1-At what age should breast control begin? How often should it be done? When should a doctor be checked and when should radiological checks be done?
Breast cancer is the most common cancer in women and is among the cancers that have the highest chance of being completely treated when detected early, after a certain age. It is very important to carry out certain checks.
What should be especially emphasized is the need for personalized follow-ups in people with a high risk of breast cancer (such as familial breast cancer or genetic breast cancer). The routine checks we will explain below explain how to follow up people who are not at high risk of cancer. Because 75% of newly diagnosed breast cancer cases (that is, three out of four patients) are people whose family has never been diagnosed with breast cancer before.
All women have monthly breast cancer after the age of 20 (preferably after menstruation). It is important that they make it a habit to do their own breast examinations (within the next 5-10 days). In case of a change that they have not detected before during their routine check-ups (especially a lump, a spontaneous nipple discharge without squeezing, shrinkage on the nipple and skin), they should consult a doctor.
From the age of thirty, monthly breast self-examination as well as annual doctor's examination. should start.
In their published guidelines, some centers recommend a doctor's check-up every 6 months for the follow-up of patients who do not want to do self-examination.
In terms of follow-up, 40 years of age is considered a milestone for patients who do not have an additional risk. can be done. Starting from this age, annual radiological checks must be added and radiological checks (Mammography and, if necessary, ultrasonography or MRI) are very important. The frequency of breast cancer increases, peaking after the age of 50. Radiological findings of a cancer that reaches a level of clinical symptoms at the age of 50 may begin much earlier, and more than 90% of cancers diagnosed only with radiological findings can be diagnosed at a very early stage and the probability of complete treatment is very high. For this reason, radiological checks begin ten years in advance.
2-A person with a family history of breast cancer. How should follow-up be in the future?
The risk of a person with breast cancer detected in their family depends on the degree of kinship of the diagnosed patient, how many people in the family have breast and ovarian cancer, the status of a positive genetic test detected in the family, and how old is the youngest among the close relatives diagnosed? It varies depending on the genetic mutation.
The first-degree relatives of an individual whose genetic test is positive must also be tested to see whether they carry the same genetic mutation.
If there is a genetic mutation passed down from generation to generation in a family (grandmother, mother). If there is a situation such as breast cancer (aunt-aunt, sibling), breast cancer in a first- or second-degree relative younger than 40 years of age, breast cancer in a male relative, or a relative diagnosed with breast cancer in both breasts, these family members should be followed up specially. They must be below. They should be followed according to the doctor's recommendations.
3- Is mammographic follow-up absolutely necessary? What should be the frequency? Isn't the radiation received harmful?
Mammographic examination is the most basic and indispensable examination in breast cancer screening. Mammography can best show microcalcifications, one of the early findings of breast cancer. Community screening has generally been performed on people over the age of 50, and the effect of breast screening on survival has been shown. In personal checks or opportunistic scans, the starting age is generally considered to be 40. After the age of forty, mammographic screenings can be performed annually or every two years, but after the age of 50, they must be performed annually. The radiation dose received, especially in digital mammography used today, is insignificant.
4-What are the symptoms of breast cancer? Who is at risk?
In underdeveloped and developing countries, breast cancer is most often diagnosed when a person consults a doctor with a lump that occurs to her. In developed countries, the disease is diagnosed by physicians and radiological controls before it even shows symptoms. For this reason, in developed countries, breast cancer is diagnosed at an earlier stage and the chance of treatment may be higher.
Main risk factors for breast cancer:
- Breast cancer in the family having cancer
-Advanced age
-Never gave birth and not having breastfed
-The person has had cancer in one of the breasts before.
-Having used birth control pills (5-10 years)
-Estrogen due to menopause Having received hormone therapy
-Lobular carcinoma in situ and atypical ductal hyperplasia detected in a previous breast biopsy
-Obesity
-Alcohol and cigarette consumption
5-Is nipple discharge dangerous?
Although nipple discharge is mostly innocent due to reasons such as fibrocystic change, it can also be a sign of cancer.
If nipple discharge occurs spontaneously, from a single breast and from a single duct, If it is bloody or clear, it is defined as pathological nipple discharge and must be examined.
It is not desirable for the person to squeeze the nipple during the monthly self-examination of the breast. Discharges created by squeezing may cause unnecessary anxiety and examinations. What we want from our patients is to be aware of a discharge that contaminates their bra.
The most common cause of nipple discharge is greenish, yellowish, brownish discharge that is accompanied by pain, mostly in young people, and usually develops from both breasts. These discharges are conditions that do not require further examination unless accompanied by an additional finding.
6-What are the causes of breast inflammation? Is it related to cancer?
