What are the stages of breast cancer? When should mammography shoot be done?

When the incidence of global cancer is examined, it can be said that this type of cancer, which is most commonly encountered in women, affects 2.088,849 women as of 2018, the rate of breast cancer among women is more than 25 %, ie 1 out of every 4 women caught in cancer. According to the incidence of 2018 global cancer, breast cancer is the first among cancer diseases that result in death in women with 15 %. Early diagnostic factor is critical within the scope of this type of cancer, which affects community health. In order to be noticed in the early stage of the disease, it is very important to recognize this disease in full sense, to have complete information about the common symptoms and findings, and to diagnose the disease with mammography withdrawal at the right time.

What is Breast Cancer?

Breast cancer can be defined as the uncontrolled proliferation of cells and cell groups in the breast tissue and the emergence of cancerous cell structures after this proliferation. As a result of this uncontrolled proliferation in the breast channels or milk glands, mass and similar structures occur in the breast. Cancer cells, which then continue to multiply rapidly, generally grow in a certain area by clinging to the tissues in their environment. This mass, which can be noticed as a result of physical examination from the outside, makes it much easier to recognize breast cancer than lung, liver, stomach and similar organ cancers. It facilitates the diagnosis and effective treatment of the early stage. For this reason, this method, which is called self -breast examination, has critical importance within the scope of combating breast cancer.

Symptoms of Breast Cancer

Breast cancer may progress insidiously without showing any symptoms for many years, and different findings may arise according to the stages of the disease:

Mass in the breast

The presence of a palpable mass in the breast is one of the most important symptoms of breast cancer. The mass may occur in the milk ducts or breast tissue, or it may be felt in the axillary region called the armpit. These hard lesions, which are usually painless, are considered one of the first signs of breast cancer and it is recommended to apply detailed imaging methods with physician control.

Nipple discharge

Breast discharge may occur due to various conditions such as hormonal, periodic or infection. Considering the amount, density, color and frequency of the discharge, it is determined whether it is associated with breast cancer. Nipple discharge that occurs with breast cancer is usually in the form of bloody, spontaneous discharge from a single breast.

Breast deformity

The mass that occurs in the breast tissue usually grows rapidly and may cause deformity in the breast. Especially the differences in size and shape between the two breasts should bring to mind the presence of a breast cancer-related mass.

Change in breast skin

Thickening of the breast skin, appearance of cellulite, superficial wounds called ulceration, edema and regional pits due to edema, erythematous or eczematous differentiations may occur.

Retraction at the nipple

Depending on the location of the mass in the breast tissue, symptoms such as recession or dimpling of the nipple may occur. If the mass is close to the surface, recession, tension, deformity and lump-like formations are seen in the skin tissue. Deeper located breast tumors attach to the structure called Cooper’s ligament, and the nipple is pulled inward with the stretching of this ligament. This finding usually occurs in the later stages of the disease or in the presence of very large masses.

What are the Stages of Breast Cancer?

Although breast cancer is a very common and rapidly progressing cancer, it can be treated effectively and very successful when diagnosed at an early stage. In the first stage of cancer, the diameter of the tumor tissue in the breast is less than 2 centimeters and there is no lymph node enlargement in the armpit area. In this period, which is called stage 1, the survival rate after 5 years is 98% in people who are diagnosed and treated. The period when the mass is larger than 2 centimeters in diameter is called stage 2, and enlargement of the lymph nodes may or may not be seen at this stage. In the period defined as stage 3, the diameter of the tumor tissue has exceeded 5 centimeters, and lymph enlargement in the armpit has become evident. In breast cancer patients diagnosed at this stage, the survival rate is reduced by half in the 5-year period after treatment, and success is achieved at a rate of 50.6%.

Since early diagnosis is critical in the fight against breast cancer, it is extremely important to have information about cancer stages, to detect the mass at the earliest stage by performing regular breast self-examination, to consult a physician at the right time and to use advanced imaging techniques such as mammography.

How to Perform Breast Self-Exam?

For breast self-exam, first of all, the menstrual cycle must be followed accurately. First of all, the first day of each monthly cycle is considered as the 1st day, and a day between the 5th day and the 14th day after today is determined and the same day is consistently preferred for breast examination. For example, if the 9th day after the onset of bleeding was selected for the first examination in that month’s menstrual calendar, 9 days should be counted from the beginning of the menstrual bleeding in the other months, and the examination should be repeated on that day. If the person is in the menopause period, he can choose a certain day of each month for breast self-examination.

Clothing on the upper body should be completely removed before the examination. In front of the mirror, the arms should be lifted up, one by one, and the findings such as protrusion, tension, nipple retraction, scar, color change in the breast tissue should be evaluated and both breasts should be compared in terms of all these features.

In the next step, the arms are extended forward and it is evaluated whether there is a shape change between both breasts in this position. Then, the hands are positioned at waist level and the mirrored image of the breasts is checked by keeping the shoulders in an upright position. After these stages are completed, the manual inspection method is applied. The breast to be examined and the right breast are placed on the head by bending the right arm at the elbow, and the second, third and fourth fingertips of the left hand are moved around the breast tissue with circular movements. In the left breast examination, the left arm should be placed on the head, a tight appearance should be obtained in the breast tissue, and then the breast tissue should be evaluated with the fingertips of the right hand. Approximately 90% of the masses detected in the breast are sebaceous gland-like formations that do not have pathological features, but in any case, a physician’s examination and detailed imaging methods such as mammography should be applied.

When should a mammogram be done?

Mammography is still considered the gold standard for the diagnosis of breast cancer today. However, in order to detect the mass in the breast at an early stage and to determine the need for mammography, every woman should pay attention to performing a regular breast self-exam once a month.

For women aged 20-40, if there is no risk factor, a detailed physician examination every 3 years is sufficient. If there is a family history of breast cancer in one of the first-degree relatives, the risk of developing breast cancer increases 3 times. For this reason, women in the risk group may need to be followed closely in line with the physician’s recommendation.

Being over the age of 40 is one of the important factors that directly increase the risk of breast cancer. This type of cancer, which can be seen in women of all age groups from the age of 20, most commonly occurs between the ages of 45-60. Therefore, it is recommended that all women, starting from the age of 40, have a breast examination once a year and preferably consult a breast surgeon.

Having at least one digital mammogram between the ages of 35-40 provides a much more accurate assessment of the person’s examinations in the following years. The first mammogram and the detailed breast examination performed simultaneously are very helpful in determining how the follow-up will take place between the ages of 40-45. After the age of 45, a mammogram is recommended once a year.

Therefore, even if there are no signs of breast cancer, it is critical for every woman over the age of 20 to regularly perform breast self-examination and to participate in mammography screenings at intervals appropriate for her age and health status.