Breast cancer is the 2nd most common type of cancer in Turkey. Moreover, it ranks first among
cancers seen in women. It is seen in 43 out of every hundred thousand people in our country, and it is expected that there will be approximately 17,000 new breast cancer patients annually. This figure roughly shows that one in every four cancers seen in women is breast cancer. According to
studies, one in every 8 women has a risk of developing breast cancer during their lifetime.
- Pathology
When breast cancer is mentioned, invasive cancers come to mind. In addition, the type of cancer called "in situ" cancer is called cancer, but it does not have the ability to spread (invasion), so it is not considered breast cancer. The most common type of breast cancer is cancer arising from the milk ducts, called
ductal cancer. Another common type is the so-called "lobular"cancers arising from
milk-producing glands. Apart from these, there are also rare
cancers of the breast such as mucinous, medullary, tubular, adenoid cystic, papillary, etc.
Breast cancers are a heterogeneous group of diseases. They are roughly examined in 4 subgroups according to hormone receptor and Her2 receptor expression:
1. Luminal A breast cancer:Estrogen and/or progesterone receptor positive, Her2 negative.
2. Luminal B (triple positive):Estrogen and/or progesterone receptor positive, Her2 positive. There is also a negative subgroup Her2
.
3. Her2-positive:Estrogen and/or progesterone receptor negative, Her2 positive
4. Triple negative: Estrogen and/or progesterone receptor negative, Her2 negative
While the luminal A type of these cancers has a good clinical course, the triple negative subgroup has a more
aggressive course. When planning treatment, a decision should be made by taking these features into consideration.
- Breast Cancer Risk Factors
Female gender and older age are the risk factors for breast cancer. are the most important risk factors. The average age at which breast cancer occurs is around 62-65 years old. However, it should not be forgotten that it can also be seen at an early age.
Long-term use of estrogen hormone The risk of breast cancer increases in extreme situations.
These situations include giving birth at an advanced age, menstruating at an early age, entering menopause at a late age,
short-term breastfeeding, birth control pills, post-menopausal hormone therapy, tall height,
br /> obesity, eating foods high in fat, and chronic alcohol consumption.
In addition, benign breast cysts and fibroadenoma diseases also increase the risk of breast cancer.
Having a family history of breast cancer is also important. is a risk factor. Genetic
disorders may be seen in breast cancer. These changes may lead to the development of breast cancer. Although a family history of breast cancer increases the risk of breast cancer, only
6-8% of breast cancers can be explained by genetic transmission. Detection of mutations in the BRCA1 and BRCA2 genes in these patients indicates that there is a genetic transition. Having breast cancer at an early age on the mother's side or having male breast cancer in the family may indicate the possibility of genetic familial breast cancer.
- How Does Breast Cancer Show Symptoms?
Small tumors usually do not cause symptoms. The most common symptom of breast cancer is a palpable mass. Although some may experience pain, tumor masses are generally painless.
Other important symptoms are shrinkage of the breast skin due to the adhesion of the tumor to the skin and retraction of the
nipple. An orange peel appearance may occur due to edema and thickening of the breast skin. There may be bloody discharge from the nipple, but not every bloody discharge
means cancer. In advanced stages, symptoms specific to the affected organ may occur.
- How is Breast Cancer Diagnosed?
Until breast cancer reaches a clinically detectable size. It is not a tumor that develops and grows rapidly. After reaching a certain size, its growth accelerates. The tumor reaches 1 cm in diameter within 5-6 years on average. It first spreads to the armpit lymph nodes via lymph channels and then to distant organs such as liver and bone via blood. Small tumors in the early stages
may not be noticed and may not show any symptoms. The most important
factor in early diagnosis is awareness of this issue. Increasing awareness and raising women's awareness. In our country, screening programs recommended by the Ministry of Health of the Republic of Turkey are carried out
in KETEM centers. Mammography is the most important early diagnosis method. Although breast self-checks
at home are important for increasing awareness, they are not reliable for diagnosing the tumor in the early stages, as it is not a very sensitive method. Similarly, since annual breast examinations by a doctor are not objective, small
tumors may be missed. It has been shown that these methods, other than mammography, do not contribute significantly to the early diagnosis of the disease and
life expectancy of the patient. However, it is still recommended by the relevant authorities and organizations to increase breast cancer awareness and raise awareness among women.