The most common condition of mastitis is puerperal mastitis and abscesses seen in breastfeeding mothers.
They are inflammations unrelated to cancer that quickly resolve with appropriate medical and surgical treatment.
One of the frequently recurring inflammatory conditions seen around the nipple is periductal mastitis.
Inflammatory diseases of the breast, the diagnosis and treatment of which are more troublesome for patients and physicians, are specific inflammations of the breast. This group is called granulomatous mastitis. Fungi such as tuberculosis and actimomycosis may be among the causative agents. However, the majority of this group consists of idiopathic (lobular) granulomatous mastitis, where the cause is not known medically. This group of patients are generally patients who have had many attacks, have consulted several physicians, and have not responded to antibiotics. Diagnosed thick needle biopsy material It is diagnosed by eliminating specific factors and microscopic appearance.
The situation to be emphasized is; If a woman over the age of 40 who is not breastfeeding develops a breast infection, the necessary examinations must be performed to ensure that there is no underlying cancer.
7- Isn't it risky for the future not to remove the entire breast in case of breast cancer? ? Isn't it better to remove the entire breast?
Nowadays, in patients who are diagnosed early and suitable for breast-conserving surgery, the primary surgical treatment method is breast-conserving surgery if the patient does not persistently refuse breast-conserving surgery and there is no medical obstacle. .
Breast-conserving surgery is a surgical method in which the tumor is removed with clear borders, without compromising the principles of cancer treatment, and by adhering to aesthetic principles, the tumor site is marked with titanium clips, and then the necessary additional systemic treatments (chemotherapy, hormonotherapy) and irradiation of the breast are performed.
There is no statistically significant difference in medical terms in terms of the results of breast-conserving surgery and mastectomy. It is accepted that the medical results of the two surgical methods are the same. The differences are that in breast-conserving surgery, it is necessary to receive radiation therapy to the breast. Radiation therapy may not be required in patients who have undergone mastectomy, depending on the stage of the cancer (if it is at a very early stage and its biological characteristics are positive). This is a situation that is usually decided by postoperative pathology results.
8-What is oncoplastic surgery? What are its advantages and disadvantages?
Oncoplastic surgery aims to achieve more cosmetic results by using plastic surgery principles without compromising oncological principles during the surgical treatment of breast cancer. Sometimes it offers advantages such as providing breast protection with oncoplastic techniques in patients where breast-conserving surgery is not possible.
While the necessary surgery is performed on the breast with breast cancer, symmetry can be achieved by performing the necessary intervention on the other breast (For example, the tumor in the cancerous breast of a patient with very large breasts can be reduced by reducing the breast size). The healthy breast is also reduced in the same session and ideal bilateral cosmetic results are achieved.)
Oncoplastic techniques They are surgical methods that are quite diverse and have varying degrees of difficulty.
One of the simplest and most frequently used techniques is the filling of the area where the tumor was removed in the patient who underwent breast-conserving surgery by preparing intraglandular flaps from the surrounding breast tissue. Thus, collapse in the tumor area can be prevented and better aesthetic results can be achieved.
One of the most frequently used methods around the world is to perform mastectomy by preserving the breast skin and, if appropriate, the tip, and filling it with silicone implants instead of breast tissue (Skin-sparing mastectomy + silicone). reconstruction with ). It is a method that is most frequently used, especially in genetically risky patients, and has been shown to reduce the risk of developing breast cancer by over 90%.
9- Why are armpit lymph nodes intervened in breast cancer? Is it necessary?
Breast cancer spreads through the lymph. The lymph nodes where the lymph flow of the breasts primarily collects are the lymph nodes in the armpit. Nowadays, investigating tumors in the armpit lymph nodes is of indispensable value in terms of determining the stage of the disease and the subsequent treatments to be planned. When the patient first applies, the condition of the lymph nodes should be determined by hand examination, then by ultrasonography of the armpit, and if necessary, by fine needle biopsies performed under ultrasonography. The diagnostic value of these studies is never as high as the diagnostic value of the sentinel lymph node biopsy to be performed during surgery. If no spread is detected in the armpit before the surgery, a sentinel lymph node biopsy is performed during the surgery to clarify the condition of the axillary lymph nodes. If it is detected preoperatively, further staging of the disease and treatment planning should be done according to the degree of axillary involvement. If there is no obstacle to intense armpit involvement, it would be a better approach to start the treatment with chemotherapy. If the involvement in the axillary lymph nodes is detected to have disappeared clinically and radiologically with chemotherapy, a sentinel lymph node biopsy and a chance to protect the axilla from curettage may be obtained during the surgery.
However, since they are special oncological surgical operations, both surgery to be performed on the breast and sentinel lymph node biopsy under the armpit and
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