In what cases does the risk of getting breast cancer increase?
The most commonly seen type of cancer in women is breast cancer worlwide. The male counterpart for this is prostate cancer. The common feature of both cancers is that they are hormonal background, or rather endocrine-related cancers. Exposure to intensive estrogen hormone increases the incidence of these cancers in women, while intensive testosterone exposure in men. Prostate cancer is not included here because it’s out of the topic (I have to give a few personal opinions here. Endocrine disruptors – which many scientists who deal with cancer are not well informed about – are somewhat involved in the development of these two types of cancer. Plastics, rubber and some petroleum products, in particular, are potentially endocrine-destroying, contributing to the development of breast cancer. (You can ask me for more detailed information).
The risk factors known to date (which increases the risk of cancer by 1.5 to 4 times) are:
- Prevalence of breast cancer in first-degree relatives (mother, sister)
- Intensive oestrogenemia (pre- 12 years of birth and after 55 years of menopause)
- Late pregnancy (after 30-35 years). (IMPORTANT NOTE: a woman becomes fully pregnant before the age of 24 and is less likely to develop breast cancer if lactated in time)
- Obesity (especially postmenopausal). At this point, western diet probably has a role to play in fast foods. I think girls are much less likely to get breast cancer if they don’t gain weight by eating vegetables and eating healthy foods and practicing active sports in their lives from adolescence onwards.
In some genetic circumstances, the risk of developing breast cancer is very seriously increased (e.g., 40-70%):
- more than two persons in the same family have breast cancer
- one person in that same family has breast cancer at a young age or the existing cancer is present in both breasts
- Ashkenazi Jewish families
- have BRCA mutation
Some histo-pathological diagnosis are associated with an increased likelihood of cancer in people who have had a breast biopsy for any reason other than the above factors (you should consult your doctor, General Surgeon, for this matter).
What are the symptoms of breast cancer?
- During bathing or clothing, a feeling of a obvious mass or stiffness than the breast tissue (sometimes accompanied by pain)
- Spontaneous nipple discharge that does not appear to be milk-like so that it can be seen on clothes or linen
- Detection of cancer-thinking signs on a breast film taken without any complaints (mammography or ultrasound)
- appearance of an ulcera on nipple or areola
- redness or edema in the entire breast
Simply what to do to prevent breast cancer and to diagnose it early?
- The most convenient method is to examine your body during each bath, except during menstrual periods. The breast tissue is compressed between the fingers and the chest wall and circular movements are performed (PHOTO). Do not press the breast tissue between your fingers.
- Take a mammogram once a year after the age of 40 and go to the general surgeon. Mammography without physical examination is not enough. If possible, mammography should be a high-quality screening, and again, if possible, it should be repeated at the same radiology center every year.
(Important note: You should have your previous mammography, ultrasound and MRI reports with you when visiting a doctor.)
- Mammography is almost always done in conjunction with ultrasound. If these two methods are diagnostically inadequate, breast MRI is used and the technique is particularly require when the breast structure is dense or in the presence of breast cancer in the family (please consult your doctor about this)
- The following BIRADS scoring system (Breast imaging-reporting and data system) are used in current breast imaging reports. The meanings of these stages are as follows:
BIRADS O: The examination done is inadequate, more examination is needed.
BIRADS 1: Completely normal breast structure requiring annual monitoring.
BIRADS 2: A benign finding that is unlikely to cause cancer. Continue the annual follow-up.
BIRADS 3: Probably benign lesion (should be monitored at intervals of 3-6 months). The chance of cancer is about 1-2%.
BIRADS 4: Suspected breast cancer. Definitely need a biopsy.
BIRADS 5: Very likely cancer.
BIRADS 6: Cancer now confirmed by biopsy.
(The density of breast tissue is also scored by the BIRADS system. This doesn’t mean cancer.
Which lesions are required biopsy?
- The all BIRADS 4 and BIRADS 5 lesions require breast biopsy because of probability of breast cancer
One important point: these lesions may sometimes be nonpalpabl even during a medical examination. So, there’s a lesion that can only be seen on a mammogram or ultrasound, while there is no mass in a doctor’s examination. In this case, the biopsy method is changed (see Biopsy Methods). It is appropriate for the General Surgeon and the Radiologist to make a joint decision on the biopsy here.
- BIRADS 3 lesions require biopsy when palpabl (can be found during physical examination) However, the biopsy method again varies from doctor to doctor. The biopsy decision here definitely belongs to the breast or general surgeon (MY OPINION)
- Disharge from the nipple (bloody or woter-like) is a very important finding. Sometimes cancer or a precancerous lesion can lead to this complaint. The general surgeon uses several special biopsy or diagnostic methods in these cases.
