What is Breast Cancer? Symptoms, Stages, and Treatment Methods

Breast cancer is a condition that occurs when the cells making up breast tissue multiply in an uncontrolled and unhealthy way. While it is the most common type of cancer in women, it is highly treatable with a very high success rate when diagnosed early. Breast self-exams and regular screenings play a vital role in catching the disease in its early stages.

• At a glance:
• 1 in 8 women has a risk of developing breast cancer in her lifetime.
• The most common symptom is a painless, palpable lump in the breast or under the arm.
• Direct genetic factors account for only about 10% of cases.
• According to the Turkish Ministry of Health guidelines, a mammogram is recommended every two years starting at age 40.
• Depending on the stage, the treatment plan may include surgery, chemotherapy, and radiotherapy.

What is Breast Cancer and How Does It Develop?

The breast consists of milk-producing glands (lobules) and ducts that carry this milk to the nipple. Breast cancer occurs when the DNA structure of the cells in these tissues breaks down, causing them to divide at an abnormal rate. When this uncontrolled multiplication starts in the ducts, it is called "ductal carcinoma," and when it begins in the glandular tissue, it is known as "lobular carcinoma."

The disease is generally seen more frequently in women between the ages of 50 and 70. However, statistics in Türkiye indicate that the incidence rate among younger age groups is slightly higher compared to the global average. Over time, these cancer cells grow to form a tumor mass and, if left untreated, carry the potential to spread (metastasize) to other parts of the body through the blood or lymphatic system.

Causes and Risk Factors of Breast Cancer

Although the exact cause of breast cancer is not fully known for every patient, several factors that increase the likelihood of developing the disease have been identified. The biggest risk factor is simply being a woman. While it can occur in men, the incidence rate is significantly higher in women. Advanced age is another primary factor that increases the risk.

While genetic predisposition is frequently discussed, it is believed that genetic factors (especially BRCA1 and BRCA2 gene mutations) play a role in only about 10% of all breast cancer cases. Individuals with a family history of breast cancer, particularly first-degree relatives diagnosed before the age of 40, face a higher risk. For more detailed information on this topic, you can read our article Breast Cancer Risk Factors: Are They Genetic or Preventable?.

Modifiable risk factors for breast cancer include obesity, a sedentary lifestyle, smoking, and alcohol consumption. Furthermore, conditions that cause prolonged estrogen exposure—such as starting menstruation at an early age (before 12), entering menopause late (after 55), never having given birth, or having a first child after the age of 30—also increase the risk.

What Are the Symptoms of Breast Cancer?

In the early stages of the disease, there are usually no obvious complaints. This is why regular screenings are of immense importance. However, as the tumor grows, certain physical changes may become noticeable. Breast cancer symptoms can vary from person to person.

The most frequently encountered symptom is a palpable, usually painless, and firm lump in the breast or armpit. Alongside this, thickening of the breast skin, swelling, or dimpling known as a "peau d'orange" (orange peel) appearance are notable signs. An inward turning of the nipple, redness, crusting, or flaking around the nipple are also signs that should be taken seriously.

Although the classically known bloody nipple discharge is less common, it is a crucial warning sign. If you notice any sudden, asymmetrical change in the size or shape of your breast, you should consult a general surgeon without delay.

Step-by-Step Breast Self-Exam (BSE)

A breast self-exam is a simple yet effective method that allows every woman to become familiar with her own breast tissue and notice any potential changes early on. It is recommended that every woman from the age of 20 perform this exam once a month. The most suitable time is the 4th or 5th day after the end of your menstrual period (when the breast tissue is least sensitive and swollen). Women who have entered menopause or have had a hysterectomy should perform this check on a fixed day of their choosing each month.

1. Observation in Front of a Mirror

Stand in front of a mirror, bare-chested. First, let your arms hang freely at your sides and examine the size, shape, and skin color of your breasts. Then, raise your arms and repeat the same inspection. Finally, press your hands firmly against your hips to flex your chest muscles, and look for any pulling, dimpling, or asymmetry in the breasts.

2. Lying Down Manual Exam

Lie flat on your back. To examine your right breast, place a small pillow under your right shoulder and put your right arm behind your head. Using the pads of the middle three fingers of your left hand, scan your right breast in circular motions from the outside in, applying light to firm pressure. After checking the entire breast tissue and armpit, repeat the same process for your left breast.

3. Standing or Shower Exam

Since fingers glide more easily over soapy skin, performing a manual exam in the shower is highly practical. Apply the same circular scanning motions you used while lying down while standing up. Finally, gently squeeze the nipple to check for any discharge (especially bloody or clear).

Stages of Breast Cancer (Stage 0 to Stage 4)

Breast cancer stages are used to determine the extent of the disease's spread and to create the most appropriate treatment plan. When staging, factors such as tumor size, spread to the axillary (armpit) lymph nodes, and spread to distant organs (metastasis) are evaluated.

• Stage 0 (Carcinoma In Situ): Cancer cells are confined strictly within the milk ducts or glands. This is a non-invasive stage, meaning it hasn't spread to surrounding tissues. It is the stage where early diagnosis is most successful.
• Stage 1: The tumor is smaller than 2 centimeters, and cancer cells have not spread outside the breast tissue or to the axillary lymph nodes.
• Stage 2: The tumor is between 2 and 5 centimeters, or cancer cells have spread to a few lymph nodes in the armpit. The disease is still considered local.
• Stage 3 (Locally Advanced): The tumor is larger than 5 centimeters or has spread extensively to the axillary lymph nodes. Cancer cells may be attached to the chest wall or breast skin.
• Stage 4 (Metastatic Cancer): Cancer cells have spread from the breast through the blood or lymph system to distant organs such as the liver, lungs, bones, or brain (metastasis).

