The increasing incidence of breast cancer and the decrease in the age of onset worries many women. In early diagnosis of the disease; It is important for the person to recognize his own breast structure, to perform regular hand examinations in front of the mirror and not to neglect the doctor’s checks. Used today with the developing technology; Diagnostic methods such as ultrasonography, mammography, MRI and biopsy also play an important role in the early diagnosis of breast cancer.
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What is the importance of early diagnosis and diagnosis in breast cancer? Which methods are used in early diagnosis?
In the period between the occurrence of breast cancer and its clinical findings, breast cancer can be detected early with radiological screening methods. With early diagnosis, the course of the disease can be changed, treatment options increase and the survival time of the disease can be extended. For example, depending on the location, type and size of the cancer, surgical methods can be applied in which a part of the breast is removed or the axillary lymph nodes are preserved without removing the entire breast. For these reasons, early diagnosis is important enough to affect the patient’s life in the later period. There are three basic standard screening methods used in diagnosis. These; breast self-examination, clinical breast examination and mammography. But mammography is the only test that has been scientifically proven to reduce breast cancer mortality in the long term.
Are there any risks or damages of screening methods for the person applied?
AE: In routine follow-up, mammography is recommended over the age of 40. However, after the age of 20, every woman should examine herself in front of the mirror every month after the end of her menstrual period, and after the age of 30, she should go to a general surgeon and have an annual routine doctor examination, and after the age of 40, she should add mammography to the annual routine doctor examination. There is no harm in palpation among these. Although mammography theoretically mentions a harm, no direct mammography risk or risk of breast cancer has been proven. During mammography, the amount of radiation taken in 2-3 months in normal life is taken at once. This is a dose similar to the doses taken when a lung film is taken. During mammography, 25 to 50 times less radiation is received than during tomography. If the patient is younger than 40 and has a palpable mass, ultrasonography is also used to distinguish it. MRI should be used together with mammography in high risk patients. Ultrasonography and MR application do not harm the patient. At this point, I would like to state that; The main screening method in breast cancer is mammography, not ultrasonography. Ultrasonography is a method used in addition to mammography in patients with dense breast tissue. If there is a palpable mass during pregnancy and breastfeeding or in male patients, ultrasonography should be preferred first. At this point, I would like to state that; The main screening method in breast cancer is mammography, not ultrasonography. Ultrasonography is a method used in addition to mammography in patients with dense breast tissue. If there is a palpable mass in pregnancy and breastfeeding periods or in male patients, ultrasonography should be preferred first. At this point, I would like to state that; The main screening method in breast cancer is mammography, not ultrasonography. Ultrasonography is a method used in addition to mammography in patients with dense breast tissue. If there is a palpable mass in pregnancy and breastfeeding periods or in male patients, ultrasonography should be preferred first.
Are there any measures to be taken to prevent breast cancer? If so, what are these?
SG: Breast cancer risk factors can be divided into changeable lifestyle-related risks and unchangeable risks. Measures can be taken for risk factors related to lifestyle habits. For example, factors such as not being overweight, not consuming regular and high levels of alcohol, exercising regularly, not smoking are modifiable risk factors. Although there are no definitive results about hormones or birth control pills taken after menopause, their use for more than 5-10 years is not recommended. Advanced age, genetic factors, dense breast structure, some breeds, early menstruation, late menopause, having never given birth or giving birth after the age of 30, and not breastfeeding are risk factors that we cannot change.
Among these risk factors, how effective are genetic factors in the occurrence of breast cancer?
SG: There is no family history in 80-85% of all breast cancers. The remaining 5-8% have proven genetic defects. Therefore, having breast cancer in the family does not mean that the person will definitely have breast cancer, nor does it mean that the person is protected from breast cancer in the family. The important thing is that everyone has regular checks. We must not forget that the most important risk factor in breast cancer is actually being a woman.
How and how often should women perform self-examination at home?
AE: Women should examine themselves every month, at the end of their menstrual period. If the patient has entered menopause, he should examine him on certain days of each month. Manual examination allows the patient to get used to his own breast tissue, and he should go to the doctor whenever something other than what he is used to.
