The incidence of breast cancer is steadily increasing. 50 years ago breast cancer was diagnosed in one out of 20 women. Today, one of 8 women suffers from the disease throughout her lifetime (according to National Cancer Institute, USA).
What is Breast Cancer?
Breast cancer occurs as a result of the modification and uncontrolled multiplication of a group of cells that makes up breast tissue. Cancerous tissue first spreads to its immediate surrounding region, particularly to the lymph nodes near the breast. If not diagnosed and treated, cancer rapidly spreads to other organs and becomes incurable.
The main reason for this is that the disease is poorly known. Two thirds of women diagnosed with breast cancer had no previously recognized risk factors.
The incidence of breast cancer has doubled over the past 50 years.
Did You Know?
Beware of symptoms!
- Hardness or bulk that can be recognized by hand in the breast;
- Recently noticed asymmetry of the breasts;
- Inward pull in the nipple or breast skin;
- Rashes, sores, eczema, peel or fracture in the breast;
- Breast skin becomes similar to orange peel;
- Changes in size and/or shape of the nipples;
- Extraordinary swelling or increase in size of the breasts;
- Different types of acne during menstruation;
- Suppuration of nipples, especially pink and red;
- Hardness, swelling or bulk in underarms.
What are the Risk Factors?
- Being a woman;
- Age from 50 to 70 and menopause;
- Relatives (on either mother’s or father’s side) who have had breast cancer (the risk grows in proportion to the proximity of relationship and the number of relatives who have contracted breast cancer);
- Previous cancer case;
- Early menstruation and late menopause;
- Never delivering a child;
- Never being pregnant;
- Failure of breast-feeding;
- Long term hormone therapy;
- High social and economic standards of life;
- Modern city life;
- Obesity; in particular, gaining weight after the menopause and excessive consumption of food with high saturated fat content;
- Little physical activity.
Although these factors increase the probability of the disease, more than half of women diagnosed with breast cancer were not exposed to the recognized risk factors.
What are the Methods of Diagnosis?
70% of breast cancer cases are diagnosed by patients themselves while examining their breasts. Therefore, after the menstrual period, women over age of 20 should conduct an examination of the breasts and underarms with their hands. If any changes recognized, a woman should seek a physician’s advice as soon as possible.
Even if there are no complaints, every woman between ages of 20 and 40 should consult a physician specializing in breast cancer every 36 months. For women over 40, a clinical breast examination should be done every 12 months.
Methods of Imaging
Breast imaging aids in diagnosing breast cancer at early stages. Due to the development of technologies, in particular, the spread of mammography, there has been a significant increase of breast cancer diagnosing using image-producing methods, especially when manual examination failed.
Most Frequently Used Methods of Diagnosis
Mammography. Mammography is a technique that involves the use of X-ray radiation for breast examination. Minor changes and malignant tumors not detected during manual examination can be detected by mammography.
Mammography is the main method of diagnosis of breast cancer. The World Health Organization (WHO) recommends that every woman over age of 40 undergo mammography procedure annually.
The level of radiation emitted by mammography is low and harmless. The method causes no complaints by patients during the examination and/or diagnosis. Modern digital mammography equipment provides better screening and higher rates of diagnosis.
Mammography is not recommended for women under the age of 35, due to the danger of condensation of the breast tissue in these ages and, thereby, the low effectiveness of mammography, and the high sensitivity of breast tissue to radiation during this period.
Ultrasound. Ultrasound is a supportive technique in examination breast tissue. Ultrasound waves are used to obtain images of the breast. The method is mainly used to obtain information about the internal structure of tumors detected during clinical examination or mammography. Compared to mammography, ultrasound provides more information on younger patients.
Magnetic Resonance Imaging (MRI). Due to its capability to combine structural and functional evidence, MRI is considered to be one of the most accurate methods of detecting breast cancer. When applied in an accurate and timely manner, MRI can provide invaluable information. Its use is becoming more common.
Biopsy. This is a method of taking tissue samples from bulks and lesions under the suspicion of breast cancer for pathological examination. It is the operation of taking a specimen from a suspicious bulk with a thin needle, tru-cut or other surgery technique. In surgery biopsy, the whole tumor is removed and examined for abnormalities.
Biopsy of suspicious lesions, which cannot be sensed by hand and reside in the deeper parts of breast tissue, is performed with mammography, ultrasound or MRI. The radiologist marks suspicious lesions which cannot be recognized by hand with a wire before the surgery. The surgeon follows the wire and performs the surgery without any unnecessary damage to the breast. The main objective of such marking is to assure the best cosmetic result while removing the entire tumor with a least possible amount of healthy tissue.
In recent years, modern medical facilities use radioisotope units as an alternative to marking-with-wire method. The radioisotope method is more accurate and efficient. It is also referred to as the ROLL (radionuclide occult lesion localization).
How is the Surgery Performed?
Successful treatment of breast cancer depends on timely diagnosis. If cancer is detected at an early stage, chances of living more than 5 years increase to 96%.
Surgery is the most important part of treatment for breast cancer. The main purpose of surgery is to remove the whole tumor from the body. Treatment methods other than surgery aim to prevent the recurrence of tumor or its spread to other organs.
There are 3 main types of surgery:
Mastectomy. This method involves the complete removal of the breast with a tumor. During the surgery or at a later date (in 12 to 24 months), surgeon can use silicone prosthesis or patient’s own tissues for breast reconstruction procedure.
Mastectomy with Preservation of the Skin. This type of surgeries is performed when it is necessary to remove the breast tissue but it is possible to save the breast skin. To replace the breast tissue, silicone prosthesis can be placed under the breast skin. This method is particularly preferred to reduce risks associated with the surgery (prophylactic mastectomy).
Breast-Protective Surgery. This method of surgery provides for removal of the tumor and the nearest breast tissues only. The objectives are:
To preserve the breast and its shape;
To ensure that psychological and physical damage done to the patient is minimal.
After the surgery, the patient receives 5 to 7 weeks of radiation therapy.
The following patients should NOT undergo breast protective surgeries:
- Those who have received radiation therapy to the breast and chest membrane;
- Patients who are pregnant;
- Those who have multifocal tumor within the breast;
- Patients diagnosed with malignant microcalcification or suspected of having the disease.
Cases that are specifically considered before recommendation of a surgery:
- Patients who have collagen vein diseases;
- Patients with tumors of considerable sizes;
- Patients whose breast size is insufficient;
- Patients with multifocal tumors which requires multiple cuts.
Protection of the Lymph Nodes
The first location where the breast cancer spreads is the underarm lymph nodes. During the tumor removal surgery, the nodes are removed even if cancer cells have not spread to the underarm area. However, it was also found that there are side effects after the treatment, including swelling of the arms, functional and/or emotional effects. Thus, the Sentinel Lymph Nodule Biopsy (SLNB), a new method of treatment, was developed. With this method, in a course of the surgery, the first lymph node (sentinel lymph node) is examined by means of a special dye and drugs. If abnormalities are detected, the lymph node is removed. Thus, a biopsy of a frozen section during the surgery allows determining whether or not cancer cells reached this lymph node. If the tumor has not spread to this lymph node, other lymph nodes are not removed. The purpose of such operations is to prevent any unnecessary surgical removal of healthy organs.
No need to completely remove the breast
There have been many developments in the surgical treatment of early phase breast cancer over the past 20 years. Today, in breast cancer surgery, there is generally no need to remove the whole breast. The breast has an important place in women’s perception of their sexual identity and body. The breast removal can be avoided by means of partial mastectomy, lumpectomy and quadrantectomy. However, in some cases, it may still be necessary to completely remove the breast.