It is recommended that women have regular mammography once a year after the age of 40.
Although controversial, the real benefit of mammography is after the age of 50. For this reason, there are physicians who suggest that there is no harm in having a mamography every 2 years between the ages of 40-50, unless there is any
doubt. The reason for this is that the sensitivity of the test decreases due to the tighter and harder breast tissue in the pre-menopausal period and the possibility of missing small lesions
. With menopause and increasing age, the fat content in the breast tissue increases and
imaging may be healthier.
- How is Breast Cancer Treated?
Surgery
The main treatment for early stage breast cancer is surgery. Surgery has no place
in widespread disease. Especially in small tumors, it is preferred to partially remove the tumor section instead of removing the entire breast with a technique called breast-conserving surgery. Breast
conserving surgery may take the form of lumpectomy or quadrantectomy. In patients who undergo breast-conserving surgery
and healthy breast tissue is not removed, radiotherapy must be given to the remaining breast tissue
. With another surgical method called "mastectomy", all of the breast
tissue is removed. In large masses, in case of more than one tumor and in small
breasts In cases where satisfactory results cannot be achieved, mastectomy is preferred.
Chemotherapy
Post-surgery "protective" (adjuvant)chemotherapy in the early stages Its application is often done as a complementary
It is usually performed on tumors larger than 2 cm or if there is spread to the armpit lymph nodes
. The decision must be made on a patient-by-patient basis. When deciding on treatment, the size of the tumor (T
stage), whether it has spread to the armpit lymph nodes or not (N stage), the presence of
estrogen/progesterone receptors in the tumor should be taken into account. Factors such as hormonal sensitivity status and the presence of the cancer gene called Her2 (c-erb-B2)
are evaluated. In some cases
genetic tests can be performed to decide whether chemotherapy will be given or not, but since these genetic tests are not reimbursed, they must be borne by the patients. In cases where there is a tumor and surgery is not suitable
, "neoadjuvant"chemotherapy can be started and surgery can be postponed. In advanced stage disease
palliative chemotherapy is applied.
Anti-Her2 targeting agents must be used in the treatment of Her2-positive patients.
These are approved for use for "protective" purposes. The only drug is a drug called "trastuzumab", which is a monoclonal antibody. It is recommended to be given for 52 weeks for preventive purposes. Combinations containing trastuzumab are standard in the first series of treatment in advanced stage
disease. In the first step, the smart molecule called "pertuzumab" is also licensed in our country. Trastuzumab emtansine and lapatinib are other
drugs that can be used as second-line and
anti-Her2 therapy.
Hormonal therapy
Early stage If hormone receptors are positive in the disease, hormone therapy is applied as a preventive measure for at least 5 years. For this purpose, tamoxifen is often preferred. In patients who have entered menopause, drugs called anastrazole or letrozole, called aromatase inhibitors, are increasingly preferred. Women who have not entered menopause may need to be put into artificial menopause with injections called LHRH analogues.
Radiotherapy
Prophylactic radiotherapy is applied routinely after breast-conserving surgery. It has now become a standard practice for patients who are detected to have spread to the underarm lymph nodes after mastectomy.
Screening for Breast Cancer
In our country, T.R. The screening principles recommended by the Ministry of Health are implemented in centers called KETEM
. Accordingly, "the ideal method for breast cancer is screening with mammography every two years. Although the main screening method is mammography, clinical breast examination should also be performed for every woman who participates in screening in order to increase the effectiveness of mammography. In addition, in society In order to raise awareness, every woman after the age of 20 should be given consultancy service
to perform breast self-examination. Screenings start at the age of 40 and end at the age of 69.
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