About Breast Health

The most important methods to detect breast cancer are; doctor’s examination, mammography, ultrasonography and if these are not possible, self-examination by the patient. However, methods known as tumor markers where blood tests are made to detect the elements secreted by the tumor should not be used in the diagnosis of breast cancer. Tumor markers especially used in breast cancer are Ca15-3 or CEA. However, these tests are used in the follow-up of patients who have already been diagnosed with breast cancer. It is not a right method to use these tests to determine the presence of cancer. These tests can also be misleading. They may show false positive results (they may be high even though the person does not have cancer-false positive result) or show negative results when the person does have cancer (false negative results). Therefore, breast cancer cannot be diagnosed through the use of blood tests. The best scanning method for breast cancer is mammography screening.

Breast cancer can be noticed by self-examination. However, this may take a long time. Therefore, it is definitely advised to have annual examinations and mammograms after the age 40. However, women with small breasts or with a tumor close to the skin who cannot undergo a doctor’s examination and mammography may be able to recognize breast cancer by self-examination. This is why you should examine your breasts. Self-examination of the breasts can be made in front of a mirror by viewing and feeling by hand (See: our examination guide). During this examination, the presence of wounds or rashes that don’t heal on the breast skin or nipple, the feeling of an outward push in the breast skin or an inward pull in the breast skin (hollowness or dimple) are all important signs. Also; thickening of the breast skin, redness or the breast skin taking the form similar to orange peel may be signs of breast cancer. During a manual examination, a lump is usually felt as a sign of breast cancer. You must contact a doctor as soon as you feel a change in your breasts. Also; a discharge from the nipples may be a sign of breast cancer.

Breast cancer can be noticed by self-examination. However, this may take a long time. Therefore, it is definitely advised to have annual examinations and mammograms after the age 40. However, women with small breasts or with a tumor close to the skin who cannot undergo a doctor’s examination and mammography may be able to recognize breast cancer by self-examination. This is why you should examine your breasts. Self-examination of the breasts can be made in front of a mirror by viewing and feeling by hand (See: our examination guide). During this examination, the presence of wounds or rashes that don’t heal on the breast skin or nipple, the feeling of an outward push in the breast skin or an inward pull in the breast skin (hollowness or dimple) are all important signs. Also; thickening of the breast skin, redness or the breast skin taking the form similar to orange peel may be signs of breast cancer. During a manual examination, a lump is usually felt as a sign of breast cancer. You must contact a doctor as soon as you feel a change in your breasts. Also; a discharge from the nipples may be a sign of breast cancer.

You must start examinations at age 20. All women starting from age 20 must learn self-examination and be aware of her breast structure so that she can notice any changes. Starting at age 40, you must have a clinical examination performed by a doctor and annual mammograms. With annual mammograms after 40, a very early diagnosis of breast cancer is possible.

The World Health Organisation (WHO) recommends mammography screening for all women starting from age 40. However, considering personal risks, a different program may be recommended by your doctor. For public screening, once a year starting from the age 40 is the best approach. All countries do not apply this. Most countries decide on the frequency of mammography screening for their citizen women according to their financial resources. The decision of the World Health Organisation (WHO) has been scientifically made without taking into consideration the special conditions of each country. However, for example, the UK applies mammography for all women every 2 years as its health budget, number of doctors and devices are not sufficient for annual mammography. In some countries there are annual examination programs for all women. In some countries annual check-ups recommended by the WHO are applied.

It is naturally mandatory to take 2 projection views of each breast during a mammography screening. By applying a slight compression from top to bottom and medial to lateral, 2 films from each breast are obtained. Since the breast tissue is slightly compressed, this may cause a short, slight pain. With the use of digital mammography in the past 10 years, there has been a considerable decrease in the pain felt during mammography screening. If you normally have pain and sensitivity in your breasts, you can use a mild analgesic before screening. Does mammography contain X-rays? Yes, mammography is a method of screening that contains x-rays (radiation). However scientific studies have shown that the relative risk of having mammography screening once a year is much lower than the benefits of early diagnosis of breast cancer. In some cases, mammography screening is applied more than once a year.

The most important risk factor is being a woman. Breast cancer occurs in women who do not have a high-risk factor as well. Being over 40 is a risk factor, the risk factor increases with age. While it’s rare in women in their 20’s; after the age 40 there is an increasing percentage. Having a family member with breast cancer increases the risk. Long term hormone treatments, especially female hormone treatments can increase the risk of breast cancer. Early menstruation and late menopause (meaning women who are hormonally active for a long period) are also under a higher risk. Regular consumption of alcohol and smoking increase the risk. Never having given birth or giving the first birth after the age 35 carries the same risk. Having had cancer in one breast increases the risk for the other breast.

Environmental factors are very important in breast cancer. As genetic factors play a 20% role in women with breast cancer, in 80% of the women there is no certain cause. However, we know that environmental factors have a role. What is meant by environmental factors? Diet, use of alcohol, smoking and where the person lives. We know that breast cancer is seen less frequently in underdeveloped countries and more frequent in developed countries such as North European countries and the USA. However, although Japan is also a developed country, breast cancer cases are less here. ’’Is it due to genetic features?’’. Breast cancer has increased among the second generation Japans who have migrated to the USA. Although breast cancer is less common in Japanese women who live in Japan, after migrating to the USA, breast cancer cases are equal to the Americans. In other words; breast cancer in Japanese women who live like the Americans is as common as the Americans. This fact shows the significance of environmental factors.

