Cancer ranks second after cardiovascular diseases in the list of diseases that cause death all over the world. The cancer that causes the most deaths regardless of gender, lung cancer; The second most common type of cancer in women is it. İt ranks first among all causes of death in women aged 40-50. It is known that there are 10 million cancer cases in the world every year. 1 million (10%) of these cases are breast cancer. Rarely, breast cancer may develop in men. For every 100 women, 1 man is diagnosed with breast cancer.
Breast cancer is a major public health problem. While in the USA in the 1970s, the lifetime probability of developing It in women was 1/13, today it has progressed to 1/8. This increase can be explained by the increase in risk factors for breast cancer as the diagnosis becomes widespread as a result of mammography and screening programs.
What are the risk factors?
Unchangeable risk factors:
– For every 100 women, 1 man is diagnosed with breast cancer.
The incidence of breast cancer increases with age.
– 5-10% of all breast cancer cases are inherited. Particularly, individuals with mutations in BRCA1 and BRCA 2 genes are at risk.
– There is a family history in 15-20% of all breast cancer cases. Familial breast cancer is mentioned when a first-degree relative has breast cancer under the age of 40, bilateral breast cancer is seen in first and second-degree relatives, the father has breast cancer, two breast cancer relatives under 60, or three-family history of breast cancer regardless of age.
– The risk of cancer in the other breast of patients who have been treated with a diagnosis of breast cancer has increased 3-4 times.
– Caucasian people have a higher risk of breast cancer.
– Detecting some proliferative diseases by biopsy is important for follow-up. The biopsy itself does not increase the risk.
– It is detected mammographically, it also reduces the sensitivity of mammography.
– Having previously received radiotherapy to the chest area.
– Starting menstruation before the age of 12, stopping menstruation after the age of 54, increases the risk because exposure to estrogen hormone increases.
Modifiable risk factors:
– First, live birth after the age of 30, never giving birth, or not being able to breastfeed.
Hormone treatments are given for menopausal symptoms. Use for more than 5 years increases the risk of breast cancer. It is not recommended to be given to every menopausal woman.
Birth control pills do not increase the risk much. It is said that the risk increases in continuous use for more than 14 years and the risk returns to normal with the discontinuation of the drugs.
– Regular alcohol consumption, obesity, and a fatty diet increase the risk of breast cancer due to the increase in the amount of estrogen hormone circulating in the body. Lack of physical activity also increases the incidence of breast cancer.
Be a doctor yourself for early detection
The most effective method to reduce deaths due to breast cancer is early diagnosis. For this purpose, screening studies are carried out in many countries. Screening is the name given to studies conducted in a population that is likely to have a disease but does not show any symptoms for that disease before the disease manifests itself clinically. . Self-examination of the patient, examination by the doctor, and mammography are used in breast cancer screenings. As a result of these screenings, many international studies show that deaths from breast cancer are reduced by 30-40%.
Self-examination is that each woman examines her breasts in turn. The aim is for each woman to recognize her normal breast tissue starting from an early age and to apply to health institutions by recognizing any unusual changes early. What’s more, it takes responsibility for its own breast. 60-70% of women with breast cancer in our society detect the disease themselves.
Check after your period
Women over the age of 20 should examine their breasts every month. The best time for the examination is the 2nd and 3rd day after the end of the period. These days are the least swelling and sensitivity in the breasts. Women who have gone through menopause can choose the first day of each month. After breastfeeding, breastfeeding women should examine the breasts after the milk is emptied.
While examining the breasts, the principles of visual examination while standing, hand examination while standing and inpatient palpation should be applied. Inspection 2-3-4. It should be done with the inner surfaces of the fingers, and also the nipples should be gently squeezed to investigate whether there is any discharge. Both armpits should be examined separately. During the examination, both breasts should be compared with each other.
As a result of self-examination, it should be checked whether there is an abnormal growth or sagging in one of the breasts, wrinkles or wounds on the breast skin, change in the color of the nipple, dimpling of the nipple, discharge from the nipple, localized swelling in the breast, enlargement of the armpit lymph nodes, swelling in the upper arm, any In case of doubt, health institutions should be consulted. The thing to remember is that a lump in the breast is unlikely to be malignant. However, each mass must be evaluated with further examinations by the doctor.
Detect non-spreading tumors with mammography
Examinations by the doctor should be performed every 3 years between the ages of 30-40 and once a year at the age of 40 and after the age of 40, in the absence of any complaints and in patients with no family history of cancer. Mammography screenings reduce deaths from cancer by at least 30%. 40% of deaths due to breast cancer occur between the ages of 35-49, so catching the tumor at an early stage is especially important in this age group. Tumors called ‘in situ cancers’ of the breast that have not spread and are not palpable with an examination in the breast have started to be detected more frequently with the widespread use of mammography. In this way, tumors have begun to be detected before metastases, which significantly shorten the life span of the patient, occur.
Routine check frequency depends on the person.
While every woman between the ages of 30-40 is examined by a doctor every 3 years, women with suitable breasts should have initial mammography at the age of 35, and annual mammography checks after the age of 40. Annual controls should continue until the age of 75. In women whose first-degree relatives are diagnosed with breast cancer at a young age, screening should be started 10 years before the age at which the cancer was detected.
Ultrasonography, which is widely used in the diagnosis of breast diseases, is not used for screening. It is used for the characterization of the mass detected in mammography as an aid to mammography. Apart from this, it may be preferred to mammography in patients with dense breast tissue, masses that cannot be detected in mammography but palpable by examination, palpable masses under 30-35 years of age, pregnant women, breastfeeding periods, patients with a clinical infection, male patients. Especially in patients with dense breast tissue and in young patients, breast MRI is also used for diagnosis.
The patient-doctor relationship is important for treatment
Determining the stage of the disease in breast cancer also plays an important role in planning the treatment to be applied. The treatment plan created by determining the stage of the disease increases the success rate. The most effective treatment in it is in early-stage tumors. Those in Stage 1 and Stage 2 groups are considered as early stage. One of the important points in treatment is to decide on treatment with the patient. If radiotherapy is required after breast-conserving surgery, options such as breast reconstructions with mastectomies in addition to chemotherapies or size reduction preoperative chemotherapy options should be evaluated individually for each patient and the appropriate option should be decided.