What You Should Know About Breast Cancer

1- What is breast cancer?

Breast cancer is a type of cancer that can originate from any part of the breast tissue, most commonly occurring in the ducts. It develops in the milk-producing lobules and the ducts that carry this milk. It is the most common cancer among women worldwide and typically occurs after menopause. However, in recent years, there has been a significant increase among women under 40. Studies show that 1 in 8 women have a lifetime risk of developing breast cancer, while its incidence in men is very low. Despite its high prevalence in women, breast cancer can be prevented through exercise, diet, and medication. Furthermore, thanks to early detection with mammographic screening and modern treatment methods, it is a completely curable disease.

2- What factors trigger the development of breast cancer?

Approximately 75% of breast cancers are sporadic, meaning they occur in women with no identified risk factors, family history, or genetic predisposition. About 15% occur in women with a family history of breast cancer, particularly in first-degree relatives (mother, sister, daughter, etc.), and roughly 10% are seen in women carrying cancer-related genes (BRCA 1,2). The longer the body is exposed to estrogen produced by the ovaries, the higher the risk of breast cancer. Factors such as early menstruation, late menopause, prolonged use of estrogen-based birth control pills, and postmenopausal hormone therapy increase the risk of breast cancer. Additionally, women who have not given birth or had their first child after the age of 35, and those with a body mass index (BMI) over 25, have a higher risk of breast cancer. A family history of breast cancer, especially in first-degree relatives like mother and sister, and the presence of breast cancer predisposition genes such as BRCA genes, constitute high-risk situations for breast cancer.

3- How is breast cancer diagnosed?

The most important finding for detecting this type of cancer is painless lumps in the breast or armpit that can be felt by hand. Additionally, dimpling or retraction of the skin or nipple may be observed. Rarely, there may be changes in nipple color or bloody discharge. In advanced cases, wounds may develop on the breast. The aim of all diagnostic efforts is to detect cancer through regular mammographic screenings before a lump is noticeable. This approach allows for both healthy living and breast preservation.

4- What is the incidence, and who is most affected?

Studies have shown that breast cancer is the most common type of cancer among women worldwide. Although protective measures have led to a decline in incidence, it is more frequently seen in developed countries. Conversely, in developing countries like Turkey, the incidence is rapidly increasing. Unfortunately, breast cancer ranks second after lung cancer among cancer-related deaths.

5- Is it possible to identify breast cancer genes in advance?

There are many genes that can lead to breast cancer. These genes are passed down from carrier parents to daughters. Among these, the most important are the BRCA 1 and BRCA 2 genes. These genes can be investigated in women with close relatives who have had breast cancer. To this end, Genetic Counseling Clinics have been established where these tests are performed. In these clinics, a woman's eligibility for testing is first assessed, and a decision is made regarding whether to proceed with the test. Women who are approved for testing are informed about the implications of undergoing the test and provided with psychological counseling. For example, actress Angelina Jolie's positive genetic tests for breast cancer (BRCA 1,2) and her decision to have a preventive mastectomy before developing cancer significantly increased the number of women in the U.S. seeking BRCA 1,2 testing.

6- At what age do women enter the risk group?

Breast cancer occurs in women at a much higher rate than in men. Women without hereditary predisposition or defined risk factors are considered to be in the risk group starting at the age of 50. In patients with familial or genetic predisposition, breast cancer can occur at younger ages.

7- How is breast cancer treated?

As with any disease, there are many treatment options for breast cancer. However, one of the key characteristics of this disease is that its treatment requires collaboration among multiple medical specialties, necessitating a highly specialized and experienced approach. The critical factor is detecting breast cancer at an early stage and in a small size through mammographic screenings. This allows for complete removal of the cancer via surgery, avoiding the need to remove all lymph nodes in the armpit and preserving the breast. Breast cancer cases detected at this stage and removed surgically may not require chemotherapy. In more advanced cases, chemotherapy and even radiotherapy may be needed after surgery. In some situations, chemotherapy may be administered before surgery to shrink the tumor, followed by surgery and radiotherapy. In early-stage breast cancer, treatment success rates are close to 100%.

8- What are the most modern and up-to-date tests and studies for diagnosing breast cancer in our country?

