55 years old.
Radiation exposure: This type of cancer can result from exposure to x-rays during an endoscopy or when doing regular chest x-rays.
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 a higher risk of developing breast cancer.
Also, in terms of genetic mutations, these mutations in the genetic material include the presence of genes such as BRCA1 and BRCA2.
History of breast cancer: The risk is greater if you have had breast cancer and/or other types of benign breast tumors such as lobular carcinoma, or atypical hyperplasia. or ductal carcinoma in situ.
Exposure to diethylstilbestrol (DES).DE): DES was prescribed to some pregnant women in the United States during 1940-1971. Eating this substance has been linked with 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.
A lump that may look as small as a pea.
A change in the shape or/and size or contour of the breast.
A fluid, blood-stained or clear discharge from the nipple.
Change in the look or feel of the skin of the breast or nipple (dimpled, wrinkled, scaly, or inflamed).
Redness of the skin on the breast or nipple.
An area that is clearly different from any other area in the breasts.
A hard area under the skin.
These changes can be found when performing monthly breast self-exams. By doing a breast self-exam, you can learn about normal monthly changes in your breasts.
Breast self-exams should be done at the same time each month, three to five days after your period ends.
If you are menopausal, get the test done on the same day every month.
Diagnostics and tests
How is breast cancer diagnosed?
During a regular physical exam, your doctor will order one or more of the following:
Breast test:
During a breast exam, your doctor will carefully feel for the tumor and surrounding tissue.
Breast cancers usually feel different (in size, texture, and movement) than benign lumps.
mammography :
A breast X-ray test can provide important information about a breast lump.
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).
This can be done along 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 a breast lump.
Biopsies are done using surgery or needles.
After the sample is taken, it is sent to a laboratory where a pathologist — a doctor who specializes in diagnosing abnormal changes in tissues — views the sample under a microscope and looks for cell shapes or abnormal growth patterns.
When there are cancer cells present, the pathologist can often tell the type of cancer (ductal or lobule) and whether it has spread beyond the ducts or lobules (invasive).
Tests, such as hormone receptor (estrogen and progesterone) and human epidermal growth factor receptor (HER2/neu) tests, can show whether hormones or growth factors help cancer grow.
If the test results show it (the test is positive), the cancer will likely respond to hormone therapy or antibody therapy.
These treatments prevent the cancer from getting the estrogen hormone and thus cause the cancer to shrink in size.
Other diagnostic tests in Turkey
A range of other diagnostic methods:
Breast scintigraphy:
A technique in which a contrast material is injected into a vein in the arm. An image of the breast is taken with a special camera that detects rays (gamma rays) emitted from this substance. Cancer cells, which have more blood vessels than benign tissue, collect cancerous cells, emit more pigment and the overall image appears brighter.
Positron emission tomography (PET) scan:
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 very clear images of the human body without using x-rays, so it is safe for pregnant women.
Breast cancer treatment in Turkey
If breast cancer is diagnosed, the medical team will develop a treatment plan to eliminate it, to reduce the chance of recurrence, as well as to reduce the chance of the cancer spreading to a place outside 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.
Topical or systemic breast cancer treatments.
Topical treatments (such as surgery and radiotherapy) are used to remove, destroy or control cancer cells.
Systemic treatments (chemotherapy and hormonal therapy) are used to destroy or control cancer cells throughout the body.
mastectomy surgery:
Breast-conserving surgery involves removing the cancerous part of the breast and the surrounding normal tissue, while striving to preserve an almost normal appearance of the breast. This procedure is often called a lumpectomy, also referred to as a partial mastectomy.
Usually, radiotherapy is followed to treat the remaining breast tissue.
Most women with a small tumor in its early stages are excellent candidates for this method.
A mastectomy (removal of the entire breast) is also an option.
But today's mastectomy procedures are not the same as the ancient radical mastectomy.
Radical mastectomy was a large-scale procedure that involved removing breast tissue, skin, and chest wall muscles.
Today and in Turkey, mastectomy procedures usually do not remove muscle, and for many women, mastectomy is accompanied by either immediate or delayed breast reconstruction (reconstruction).
