Breast cancer, which is the most common cancer in women in our country and in the world and also the most common cause of death, is caused by the uncontrolled proliferation of cells in the breast tissue. On February 4, 2021, the World Health Organization announced that breast cancer has risen to the first place with 11.7% of all newly diagnosed cancers, followed by lung cancer with 11.4%, colon cancer with 10%, prostate cancer with 7.3% and stomach cancer with 5.6%.
Breast cancer, which was diagnosed at an advanced stage in the past, can now be diagnosed at an earlier stage with the effect of the screening programs carried out by our Ministry and an increase in our early diagnosis rates can be achieved. In our latest national cancer statistics, 48.2% of newly diagnosed breast cancers are localized cancers, while 10.2% are cancers with distant organ involvement.
Breast cancers detected at early stages are more successfully treated and the quality of life is significantly improved. For this reason, through community-based screenings, it is possible to detect the cancer development process at an early stage, before clinical symptoms appear, and to reduce the mortality rate due to breast cancer in women.
Screenings for breast, colorectal and cervical cancers, which the modern world recommends to be included in screening programs, are carried out free of charge by Community Health Centers (CHCs), Healthy Life Centers (HHCs), Cancer Early Detection, Screening and Education Centers (KETEM) and Family Health Centers. While our screening program for all three cancers is actively carried out at 306 points throughout the country, 41 mobile screening vehicles provide easy access to the screening program. Today, Family Health Centers (FHCs) take primary responsibility for ensuring timely participation in mammographic screening and monitoring of women in the 40-69 age group who are registered in their regions.
The Cancer Appointment System was introduced to increase the participation of our citizens in screening and to ensure that more people benefit from our free screening services. With the Cancer Appointment System, our Family Physicians call people in their target population and invite them for screening, inform those who accept screening about the centers (KETEM, SHM, ASM) where screening can be performed and make appointments. When an appointment is made, the system sends information about the date and place of the screening to the mobile phones of the individuals.
While 4.4 million screening services were provided in 2021, when the effects of the pandemic started to decrease, 4 million screening services were provided only in the first 6 months of 2022. Of the 4 million screenings, approximately 1.3 million were breast cancer screenings.
In order to continue our fight against cancer without interruption, infrastructure renewal and strengthening works are regularly carried out in our screening centers. In addition to screening center capacities, the number of devices used throughout our country is also being increased. In this context, our Ministry made the necessary planning and purchased 48 mammography devices in 2022. Our people are provided free of charge with our state-of-the-art digital mammography devices.
Protection
As with all cancers, the risk of breast cancer can be reduced by eating foods rich in vegetables and fruits and prepared under appropriate conditions, adopting healthy eating habits, increasing physical activity, maintaining a healthy weight, and avoiding smoking and alcohol use. You can find out whether you are at a healthy weight by consulting your family physician. Since there are many studies showing that breastfeeding protects against breast cancer, it is recommended that all mothers breastfeed their babies for at least 2 years.
Breast cancer is a chronic disease caused by many factors. For all invasive breast tumors, the risk attributed to modifiable risk factors was 62.8%, while the risk attributed to non-modifiable risk factors was 37.2%.
Lifestyle-related modifiable risk factors for breast cancer are as follows:
· Living a sedentary lifestyle,
· Being overweight or obese (gaining more than 5 kg, especially after menopause),
· Smoking
· Having never given birth,
· Becoming a mother after the age of thirty-five,
· Never having breastfed a baby,
· Taking hormone medication (HRT) for more than two years after menopause,
· Alcohol consumption: Drinking more than 1 glass of alcohol per day (1 beer, 1 glass of wine, 1 double strong alcoholic drink) increases the risk even more.
The risk factors for breast cancer that cannot be changed are
· Being a woman: Women are 100 times more likely to develop breast cancer than men.
· Age: The risk of breast cancer increases with increasing age (40 years and older).
· Having certain genes (BRCA1, BRCA2)
· Family history of breast cancer: Breast cancer in first-degree relatives (mother, sister, daughter) doubles the risk. However, it is important to note that the majority of women with breast cancer (about 8 out of 10) do not have a family history of breast cancer.
· Having cancer in one breast: This increases the risk of cancer in the other breast and other parts of the same breast.