SG: The American Cancer Society adds breast self-examination once a month from the age of 20 to breast self-examination after the age of 30-35, and a professional physician examination every 1-3 years.
What is the incidence of breast cancer in women and men?
AE: While breast cancer is seen in every 7-8 women, among all breast cancers, the probability of occurrence in men is less than 1 percent.
SG: In men, the mass or other examination findings can be noticed immediately in the early period, so men are more fortunate in terms of early diagnosis. Since breast cancer is seen 100 times less than women, routine screening is not performed in men, but if there is a palpable mass, they should immediately consult a physician. Although the first radiological examination method in men is ultrasound, mammography can also be performed in case of suspicion. In addition, because male breast cancer is more likely to indicate a genetic mutation, first-degree relatives of these patients are in the high risk group.
What are the well-known mistakes about breast cancer screening and diagnosis methods?
SG: The first of the misconceptions about breast cancer screening and diagnostic methods is the desire to be examined only by ultrasound without mammography. Mammography is a screening test with proven efficacy, and ultrasonography can only be used for screening after the age of 40, in addition to mammography in women with dense breast structure and moderate risk. In women under the age of 30-35, the first examination method used in complaints and findings about the breast is ultrasonography. In the presence of a suspicious finding in the ultrasound, the radiologist can add the mammography to the ultrasound, if necessary. The second wrong is the fear that mammography is an unbearable painful procedure. Although patients feel pain for a few seconds due to compression during mammography, this is not an unbearable pain. Moreover, although it does not affect the accuracy of the examination, performing mammography in the post-menstrual period for the comfort of the patient further reduces the pain. The third misconception is that needle biopsies from the skin are suspected to spread breast cancer. Scientific studies have shown that cell displacement that may occur during needle biopsy does not change the course of the disease.
Should mammography be done after the age of 40? Is there a group that should have it done earlier?
SG: Before the age of 40, mammography can be applied to high-risk groups for screening purposes or to patients younger than 30-35 years of age who are suspicious of breast cancer in their first radiological evaluation. Personal history of breast cancer, those with BRCA 1-2 genetic mutations and their first-degree relatives, those with a first-degree relatives with a history of pre-menopausal breast cancer, those with high-risk lesions in their previous biopsies, and those between the ages of 10-30 with high-dose radiation to the chest area. Those who receive treatment are in the high risk group. Mammography can be started before the age of 40, within the framework of certain rules. For example, if the mother has pre-menopausal breast cancer, the -10 rule is applied to her daughter. If the mother had cancer before the age of 40, an annual mammogram is recommended for her daughter from the age of 30. In addition to mammography, annual breast MRI is recommended to some subgroups of this high-risk population. But in healthy people, screening mammography is never started before the age of 30.
When is MRI of the breast used?
AE: If a mass is seen in the patient, it may sometimes be necessary to evaluate the mass before surgery or to evaluate the opposite breast. In some types of breast cancer, in addition to mammography in high-risk patients, breast MRI may be recommended in patients diagnosed at a young age, in patients with dense breast tissue. When something is seen on mammography or ultrasonography, breast MRI can be recommended as a problem solver. In patients with silicone, breast MRI can be used to evaluate if there is a problem with the silicone. In cases where we are suspected but cannot make a definite decision, breast MRI is applied.
What is a biopsy? After what stage is it decided to do it? Is it a painful, painful procedure?
SG: In biopsies, after the biopsy area is numbed with local anesthesia, parts are taken from the suspicious tissue area with special needles. Generally, the patient does not feel pain after local anesthesia in biopsies. It is very important to obtain a definitive diagnosis from a suspicious finding.
AE: It is a method used to make a definitive diagnosis after it is decided that the area seen in ultrasonography, mammography or MRI is suspicious. Whatever imaging method the lesion is seen with, that imaging method should be used for biopsy. In the past, the suspected area was removed by surgical biopsy. Surgical biopsies may cause deformation and excessive tissue removal in the breast tissues of patients, as well as adversely affect later surgical interventions. Today, it is used to decide whether to surgically remove the lesion detected by biopsies performed with imaging methods. This method makes the patient less tired and prevents unnecessary anesthesia. In a biopsy,