- Ulcerative lesion of the breast (the presence of a wound on nipple or breast skin).
What are the available biopsy methods for breast-related disorders?
I have to point out something here. Interestingly, the organ with the most biopsy diversity is the breast. The suitability of the method to be chosen here varies depending on the doctor’s preference, knowledge, experience and the conditions of the centre where it is located.
- Fine needle aspiration biopsy: does not require local anesthesia, can be performed in anesthesiological conditions, but the biopsies must be properly performed and evaluated by an experienced pathologist.
- Core biopsy: requires local anesthesia and a small cut of the skin. It can only be applied during the breast imaging. Sonography guidence is strongly suggested.
- The above methods can be applied with different forms of imaging, such as stereotactic, vacuum, ABBI. You should consult the doctor for technique selection.
- Ductoscopy: In case of pathological nipple discharge, it is used to determine the origin of nipple discharge, and removal of lesion from the duct.
- Ductal lavage cytology is another option of pathological nipple discharge diagnosisi
- Needle-wire located breast biopsy: Particularly performed in patients with non-palpabl lesions. The radiologist and surgeon must be experienced in this.
- Micronodectomy: It is used definitive diagnosis and treatment of pathological nipple discharge. It’s a surgical practice.
- Excisional biopsy: completely removal of the mass from the breast surgically.
- Incisional biopsy: removal of a small portion of the mass in the breast. This technique is used for inoperable breast cancer or Paget’s disease.
What are the stages of breast cancer and what you need to know first if you have cancer;
- If you are diagnosed with breast cancer, first of all, you have a chance of getting rid of it completely with proper treatment.
- Breast cancer treatment is not done by a single doctor. It is carried out by a team that requires the effort of several different disciplines. However, the initial attempts are planned by the General Surgeon, and the surgeon should always be actively involved in the follow-up periods.
- If we put aside the stage called in-situ cancer, it’s consisted of four stages. The first two stages are referred to as “Early Breast Cancer”. In these stages, treatment commonly begins with surgery. If necessary, he continues with chemotherapy and radiotherapy. In stage 3, there is no distant organ metastasis, but the area where the cancer is somewhat advanced. Treatment of this condition can begin with chemotherapy and then proceed with surgery. Stage 4 is a phase of distant organ dissemination.
- There are many options for the surgical treatment of early-stage breast cancer. Even if you’ve had cancer, it’s possible to preserve your breast, like you haven’t had surgery before, or re-create your breast after removing the cancer tissue. This should be discussed openly with the General Surgeon at the beginning of everything. You need to decide on treatment options and treatment alternatives in detail by consulting your doctor. PLEASE REMEMBER THAT THERE ARE HIGHLY EFFECTIVE TREATMENT ALTERNATIVES AVAILABLE AT EARLY STAGES
- Many patients with breast cancer receive hormone therapy. This condition is determined by the biological characteristics of the disease, the state of menopause. There are many medicines and methods for hormone therapy. Please consider this with your surgeon or the doctor on the team. Hormone therapy is a relatively less toxic but effective treatment.
- If you are in premenopausal age, you should discuss and evaluate issues such as the desire to pregnancy later, breast conservation, at an early stage with the surgeon, who is guiding your treatment!
What are the differences between axillary disection and sentinel lymphatic node biopsy?
Cancer surgery aimed to remove malignant tumor with safe surgical margins (R0 resection) from the organ and remove regional metastatic lymph nodes if any. Regional lymph node dissection is principally unneccessary unless tumors have spread to the nodes. In the presence of regional metastasis, this surgical procedure (lymph node dissection) is useful in the aspects of regional tumor control, prevention of recurrence and determining of prognosis and additional treatments. Breast cancer almost always metastases to axilla and the axillary lymph nodes are harvested from two surgical level when metastasis is comfirmed pre-operatively or per-operatively. However, this procedure may cause severe lympedema in the arm and shoulder disfunctions.
- Sentinel lymph nodes (SLN) are the first regional lymph nodes to receive drainage directly from a tumor. Negative or non-metastatic SLN means that other regional lymph nodes are negative. Therefore the aims of SLN procedure are to define negative axilla (N0 disease, stage 1 disease) and prevention of unneccessary axillary dissection and prevention of morbidities ie arm edema.
Sentinel lymph nodes are identified by lymphatic mapping techniques using a blue dye (isosulfan blue, lymphozurine), a radioisotope (99mTc-nano colloid), or the two in combination. These traceable substances are injected into the breast before surgery, commonly in subareolar region.