· Having dense breast tissue
· Benign formations (such as fibroadenoma) in the breast
· Early onset of menstruation (menarche) (before the age of 12)
· Late menopause (after the age of 55)
· Radiotherapy to the thorax region.
Symptoms of Breast Cancer
Knowing how breasts normally look is an important part of breast health. When women examine their own breasts regularly every month, starting at the age of twenty, they will be able to recognize the slightest changes in their breasts early on. Catching breast cancer as early as possible offers the chance of successful treatment. But knowing what to look for is no substitute for regular mammograms and other screening tests. Screening tests can detect breast cancer in the early stages, long before any symptoms appear. For this reason, in our country, women between the ages of 40 and 69 are screened with mammography once every two years, free of charge, before they have any symptoms.
The most common symptom of breast cancer is the palpation and feeling of a painless lump (mass) in the breast that grows over time. In addition, the following symptoms can also be seen in breast cancer, with or without a palpable lump:
· Swelling of all or part of one breast (even if no obvious lump is felt)
· Pain in the breast or nipple
· Inflammatory condition of the skin of the breast characterized by itching and burning (eczema, yeast)
· Nipple retraction
· Orange peel appearance in the breast
· Breast skin irritation
· Unilateral nipple discharge (especially bloody discharge)
· Swelling in part or all of the breast, shape change in the breast
· Redness, crusting, thickening of the breast or nipple skin
· Lump in the armpit (mass), sometimes before a lump is felt in the breast, cancer can cause a swelling or lump in the armpit or around the collarbone.
Although any of these symptoms can be caused by conditions other than breast cancer, if any of these symptoms are observed, a general surgeon should be examined to find the cause.
Diagnosis
Breast cancer may not show symptoms until it reaches advanced stages. For this reason, since the above symptoms are not sufficient to make a diagnosis, it is necessary to apply to the nearest health centers. Early diagnosis of breast cancer increases the success of treatment and survival time. For this reason, all women between the ages of 40-69 are recommended to have a mammogram every 2 years. The most important factor in early diagnosis is that women should be aware of this issue and have mammograms regularly from the age of 40.
The following methods are taught and applied to women in our screening centers, especially for early diagnosis.
Breast Self Examination (BSE)
CHCMM is an examination method that a woman can easily perform alone at home at any time. In order to perform CHCMM effectively, it is necessary to receive training on this subject and to do what is learned regularly every month. It is sufficient to apply to our centers to receive training.
Women should perform breast self-examination every month after the age of 20. During this examination, they stand in front of a mirror and check whether the appearance of both breasts is symmetrical. The nipple and skin of the breast are examined for collapse or retraction, redness and edema. With this examination, especially tumors close to the skin and nipple can be detected at an early stage by the woman herself. A woman who examines herself regularly can distinguish a new growth, shrinkage or discoloration of the breast skin or nipple, or an asymmetrical appearance. Masses suspicious for cancer are harder than other breast tissue (walnut hard), have indistinct borders, limited movement and are usually painless. Women who notice a lump or a different appearance than usual should consult their doctor immediately.
Clinical Breast Examination
In addition to regular and continuous monthly check-ups, women should also visit their doctor for breast examinations once a year from the age of 40.
If there is a first-degree relative diagnosed with breast cancer, these examinations should start five years before the age at which the relative is diagnosed.
Mammography
In our country, according to the National Cancer Screening Standards, it is performed for the early diagnosis of breast cancer in women between the ages of 40-69 without complaints. It is performed every 2 years. The standard for both breasts during screening is to take films in two positions, one medolateral oblique (MLO) and the other craniocaudal (CC).
With the digital mammography devices used today, more comfortable service is provided to our women.
Treatment
Although breast cancer is a single disease, each patient's cancer can have many different characteristics and treatments are tailored to the characteristics of each woman's individual breast cancer. Treatment decisions are influenced by multiple factors such as the location and stage of the disease, the age of the patient and the presence or absence of other health problems.
Breast cancer treatment can be highly effective, achieving survival rates of 90% or more, especially when the disease is detected early. There are different treatment options for breast cancer, including surgery, radiation therapy (radiotherapy) and drug therapy (chemotherapy). You can access documents for breast cancer and other cancers on the website of the Ministry of Health, General Directorate of Public Health, Department of Cancer and use the "Which Screening is Right for Me" link to be directed to your nearest screening center.