Breast cancer

The most common cancer in women. Has multiple risk factor. Presence of these factors in a person does not mean that he or she will definitely become breast cancer. People without any risk factors may become breast cancer too. Race and gender are unchangeable risk factors, however smoking, alcohol consumption, and dietary habits are factors that can be changed with life style changes.


Risks that increase breast cancer predisposition:

  1. The main risk factor is being a woman. Men also become breast cancer but the rate is 100 times less the rate of women.
  2. Increased age. 75% of breast cancer are over age 50.
  3. Breast cancer is hereditary in 5%-10%. The most common mutation is seen in BRCA1 and 2 genes. Having breast cancer in close relatives increase the risk. The risk is also affected by how many other family members have had breast cancer. Ovarian cancer risk also increases. Men with these genetic mutations also have increased risk for breast, prostate, and other cancers. Other genetic mutations that increase the risk for breast cancer are also present but less important.
  4. Early menstruation (less than age 12), late menopause (older than age 55), giving birth in older age, nulliparous women, and estrogen and progesterone treatment increase the risk for breast cancer.
  5. Having first-degree relative with breast cancer increases the risk by 2-fold. Having 2 first-degree relatives increases the risk about 3-fold.
  6. Having Breast cancer in one breast increases the risk of breast cancer in the same and opposite breast too.
  7. Being tal increases the risk.
  8. Having dense breast tissue increases the risk.
  9. Some non-cancer lesions in the breast increase the risk for breast cancer. Risk for cancer increases about 4-5 times if Atypical ductal hyperplasia or Atypical lobular hyperplasia is present. Lobular carcinoma in situ increases the risk about 7-12 times.



Physical activities, breast feeding, decreasing alcohol consumption decrease the risk for breast cancer.



Most of the breast cancers are detected with mammography. Therefore, all women are advised to have routine mammographies at 40 years and older every 1 to 2 years. Breast ultrasound might be added to mammography if needed.

If a patient has one or more of the risk factors, he or she should consult a physician for early screening.


If a mass is noticed in the breast or axilla, changes in the color and skin retractions or presence of nipple discharges, the patient should visit a general surgeon.

If an abnormal finding or a mass is encountered in the mammography films, for further diagnosis an ultrasound, MRI or biopsy may be needed.

Biopsy is an intervention performed by a needle. A tissue sample is obtained through the needle and evaluated under microscopy.




Surgery is the mainstay of breast cancer treatment.

Breast conserving surgery: aka lumpectomy or quadrantectomy. Is the procedure of removal of the breast cancer only with the surrounding healthy breast tissue. The breast is preserved.

Mastectomy: is the removal of the whole breast.

Sentinel lymph node biopsy: procedure of removal of the first draining lymph nodes in the axilla to search for lymph node metastases.


Surgical treatment is generally followed by chemotherapy or hormone treatment. Radiotherapy is given to all of the breast conserved patients and some of the mastectomy patients.


Radiotherapy: is killing of the cancer cells by administration of X-rays. This treatment is given by a Radiation Oncologist. It is administered to the breast, axilla, and supra-clavicular regions. Radiation prevents the proliferation of the cancer cells. Dead cells are removed by the body itself. Healthy cells are also affected by the radiotherapy but they can repair themselves that is lacking  in cancer cells.


Chemotherapy: is the treatment of cancer cells with drugs. This treatment is given by Medical Oncologists.

Cancer cells need some hormones for growth. Hormonotherapy prevents the cancer cells from reaching these hormones.


The need for radiotherapy depends on lymph node metastasis rate, size of the tumor, and pressence of cancer cells in the resection borders.


Not all patients get radiotherapy.


Which factors affect the risk of breast cancer?

  1. Excersize decreases the risk. As little as a couple of hours a week is helpful.
  2. Not having children increases the risk. In addition, don’t delay the first birth beyond age 30.
  3. Breastfeeding lowers breast cancer risk.
  4. Decrease alcohol consumption. Risk increases with the amount.
  5. Avoid obesity.
  6. Sleep in dark.
  7. Avoid smoking and tobacco smoke.
  8. Mediterranean diet reduces the risk.
  9. Birth control pills are conflicting (may increase the risk).
  10. Hormone therapy for menopause increases the risk.
  11. Antiperspirants have no effect
  12. Bras have no association.
  13. Women who work at night (eg. Nurses) might have slightly increased risk.