All known modern diagnostic and treatment methods and tests are available and applied in our country today. Depending on the patient's age and the characteristics of the lump and breast, diagnostic methods such as digital mammography, color Doppler ultrasound, tomosynthesis, and breast MRI can be easily utilized. For non-palpable tumors, marking and biopsy can be performed using mammography, ultrasound, and MRI. Additionally, BRCA 1,2 genetic testing is applied to women in high-risk groups. This allows the identification of women who carry breast cancer susceptibility genes, enabling the necessary information and interventions to be provided.

9- Is there a risk of recurrence after treatment?

The likelihood of recurrence is very low for breast cancer that is detected early and treated effectively. Recurrence can occur either locally in the breast and regional lymph nodes or systemically in distant organs (bones, lungs, liver, brain, etc.). For some patients diagnosed early, the OncotypeDX test provides a more scientific assessment of the likelihood of local or systemic recurrence within 10 years.

10- Are there any diet or exercise recommendations as preventive and protective measures?

As with any disease, regular and balanced nutrition is very important in breast cancer. Maintaining a normal BMI and engaging in regular exercise for at least 5 hours per week can reduce the risk of developing breast cancer by 30%. Additionally, consuming plenty of fresh seasonal fruits and vegetables, white meat (fish and chicken), and avoiding alcohol and smoking are important.

11- Is it possible to prevent this type of cancer in advance? Can you explain the importance of early detection and screening in the context of breast cancer?

Early detection of breast cancer is crucial for successful treatment. With early detection, it is possible to preserve the breast, and in some cases, chemotherapy may not even be necessary. The key element in early detection is the creation of screening programs using mammography and ensuring women's regular participation in these programs. These programs allow for the detection of cancers visible only on mammograms and not palpable. Studies show that mammographic screenings in women over 40 years old provide a 20-35% survival advantage. Therefore, the American Cancer Society, the American Surgical Association, and the Turkish Federation of Breast Diseases, which I helped establish and once presided over, recommend annual mammographic screening for women over the age of 40.

12- How can women understand the process by examining themselves? How should self-examination be done correctly?

There are three main methods for breast examination, diagnosis, and screening:
Self-examination: Women should begin self-examination at the age of 20. This should be done once a month, after a shower following menstruation, or for postmenopausal women, on a specific day each month. The woman first inspects both breasts in front of a mirror, then examines the left breast with her right hand and the right breast with her left hand, moving in three patterns: top to bottom, in a circular motion, and from the outer part of the breast towards the nipple. Any signs such as asymmetry, color changes, nipple or skin retractions, or lumps under the arm should prompt an immediate visit to a family physician, general surgeon, or gynecologist.

Clinical examination: In our country, general surgeons are trained in breast cancer examination and surgical treatment. Women without any symptoms should be examined by a general surgeon every three years between the ages of 20-40, and annually after the age of 40.

Mammographic evaluation: Mammography is the only screening method proven to reduce deaths due to breast cancer. The radiation it provides is negligible, and while it may occasionally lead to overdiagnosis and overtreatment, it is life-saving and has no alternative. It should be performed annually from the age of 40.

13- Do aesthetic operations increase the risk of breast cancer?

Recent technological advancements in aesthetic operations have reduced this risk to almost negligible levels. Especially with newer implants, the risk of developing breast cancer is very low.

14- Is every lump in the breast cancer?

More than 90% of palpable lumps in the breast are not cancer. These are usually cysts growing within the breast, benign tumors, or breast tissue that has taken on a lump-like form. Before menstruation, the internal structure of the breast becomes denser, which may lead to the perception of lumps during breast examinations conducted at this time.

15- Do fibrocysts turn into cancer?

Fibrocysts are physiological changes within the breast and are not considered a disease. Therefore, they do not carry a risk of turning into cancer. While cancer may develop in the presence of fibrocystic structures in the breast, these structures are not the cause. Stress, sorrow, and distress increase the number of fibrocysts, leading to tension. The use of caffeine, salty, and fatty foods also triggers this tension. An increase in fibrocysts causes pain in the breast.

16- Can fibroadenomas become cancerous?

Fibroadenomas are benign tumors. They have a capsule surrounding them, making it impossible for them to spread to surrounding tissue. The risk of breast cancer in fibroadenomas is similar to the risk in normal breast tissue. As the size increases, the risk rises by about 1-2%. While fibroadenomas may grow slightly due to soy consumption and birth control pill use, they are not considered to have cancer-causing effects.

17- What are the most important risk factors for breast cancer?