Screening Guidelines and Diagnostic Methods

Early diagnosis is life-saving in breast cancer treatment. According to the Turkish Ministry of Health guidelines and international standards, a mammogram every two years starting at age 40 is the standard screening protocol for women not in a high-risk group. Women between the ages of 20 and 40 are advised to perform a self-exam once a month and undergo a clinical breast exam every two years. For a more detailed schedule, you can review our Age-Based Screening and Examination Calendar.

The diagnostic process at the hospital typically begins with a physical examination. If a suspicious area is found, imaging methods such as mammography, breast ultrasound, or breast MRI are utilized. A definitive diagnosis is made by examining a tissue sample taken from the suspicious area in a pathology laboratory (biopsy). Advanced imaging tools like PET-CT may also be used to evaluate the spread of the disease.

How is Breast Cancer Treated?

Breast cancer treatment is tailored to the individual, taking into account the patient's age, overall health, tumor stage, and hormone receptor characteristics. Multiple medical disciplines work together during the treatment process. Unless there is metastasis to distant organs like the liver, lungs, or brain, a non-surgical treatment option is not applicable for breast cancer; surgical intervention forms the foundation of the treatment.

Surgical methods include breast-conserving surgery, where only the tumorous tissue is removed, or a mastectomy, where the entire breast is removed. In addition to surgery, chemotherapy with antineoplastic drugs may be administered to stop the multiplication of cancer cells. Chemotherapy can be given before surgery to shrink the tumor (neoadjuvant) or after surgery to destroy any remaining cells (adjuvant).

Radiation therapy (radiotherapy) is used, especially after breast-conserving surgery, to destroy any potential cancer cells left in the area. If the tumor is found to be sensitive to hormones (estrogen or progesterone), long-term hormone therapy medications are prescribed to prevent the disease from recurring.

Life After Treatment and Complications

One of the most common questions from patients undergoing breast cancer treatment is how their personal life will be affected. Considering all breast cancer patients, the 5-year survival rate is over 80%. This high success rate makes preserving the quality of life after treatment even more important.

Temporary complications such as fatigue, hair loss, or skin sensitivity may occur during the treatment process. However, patients should know that there are no restrictions regarding their sexual life. Pregnancy planning is a situation that can be permitted only under the coordination of a physician, after all treatments have been completed. There is no designated miracle diet program for the disease; eating a healthy, balanced diet and exercising regularly are the strongest steps to support the healing process.

When to See a Doctor?

If you notice anything unusual regarding your breast health, it is essential to seek a medical evaluation rather than waiting. You should consult a general surgeon as soon as possible if you experience any of the following symptoms:

• Newly noticed, firm, and immobile lumps in the breast or armpit
• Spontaneous bloody or clear discharge from the nipple
• Sudden redness, thickening, or an orange-peel appearance on the breast skin
• Unexplained asymmetrical changes in the shape or size of the breast

For patients who have been diagnosed with and are undergoing treatment for breast cancer, conditions such as sudden and severe shortness of breath, confusion, uncontrollable bleeding at the tumor site, or unbearable bone pain require emergency intervention. In such cases, you should call 112 without delay or go to the nearest emergency room.

Diagnosis and Treatment Process at BHT CLINIC

At BHT CLINIC İstanbul Tema Hastanesi, breast cancer diagnosis and treatment processes are carried out with a multidisciplinary approach by our expert General Surgery, Medical Oncology, and Radiology teams. The most up-to-date imaging technologies (3D Tomosynthesis Mammography, Breast MRI) and advanced surgical techniques are successfully applied in our hospital.

For sudden complications that may occur during the treatment process or situations requiring emergency intervention, our Emergency Medicine department provides uninterrupted service 24/7. In our emergency room, our Emergency Medicine Specialists quickly coordinate with the relevant branch physicians when necessary to keep your safety at the highest level. You can book an appointment to consult with our specialist physicians for a comprehensive breast exam and screening plan.

Frequently Asked Questions

Does breast cancer cause pain?

Breast cancer typically does not cause pain in its early stages. The majority of breast pain stems from benign causes such as fibrocystic changes or hormonal fluctuations. However, even if painless, any palpable lumps must be evaluated by a physician.

Is breast cancer hereditary?

Only about 10% of breast cancer cases are directly genetically inherited (such as BRCA1 and BRCA2 mutations). While having a family history of breast cancer increases the risk, the vast majority of patients do not have a family history.

Is surgery mandatory for breast cancer?

If the disease has not spread (metastasized) to distant organs like the liver, lungs, or brain, the primary treatment for breast cancer is surgery. A non-surgical cure is medically not possible.

Is a lump in the breast always cancer?

No, approximately 80% of palpable breast lumps are benign formations such as cysts or fibroadenomas. However, to definitively understand the nature of the lump, an ultrasound, mammogram, and, if necessary, a biopsy must be performed.

Can men get breast cancer?

Yes, because men also have breast tissue, breast cancer can develop. Although it is much rarer compared to women, men must also consult a physician if they notice any lumps or changes in their chest area.

This article is for informational purposes only; please consult your physician for diagnosis and treatment.