Breast cancer is the most common type of cancer in women. In developed countries, one in every 7-8 women who live to the age of 70 develops breast cancer. Although the exact figures are unknown in our country, it is an inevitable fact that the incidence of breast cancer will increase due to increasing industrialization and changing dietary habits.
Three-quarters of women diagnosed with breast cancer have no specific risk factors other than being female. However, a risk factor can be identified in one-quarter of patients. One of the most important risk factors is family history. If there is a history of breast cancer in the family, especially among first-degree relatives, and if this breast cancer occurred before menopause, the risk of breast cancer increases significantly. For example, if a woman has a history of premenopausal breast cancer in both her mother and sister, her lifetime risk can reach 50%. Other risk factors include early onset of menstruation, late menopause, never having given birth, and never having breastfed. Long-term (more than ten years) hormone therapy after menopause, a high-fat diet, and excessive alcohol consumption (more than two drinks per day) can increase the risk of breast cancer. Regular exercise, a diet rich in fruits and vegetables, and the use of olive oil are also thought to have protective properties. However, the most important risk factor for breast cancer is being female. In this regard, the most positive step women can take is to educate themselves about the early signs of breast cancer and screening methods.
The earliest diagnosis of breast cancer is possible through screening methods before any symptoms appear. The most important screening method is mammography. Mammography is the method of taking an X-ray of the breast between two plates. It has been scientifically proven that mammography reduces the risk of dying from breast cancer by at least 30%. Today, scientists (American Cancer Society – ACS, American Society of Clinical Oncology – ASCO) recommend that every woman have her first mammogram between the ages of 35 and 40 and then have one every year from the age of 40 to 70. The cancer indicators and detection rates in mammography are as follows: – Mass + microcalcifications (73%) – Tissue distortion (57%) – Mass (48%) – Asymmetric density (25%) – Microcalcifications (24%) There is a misconception among women, especially in our country, that mammography is a difficult and painful examination method. It is not necessary to compress the breast in a way that causes pain to the woman for a mammogram. With new devices, gently flattening the breast is sufficient. Furthermore, the amount of radiation received during a mammogram is negligible with modern mammography devices. Moreover, mammography is quite inexpensive (the average price these days is less than 40 TL - $75) and can be performed in a short time (total time 15 minutes). Despite mammography, one-third of breast cancers can be missed. Therefore, a yearly doctor's examination can increase the chances of early diagnosis. In addition, if every woman examines her own breasts every month, it may be possible to diagnose some cancers early that mammography misses. There are certain points a woman should pay attention to when examining her own breasts. If the woman is menstruating, the examination should preferably be done after her period ends, otherwise a specific time of the month should be determined. The examination should be performed using circular movements of the fingertips, with the left hand for the right breast and the right hand for the left breast. Lumps that are often found in women are soft, movable, and have no defined edges, which are normal mammary glands and milk ducts. In recent years, it has been found that contrast-enhanced breast MRI is a better and more reliable method of diagnosis than mammography, especially in young women. Breast MRI is now widely accepted as an essential early detection method for women under 40 or those with increased breast density on mammography. The only issue is that breast MRI is a more expensive method compared to mammography. As MRI equipment becomes more affordable, this problem may be resolved. Additionally, the fact that the patient is not exposed to any radiation during breast MRI is a significant advantage for the patient.
In many women, the walls of these milk glands and milk ducts expand under the influence of hormones, especially before menstruation, and can sometimes be painful. These are benign growths commonly known as "fibrocysts." Most of these fibrocysts are not associated with cancer.
A cancerous lump in the breast is usually felt as a firm, painless, and immobile mass. It is also possible to feel the edges of many cancerous lumps. Women who feel such a lump should consult their doctor immediately. The complete recovery rate for breast cancers detected by such early diagnosis methods is over 90%. For a breast cancer diagnosis, cancer cells must be seen under a microscope. Without a pathological diagnosis, only a suspicion of breast cancer can be made. The most common symptom of breast cancer is a palpable lump. In this case, a mammogram and, if necessary, an ultrasound are performed to obtain additional information about the nature of the lump. Following this, a sample is taken from the lump using the fine needle aspiration method, making it possible to diagnose cancer in nearly 90% of cases. In some cases, core needle biopsies are preferred. This method makes it possible to distinguish between in situ (non-spreading) and invasive (classic cancer). Furthermore, doctors with additional cytology training are not required to interpret core needle biopsies (pathologists with a subspecialty in cytology are preferred for interpreting healthy fine needle aspirations). After a definitive diagnosis of cancer, a chest X-ray, liver ultrasound, and bone scan are performed to stage the cancer. If there is no metastasis (spread through the bloodstream) to distant organs, the cancer must be surgically removed. Sometimes, if both examination and imaging methods indicate a high probability that the lump in the breast is cancerous, it may be decided to remove the lump directly through surgery without performing a biopsy.
