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 will develop breast cancer. Although the exact figures are unknown in our country, it is an undeniable 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 particularly 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 . 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 glasses a 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. Nevertheless, the most important risk factor for breast cancer is being female. In this respect, educating women about early signs and screening methods for breast cancer is the most positive action they can take.
The earliest possible diagnosis of breast cancer is through screening methods, even before symptoms appear. The most important of these screening methods is mammography. Mammography is a method of taking an X-ray of the breast between two plates. It has been scientifically shown that mammography reduces the risk of death from breast cancer by at least . Today, scientists (American Cancer Society – ACS, American College of Oncology – ASCO) recommend that every woman have her first mammogram between the ages of 35-40 and annually from age 40 to 70. The cancer indicators and their predictive rates in mammography are as follows: – Mass + microcalcifications () – Tissue Distortion () – Mass () – Asymmetric Density () – Microcalcification (). There is a misconception among women, especially in our country, that mammography is a difficult and painful examination method. Mammography doesn't necessarily require painful compression of the breast. New devices only require slight flattening of the breast. Furthermore, the amount of radiation received during a mammogram is negligible with modern mammography equipment. Moreover, mammograms are quite inexpensive (currently averaging under 40 TL – 75 $ –) and can be performed quickly (total time 15 minutes). Despite mammograms, one-third of breast cancers can be missed. Therefore, a yearly doctor's examination can increase the chance of early detection. In addition, if every woman examines her breasts every month, early detection of some cancers missed by mammography is possible. There are some points a woman should pay attention to when examining her 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 chosen. The examination should be performed with the left hand for the right breast and the right hand for the left breast, using circular motions of the fingertips. Lumps often felt in women are normal mammary glands and milk ducts that are soft, mobile, and not easily identifiable. In recent years, contrast-enhanced breast MRI has proven to be a better and more reliable diagnostic method than mammography, particularly in younger women. For women under 40 or those with increased breast density on mammography, breast MRI is now considered a frequently used early diagnostic method. The only drawback is that breast MRI is more expensive than mammography. This issue may be resolved as MRI equipment becomes cheaper. Furthermore, the fact that the patient is not exposed to any radiation during a breast MRI is a significant advantage.
In many women, the walls of these mammary glands and milk ducts enlarge due to the effect of hormones, especially before menstruation, and can sometimes be painful. These are benign growths known as "fibrocysts". Most of these fibrocysts are not related to cancer.
A cancerous lump in the breast is usually felt as a hard, painless, and immovable mass. Many cancerous lumps can also be palpated all around. Women who feel such a lump should consult their doctor immediately. The complete cure rate for breast cancers detected with these early diagnostic methods is above . A diagnosis of breast cancer requires the visualization of cancer cells under a microscope. Without a pathological diagnosis, only suspicion of breast cancer can be mentioned. 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 can be taken from the lump using fine-needle aspiration, making it possible to diagnose cancer in a percentage of cases close to . In some cases, core needle biopsies are preferred. This method makes it possible to differentiate between in situ (non-metastatic) and invasive (classic cancer). Furthermore, interpreting core needle biopsies does not require doctors with additional cytology training in pathology (pathology specialists with subspecialty training in cytology are preferred for interpreting fine needle aspirations). After a definitive diagnosis of cancer, chest X-rays, liver ultrasounds, and bone scintigraphy are performed to determine staging. If there is no metastasis to distant organs (spread through the bloodstream), surgical removal of the cancer is necessary. Sometimes, if a mass in the breast is determined with high probability to be cancerous through examination or imaging methods, it may be decided to remove the mass surgically without performing a biopsy.