The greatest risk factor for breast cancer is being a woman. Female gender represents a 100-fold increased risk. Postmenopausal women are at even greater risk. An increase in the duration of exposure to the hormone estrogen also raises the risk of breast cancer. Receiving radiation therapy to the chest area, especially before the age of 15, is a significant risk factor. Consuming high-fat foods over a long period and daily alcohol consumption of 1-2 drinks contribute to the increase in breast cancer.

18- When is the best time for self-breast examination?

Women should begin self-breast examination after the age of 20. Since the risk of breast cancer in young women under 20 is low, self-breast examination is not recommended due to its potential to cause confusion and panic. The ideal time for a breast examination is 4-5 days after the end of the menstrual period.

19- When should the first mammography and breast ultrasound be done?

Women with a family history of breast cancer can have their first mammography at age 26, and those in high-risk familial groups can have one at age 32-34, with subsequent screenings every 1-2 years until the age of 40. After 40, annual mammography is recommended.

20- Does mammography have any effect on cancer formation?

In the past, even in mammographies thought to expose patients to high doses of radiation, 30-year follow-ups have proven that the radiation dose poses no significant threat to the body. Today's digital mammography technology uses 10 times less radiation compared to the past. When undergoing regular mammography, the most important detail to pay attention to is the quality and clarity of the imaging. Inadequate and poor-quality imaging can result in missing critical tumors in the breast. High-quality mammographic findings play a crucial role in early breast cancer diagnosis, even allowing changes in breast tissue to be detected before they turn cancerous.

21- What is the current surgical approach in breast cancer?

Today, in breast cancer surgeries, if the patient is medically eligible and there are no risk factors, breast-conserving surgery is performed. If the patient's breast needs to be removed, a new breast can be created after the second year once some risk factors are eliminated. The preservation of the breast or the ability to have a new breast later provides psychological relief, facilitates social adaptation, and increases the success of treatment.

In recent years, patients who need their breast removed undergo skin-sparing mastectomy followed by immediate reconstruction.

22- Are younger patients' breasts preserved while older patients' breasts are removed?

Medically, such a view is absolutely incorrect. The breast is an important object for women of all ages. There is no rule or understanding that older patients' breasts will be removed. Depending on the tumor's stage, form, and spread, the breast of a woman aged 70-80 can also be preserved.

23- What are the criteria for breast-conserving surgery?

The patient must not want her breast removed and prefer breast-conserving surgery. This is the patient's most basic right and preference. In such cases, the doctor should prioritize breast-conserving surgery. The cancer must be localized to one area, and the tumor in the breast should not be too large, maintaining a proportion between the size of the breast and the cancer. If the cancer is large and the breast is small, the entire breast should be removed. Axillary metastases do not prevent breast-conserving surgery.

24- In what situations is breast removal mandatory?

It is not possible to perform breast-conserving surgeries for patients with widespread tumors in the breast or cancer starting in multiple areas of the breast simultaneously. In these cases, the breast must be removed. If the mammography shows widespread and malignant calcifications that indicate the possibility of breast cancer starting in multiple locations, breast removal should be planned for such patients. For patients who have previously received radiation therapy to the chest wall, mastectomy is applied instead of breast-conserving surgery because post-surgery radiation therapy would be necessary again.

25- Does breast reconstruction provide positive results for cancer treatment?

Breast reconstruction, known as rebuilding the lost breast in breast cancer treatment, increases a person's self-confidence and quality of life, positively affecting treatment processes… 

In this regard, increasing awareness has been observed due to advances in the diagnosis and treatment of the disease and improvements in breast reconstruction techniques. Preserving body integrity boosts self-confidence and quality of life, positively influencing treatment processes.

Who can undergo breast reconstruction?

This operation can be performed on those who are conscious and willing regarding their disease and treatment and do not have systemic diseases that could delay wound healing or prevent surgery.

Immediate/early repair or delayed repair?

The decision depends on the stage of the disease and treatment processes. Delayed repair may be planned for patients who will receive radiation therapy.

What are the reconstruction options?

The new breast can be created using the person's own tissues (from the back or abdomen) or with a prosthesis. Both methods have their advantages and disadvantages and require multiple surgical sessions.

What will the result be like?

The goal is to achieve results as close to the original breast as possible. However, the new breast may have visible surgical scars and slight shape differences, at least for a while. If there is a shape deformity in the healthy breast, it can also be corrected to achieve symmetry.

What are the risks?

Along with general surgery risks such as bleeding and infection, which are rare, there are specific risks associated with the technique used, such as healing issues or capsule formation (scar tissue around the prosthesis thickening over time and causing deformity).