According to statistics, one in every 10 women in Europe and one in every 8 women in the USA develop breast cancer. In breast cancer, there are mainly three recommended approaches for early detection: Breast Self Examination (BSE) and Clinical Examination and Mammography.
BSE encourages women to take responsible for their own body, recognize their own anatomy and detect any changes at the early stage. After the age of 20, every woman should self check their breasts within 7 to 10 days after menstruation, or in the case of postmenopausal women, the same day every month.
Clinical examination, i.e. examination by a practitioner, should be a part of regular health checkups for women.
Even if there are no complaints, every women after the age of 20 should see a doctor for clinical examination once every 2-3 years, and after the age of 40, once every year.
Despite its drawbacks, mammography remains to be the best imaging method for breast cancer. Mammography can detect masses which are suspect, but too small to be palpated.
Although breast self examination is important, it should not be overlooked that mammography is the most effective method for early detection of breast cancer. Every woman after the age of 50 should have a mammography once every 2 years. Women with a familial history of breast cancer, or are otherwise at risk for breast cancer should have a mammography at the age and frequency as recommended by their doctor.
If any suspect masses are found in the breast, biopsy is used for definitive diagnosis. Biopsy is conducted under imaging-guidance using a special needle to collect a small piece from the tumor. For very small tumors, the tumor is marked and resected completely.
After making a diagnosis of breast cancer, the stage of the disease and whether it metastasized to other organs should be also investigated. Sentinel Lymph Node Biopsy is the new golden standard for staging and treating breast cancer.
Sentinel lymph node biopsy allows for staging of breast cancer patients during therapy with minimal side effects. The “first” lymph node in the armpit is identified and examined surgically, and it may not be necessary to resect all lymph nodes.
To properly plan treatment, the physician must know the stage of disease, which is a measure of the tumor size and how much or whether it has metastasized.
Staging may involve X-ray imaging and laboratory testing to determine whether the cancer has metastasized, and if so to which organs or tissues. When breast cancer has metastasized, usually cancer cells can be found in the lymph nodes inside the armpit.
Usually, the size of cancer cannot be known until the tumor in the breast and lymph nodes inside the armpit have been surgically removed. The disease is staged from 0 to 4, which also determines the treatment approach.
While the definitive cause of breast cancer is not known, there are some potential risk factors. It is considered that genetic, environmental, hormonal and socio-psychological factors play a role in the disease.
Having a familial history of breast cancer, beginning menstruation at an early age (before the age of 12), entering menopause at a later age, being overweight and in particular, postmenopausal weight gain, smoking and regular consumption of alcohol increase the risk for breast cancer. Marriage and giving birth at a later age, reduced infertility, stress, difficult living conditions, uncontrolled and prolonged intake of hormones, environmental pollution and an imbalanced diet are also suspected to be a factor for higher incidence of disease. Women who have some of these risk factors are more likely to develop breast cancer.
Nevertheless, women who have none of the risk factors may also develop breast cancer. Advanced age is a key risk factor in breast cancer. The frequency of breast cancer in women aged older than 50 years is four-times higher compared to women younger than 50 years of age, hence the importance of regular screening in women aged older than 50 years.
In breast cancer, it is important to detect the disease before onset of symptoms; experiencing symptoms means the disease has already progressed.
The most common signs of breast cancer include palpable masses inside the breast or armpits, changes in the size or form of breasts, bloody exudations from nipples, deformation or discoloration of breast skin or nipples, depression of breast or nipples, palpable masses inside the armpits or neck, despite absence of any palpable masses in the breasts.
“Breast cancer is mainly treated surgically”
In other words, the first-line therapy is surgical intervention, unless it is already too late. In recent years, breast cancer surgery usually involves breast protective surgery.
Thanks to “sentinel lymph node biopsy,” which is becoming more prevalent, it is possible to evaluate whether metastasis exists in regional lymph nodes, which informs the decision to resect or leave armpit lymph nodes.
This not only prevents unnecessary surgery for the patient, it also helps avoid untoward surgical complications which may impair the patient’s quality of life. It is essential to personalize treatment in breast cancer, as with all the other types of cancer.
Ideally, all breast cancer patients should be evaluated by a multidisciplinary team of breast cancer specialists, and the patient should be involved in the treatment decision. Studies have shown that clinical outcomes are improved in patients where treatment was decided in collaboration with the patient.
