General Surgery Specialist Assoc. Dr. Fatih Levent Balcı gave important information about breast cancer. Breast cancer, which arises in the breast tissue and has the characteristic of spreading, is the most common type of cancer in women and constitutes more than one third of female cancers. It is responsible for 33 percent of all cancers in women and 20 percent of cancer-related deaths. When breast cancer is caught in the early stages, it can be treated with a success rate of 95 percent. Today, with the increase in awareness of screening methods in breast cancer, the chance of early diagnosis has increased.
Examination in front of the mirror is very important.
Although a palpable mass in the breast usually suggests cancer, not every palpable mass means cancer. First of all, women should do routine breast examinations in front of a mirror once a month. In this examination, first of all, the breast is observed from the mirror with both arms to the side. Then the arms are raised up, the hands are placed on the head and the chest muscles are contracted by pressing the head; this is how the breasts are observed. Then both hands are pressed to the hip area, the shoulders and elbows are brought forward and the breasts are observed visually. In the next step, a manual breast examination is performed. Here, the right breast is examined with the left hand and the left breast with the right hand. The left arm is lifted up and examined carefully and slowly by drawing circles on the inner surfaces of the 2nd, 3rd and 4th fingers of the right hand and the left breast, and also the left armpit is checked. At this stage, it is checked whether there is any discharge from the nipple. The same process is applied for the other breast. If an unusual situation is observed in front of the mirror, a general surgeon should be consulted immediately.
Watch out for these symptoms!
Symptoms of breast cancer can be listed as follows:
- Painful or painless, firm, limited or non-moving swelling in the breast that can grow over time.
- Significantly different size of the two breasts
- Shape change in the breast
- Change in color, shape, collapse in the nipple, change in direction of the nipple
- Formation of cracks, wounds or crusting on the nipple
- Orange peel appearance on the breast
- Redness, bruising on the breast skin
- Bloody or bloodless discharge from the nipple
- Palpable swelling in the armpit
Does not emptying the breast milk cause cancer?
There is a perception among the society that incomplete emptying of the breast during breastfeeding causes breast cancer in the future, but this is not a correct perception. Risk factors for breast cancer can be listed as being a woman, giving birth late or not giving birth at all, having a family history of breast cancer, sedentary life, and lack of weight control. In addition, other risk factors include:
- A woman with BRCA1 positivity has a higher lifetime risk of developing breast cancer or ovarian cancer.
- Exposure to radiation during breast development in adolescence leads to the destruction of tissues in this area, thus increasing the risk of breast cancer.
- The increase in exposure to estrogen hormone is also among the risks of breast cancer.
- Excessive alcohol consumption and duration of alcohol consumption can also pose risks.
- Eating foods high in fat is also a risk factor for the development of breast cancer.
- Waist circumference can also be considered among the risks in terms of breast cancer.
Routine checks are very important
Every woman between the ages of 15-85 is at risk for breast cancer. Every woman between the ages of 20 and 30 should do a routine breast examination in front of the mirror. It is beneficial for those over the age of 30 who have complaints such as pain and fibrocysts, whether they have a palpable mass or not, to go to a general surgeon once a year and be examined. If over the age of 40, mammography should be added to these imaging tests, but if there is a family history of breast cancer in one of the first-degree relatives (mother, sister, brother), mammography is also recommended under the age of 40. In addition, if the breast is hard and dense, as is usually the case in young people under the age of 40, contrast-enhanced breast MRI is recommended for these patients.
Surgical treatment without breast loss
The priority in the treatment of breast cancer is the treatment and applications for the protection of the breast. In breast cancer that is caught at an early stage (not metastasized to small surrounding tissues), only the mass is removed with a clean surgical margin, without breast loss. In cancers with a positive BRCA test, a positive family history, or multiple breast cancer in the breast (multicentric breast cancer), surgical treatment is applied while the breast is emptied, filled with silicone, preserving the natural appearance of the breast skin and nipple. In general, there are two options for treatment. In patients with a small breast mass and no cancer spread to the armpit lymph nodes, first surgery, then chemotherapy, radiotherapy and hormone therapy (oral medication that suppresses the estrogen hormone for 10 years) is used. In patients with a cancer mass larger than 5 cm in the breast or cancer metastasis in the axillary lymph nodes, first medical oncological treatment (neoadjuvant chemotherapy) is performed, and then surgery is performed after the mass shrinks.
Smart drugs can also join the treatment
Recently, smart drug treatments can be applied to some patient groups. Whether smart drug therapy can be applied or not is determined by the biological structure of the tumor. Knowing the biological structure of tumors is important in this respect. These tumors can be roughly classified as estrogen or progesterone sensitive, HER-2 receptor positive, or insensitive to neither (triple negative). Only Her2 positive patients can use smart drugs. However, this is a longer treatment compared to other tumors.
Breast cancer can also increase the risk of thyroid cancer!
Patients with breast cancer undergo PET/CT for staging. With this method, it is investigated whether there is cancer in the whole body. In most patients with breast cancer, thyroid nodules can be detected incidentally on PET. When these thyroid nodules were examined, 10-15% of them were found to be thyroid cancer. Patients with breast cancer and thyroid nodules have a high risk of developing thyroid cancer in the future. It can be said that the risk of thyroid cancer increases 1.5-2 times in patients with breast cancer. Likewise, the risk of developing breast cancer increases 1.5-2 times in those with thyroid cancer. At this point, it is important to conduct mutual examinations in patients with breast cancer or thyroid cancer. In addition, people with mutations in BRCA-1 or BRCA-2 have a very high risk of having ovarian cancer as well as breast cancer. For this reason, it is recommended that the ovaries be surgically removed within 2 years following the treatment in people with breast cancer.