What happens after treatment of localized breast cancer?
After brachytherapy for breast cancer, the treatment team will determine whether the cancer has returned outside the breast
. The oncologist may recommend medications such as tamoxifen or anastrozole (ARIMIDEX®) or possibly chemotherapy.
These treatments are used in addition to, but not in place of, brachytherapy for surgical or radiological breast cancer.
After breast cancer treatment, it is especially important that a woman continue to have a monthly breast exam.
Regular checkups will help you detect a relapse early.
Breast examination after breast cancer treatment
- after surgery
The incision line (scar) may be thick, raised, red, and may be 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 mammogram is performed for the reconstructed breast in exactly the same way as for the natural breast.
If an implant is being used for reconstruction, press firmly inward at the edges of the implant to feel the ribs underneath.
If your own tissue is used for reconstruction, you may naturally feel some numbness in the breasts.
- After radiotherapy
After radiation therapy, you may notice some changes in your breast tissue. The breast may look red or burnt, and it may become irritated or inflamed.
Once treatment is stopped, the redness will disappear and the breast inflammation or irritation will decrease.
Sometimes the skin can become more inflamed for a few days after treatment and then gradually improve after a few weeks.
During radiotherapy, monthly self-examinations of the irradiated breast as well as the other breast should continue.
If you notice any new developments, contact your doctor.
Most breast tumors (about 80 percent) are benign. However, a self-examination may lead you to early detection of a new or recurring cancer. The earlier the diagnosis, the better the chances of successful treatment.
protection
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 the age of twenty. You will get to know the features of your breasts and be more attentive to changes.
Have your breast checked by a doctor at least once every three years after age 20, and every year after age 40.
Clinical breast exams can reveal lumps that may not be detected on a mammogram.
Can exercise help reduce my risk of breast cancer?
Exercising is a big part of a healthy lifestyle.
It can also be a useful way to reduce the risk of breast cancer in the postmenopausal 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 lower your risk of breast cancer.
The general recommendation for regular exercise is about 150 minutes each week. This means that you exercise for 30 minutes, five days each week.
However, doubling your weekly amount of exercise to 300 minutes (60 minutes, five days each week) can greatly benefit postmenopausal women.
Longer exercise time 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 raise your heart rate 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 out your maximum heart rate by subtracting your current age from 220. If you are 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:
Walking/swimming/running/biking/dancing.
Choose an activity that you enjoy and that you want to do over and over again.
The more you like your activity, the more likely you are to continue exercising day in and day out.
You don't have to do the same activity for 300 minutes of your weekly exercise. 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 getting more exercise into your weekly routine. Some of the benefits of aerobic exercise can include:
- Lowering cholesterol and blood pressure.
- Increase stamina.
- Losing weight or maintaining your current weight.
- relieve stress.
- Good sleep.
Here is an article explaining How to proceed after breast cancer
How does 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 medications only work to reduce your risk of developing a certain 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 medicines called selective estrogen receptor modulators (SERMs).
These drugs work by blocking the effects of estrogen in the breast tissue By binding to estrogen receptors in breast cells.
Because SERMs bind to the receptors, estrogens are 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 medications 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.
To what extent 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 of developing the disease.
Tamoxifen reduced the risk by 50 percent.
Raloxifene reduced the risk by 38 percent.
Overall, the combined results of these studies show that taking tamoxifen or raloxifene daily for five years reduces the risk of breast cancer by at least a third.
In one trial comparing tamoxifen directly with raloxifene, raloxifene was found to be slightly less effective than tamoxifen for preventing breast cancer.
Both tamoxifen and raloxifene are approved 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 approved for use only in postmenopausal women.
To what extent do anastrozole and exemestane reduce the risk of developing a breast tumor?
Studies have shown that both anastrozole and exemestane can reduce the risk of developing breast tumors in postmenopausal women who are at increased risk of developing 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 with anastrazole and exemestane are joint pain, decreased bone density, and symptoms of menopause (eg hot flashes, night sweats, vaginal dryness).
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