
10 10 2019It ıs the most common type of cancer ın women. Durıng lıfe, one ın 8 women have breast cancer.
It is the most common type of cancer in women. During life, one in 8 women have breast cancer.The most important risk factor is undoubtedly being a woman, Breast cancer can also be seen in men and this rate is less than 1% of the incidence in women.
Breast cancer is more common in developed countries. Japan is an exception. The reason for this is the excess consumption of omega3-containing fish in Japanese cuisine.Such that the settled Japanese in the United States, after a few generations, this rate is similar to that seen in other US citizens.The most blamed in this regard are obesity and the consumption of fatty fastfoods.Especially in postmenopausal obese women, breast cancer is more common than others.
although breast cancer is more common after 40-50 years of age and advanced age is an important risk factor, unfortunately, we see much more than expected in our country at young ages.
Today, alcohol consumption is considered among the most important risk factors.
Hormones are classic risk factors.These include factors such as having given birth to her first child at an advanced age, more importantly, never having given birth, the first menstruation is too early , menopause at an advanced age, starting birth control pills at an early age and using them for a long time, and using estrogen + progesterone hormones together to alleviate menopausal complaints of menopausal women.Cancer in one breast poses a risk for cancer in the other breast (simultaneously or at different time).
In the meantime, genetic studies show that BRCA I (breast cancer I) genes with positive BRCA II (breast cancer II) genes are very likely to have breast cancer.Other organ cancers may also be more common in breast cancer patients with genetic transmission characteristics at the same time or in another time period.For example ; Breast cancer - ovarian cancer, breast cancer - colon cancer, breast cancer - brain tumor.
Such hereditary cancers occur at a younger age and are more likely to be bilateral (at the same time or at different times).
Physical examination and radiological evaluation are essential for diagnosis. However, the definitive diagnosis is made by pathological examination of the part taken from the breast.
In physical examination, we can group the findings as early and late periods with two headings. Although breast tumor can be seen all over the breast, the most common part is the upper outer quadrant.
There are early important symptoms ,these are, a slight pitting on the breast skin , nipple bloody discharge , image like eczema around nipple.
In the elderly, tissues located behind the nipple can escape into the nipple because it is atrophied. But when nipple is pulled by hand it comes out. This is a normal physiological condition.However, in breast cancer nipple does not come out.
The presence of palpable mass on palpate is a very important finding, but not every palpable mass is a cancer.Especially benign tumors called fibroadenoma in young people, middle and older ages, cysts are confused with cancer by patients.Mass under the armpit, having breast mass under the armpit is very important in terms of cancer risk.
The appearance of orange peel on breast skin in more advanced cancers, changes in breast size (shape or size) , ulceration of the breast (scar), limited or diffuse edema of the breast skin, mastitis-like appearance of the whole breast , The mass in the breast is very large, if there are glands under the armpit, they are larger than 2.5 cm or tightly adhered to deep tissues, edema can be seen on the arm.
After the necessary physical examination for patients who consults to the physician, radiological examination should be performed with or without any findings (tumors smaller than 1-1.5 cm may not be detected depending on the structure of the breast).
Because the milk glands are very intense in young people, the first radiological examination should be ultrasound. Mammography becomes more important in patients 40 years and older.
If a suspicious finding is found in both physical examination and radiological examination, biopsy is essential for definitive diagnosis.Biopsy is performed as needle biopsy or surgical biopsy. If the pathologist says there is cancer, this diagnosis is definite and treatment is started.
Staging is essential for treatment. Breast cancer is examined in 4 stages.
Stage I-II is called early stage.In the early stage, surgery forms the basis of treatment.According to pathological results, chemotherapy, hormone therapy, immunotherapy, radiotherapy can be added.There are currently two methods in the surgical treatment of early stage breast cancer.
A- Breast Conserving surgery
If there are some special conditions, breast-conserving surgery is performed. In this treatment, cancer tissue is removed with at least 2-3 mm healthy tissue and the axillary lymph nodes are cleaned.Edema in the arm may develop more or less in 30% of patients whose armpit lumps are completely cleaned.Therefore, in physical examination, under armpit lump in patients not detected,lymph node sampling by radioisotope and / or painting method.If there is no tumor in the lymph node that we call the guard (as a result of emergency pathological examination), the operation is completed at that stage. If there is a tumor in the gland, all lymph nodes should be cleaned.
B- Removing the entire breast and cleaning the underarms. (MRM)
Stage III is called locally advanced stage breast cancer.In this phase, 3-4 cycles of chemotherapy, then surgical treatment and radiotherapy are applied.Chemotherapy - hormone therapy - immunotherapy continues.
Stage IV breast cancer is advanced. These patients may also have distant metastases. Surgery and radiotherapy are performed only if necessary to improve the quality of life of the patient. Chemotherapy - hormone - immunotherapy methods are the mainstay of treatment in these advanced stage tumors.The results are very good if breast cancer is detected at an early stage.The majority of patients do not have a cause of death.Post-treatment follow-up is very important.The most common metastatic organs of breast cancer are the bones, especially the spine and the lungs.Therefore, these organs are examined together with the remaining breast tissue.Early diagnosis is very important for the treatment of breast cancer.
Therefore, all women from the age of 20, preferably the next week after menstruation, in front of a mirror and lie down to examine by hand.
Women with a positive family history should start at an early age and women 30 years of age and older should get a medical examination.The examinations should be performed every 3 months, once every 6 months or once a year according to the situation determined in the first examination.Mammography should be performed at the age of forty. Then it is repeated every 1-2-3 years depending on the situation.It is recommended to repeat this every year from the age of 50 until the age of 60.
Best Regards
Professor Doctor Bekir Yaşar