Not all lumps felt by hand are cancer. In other words, the probability of the lump being cancer is less than the probability of it being benign. They are most probably harmless lumps. Of course, a doctor must decide on whether the lump is cancer or not. A lump felt by hand could be normal breast tissue, a benign breast lump or cancer. Therefore, one must contact a doctor who can make the necessary examinations and decide accordingly. Not every lump felt by hand means cancer.

There is no method that is 100% preventive. However, it may be possible to reduce the possibility of breast cancer by reducing the risk factors. There are risk factors that we cannot change in breast cancer. For example, if your mother has breast cancer, this is a factor you cannot change. However, there are risk factors that we can change. The most important are those related to our life style. Taking care not to use hormone therapy for more than 5 years, and not to use birth control pills before giving at least 1 live birth. Not consuming alcohol regularly and not smoking are the most important things one can do. Also being physically active lowers the risk. Consuming less animal products, having a diet rich in vegetables and fruit, maintaining a normal weight are all important factors in reducing the risk. Being careful about all these risk factors does not eliminate the risk of breast cancer 100%. The best way of prevention is to take all these measurements and have regular check-ups.

First of all, you should know that most lumps in the breast are benign and are not a sign of cancer. However, if there is a lump detected in the breast, it must be checked by a doctor. The doctor will examine you and after asking certain questions may ask for a mammography or ultrasonography screening according to your age. Ultrasonography is especially used as a preliminary examination in patients under 40. However, mammography screening may also be applied in patients under 40, according to the doctor’s decision. Your doctor is the person who should decide. After ultrasonography and mammography screenings, your doctor will inform you on the next step in accordance with your results.

Breast cysts are seen in one woman out of three. These are benign formations that don’t need to be treated and do not increase the risk of cancer. Solid lumps are hard, with a tissue content and no fluid. The potential risk of cancer in these bulks can be detected though methods such as doctor’s examination, ultrasonography and mammography. A biopsy may be necessary for solid lumps or a follow-up may be advised. Your doctor must decide on the procedure.

A biopsy is a procedure in which a small piece of body tissue is taken and examined with a microscope. The final diagnosis of cancer is always made by a biopsy. There are different types of biopsies. Fine needle aspiration biopsy is to take certain fluids and cells from the bulk in the breast with the use of a very thin needle. The accuracy is not 100%. In this method, cells, not tissue samples are taken. A more advanced method is thick needle biopsy. This is called “core needle biopsy” or “tru-cut biopsy”. In this technique, a thicker needle is used to enter the breast tissue and very thin tissue samples are taken. If the right lump is entered and sufficient-accurate sampling is made, the diagnosis percentage is close to 100%. A larger biopsy is performed by making an incision through the skin and taking a small piece. The next procedure is to take out the whole bulk. These are all diagnostic methods and must be performed according to the doctor’s decision.

Without a biopsy, the probability of cancer in a lump cannot be diagnosed 100%. The first procedure to perform in patients with a probability of breast cancer is a biopsy. As long as it is performed according to the rules, a biopsy will not cause a loss for the patient. Contrary to the belief among people, a biopsy does not cause spreading of the cancer.

Although MRI or Magnetic Resonance Imaging is an imaging method for the breast, it is not the first preferred method. It may be necessary in some patients who have had mammography and ultrasound screenings. Especially in patients with a dense breast tissue or who have been diagnosed with cancer and where the presence of a different focus is searched, this is a useful method. In some patients where lesions are detected only on MRI, the follow-up can also be performed by using MRI. However, MRI is not a standard procedure that is necessary for everyone.

Having silicone implants is not an obstacle for examination or treatment. All examinations and treatments can be performed. In some patients who have silicone implants, apart from ultrasonography and mammography, MRI may also be used specially to evaluate ruptures in the implants. The slight pressure applied during a mammography does not cause a rupture in the silicone implant. As for treatment, all treatments performed on other patients can be performed for patients with silicone implants.

Stages in breast cancer show how advanced the cancer is. The planning of treatment can only be made after determining the stage of the disease. A different treatment is applied for each stage. The staging in breast cancer is determined according to 3 points: The first is the size of the tumor in the breast. Second; the conditions of the lymph nodules under the arm. And third; is to determine whether there is cancer in other parts of the body by scanning the whole body. If the tumor is smaller than 2 cm, this is defined as T1. If it’s between 2-5 cm, it is T2. If it’s bigger than 5 cm, it is T3, etc. If there are no underarm nodules, we evaluate this as N0. If there are less than 3 nodules, N1, etc. The scanning for the presence of a spreading in the body or distant metastasis is diagnosed through bone scintigraphy, lung x-ray and abdominal ultrasonography. Because breast cancer usually spreads to the bones, lungs and liver. If there is no metastasis found in any parts this is defined as MO, if a metastasis is found this is; M1. In the staging, these 3 parameters are taken into consideration in the evaluation of the stage in which the patient is in. If there is a wide spread metastasis in the body (liver, bone or lung) this patient is evaluated as stage 4. If the cancer is at an advanced stage in the breast and underarm locations this is evaluated as stage 3. If the cancer is in the breast and underarm but not at a very advanced stage, we call it stage 1 or stage 2. Both stages are early stage breast cancers.