Breast cancer is the most common malignancy and the leading cause of death among women, starting in the breast tissue and can affect both men and women.
The disease accounts for about 25 percent of all malignancies and causes 3.3 deaths per 100,000 people. In Tehran, the prevalence of this disease is about 25.5% of all cancers.
Sometimes, a diagnosis of breast cancer is made after the onset of signs and symptoms. But many women with breast cancer have no symptoms. For this reason, regular breast cancer screening is very important.
Signs and symptoms of breast cancer
Some of the symptoms include:
• Discharge from the breast
• Nipple indentation
• Changes in the skin of the breast and symptoms such as redness, changes in the texture or wrinkling of the skin of the breast
Cause of breast cancer
Starting menstruation at an early age or menopause at an older age increases the risk of breast cancer. Women who use contraception after the age of 30 and do not have children are more likely to develop breast cancer. Taking birth control pills also increases the chances of getting this cancer.
Life style
• Obesity, overweight or eating fatty foods increase the risk of breast cancer.
• People who drink a lot of alcohol are more likely to get breast cancer.
• Regular exercise is one of the measures that reduces the risk of breast cancer.
• Environmental factors: People who receive radiotherapy in the upper body are more likely to develop breast cancer.
• Genetic causes and genetic mutations and hormonal causes.
The role of mammography in the early detection of breast cancer:
Mammography is a type of X-ray that is used to diagnose breast disease. Using mammography as a screening method, breast cancer can be diagnosed before it becomes a palpable mass.
Mammography is also necessary in healthy people, and the recommendation to have a mammogram in a woman does not mean that she has cancer.
What should be noted is that the risks of X-rays hitting the breast in this way are very small and can be ignored. In fact, the benefits of early detection with this method far outweigh the potential risks, because on the one hand, the amount of X-rays that penetrate the tissues is very small, and on the other hand, the amount of radiation needed to cause cancer is much higher than the radiation. It is irradiated to the breast by mammography.
Who should have MRI screening in addition to mammography?
In certain population of women, such as:
• Women who have a known BRCA-1 or BRCA-2 mutation.
• People with a family history of breast or ovarian cancer.
• People who have had breast cancer before are known to have lobular cancer and have received radiation therapy.
New methods of laboratory diagnosis for different types of breast cancer:
Early detection of breast cancer will make its treatment easier and more successful and will play an important role in managing the disease to cause fewer complications on other organs of the body due to tumor growth, which improves the quality of life and longevity of patients.
One of the causes of cancer is proto-oncogenes, which are converted to oncogenes by various processes, including mutations and gene amplification, thereby activating or over-producing gene products.
Different genes are involved in the development and progression of breast cancer. Tumor development and growth in a group of patients is dependent on HER2 gene amplification. Among new patients, 15 to 20% belong to this group. Of course, mutations in this gene can also cause other cancers, such as ovarian, gastric and uterine cancers.
The HER2 test is performed on patients with breast cancer to determine the progression of the disease and to determine the appropriateness of herceptin therapy.
It is important to note that herceptin therapy should only be given to HER2-positive patients because, in addition to being expensive, it can also be associated with heart damage. For HER2-negative tumors, the use of herceptin is not only beneficial but may also be harmful. The HER2 test is usually done on a biopsy specimen.
HER2: Human epidermal growth factor receptor 2
Early detection of breast cancer not only increases the chances of treatment, but also prevents its psychological, familial and social complications.
One way to diagnose breast cancer early is to have a breast self-examination or breast exam.
What is a breast self-examination?
Breast self-examination is the examination of the breast by the person herself. This examination is applicable to any woman and at any age. With a monthly breast exam, you will become familiar with the characteristics of your breast and you will be able to detect any changes in the early stages.
It is important to note that a monthly checkup can not replace a clinical checkup by a doctor or mammogram and is actually helpful in the interval between medical visits. Therefore, regular examinations at intervals of 6-12 months by a doctor and mammography according to the doctor should be done along with breast self-examination.
How to do a breast self-examination?
Breast self-examination should be done every month on a certain date and in a specific way.
Breast self-examination time:
Women can have a breast self-examination from the age of 20.
The best time to have a monthly checkup is 2-3 days after your period. In other words, about the ninth or tenth day of menstruation is a good time to get tested. At this time, the breasts are the least sensitive and heavy, so the examination is easier and the result of the examination is more accurate.
In breastfeeding women, it is best to have an examination after breastfeeding and emptying the breast. Also, if you are taking hormonal treatments, it is best to talk to your doctor about when to do a self-examination.
How to do a breast self-examination:
Breast self-examination involves two steps: looking and touching.
• looking
In some cases, breast diseases, especially breast cancers, can cause changes in the appearance of the breast that can be detected by looking at the breasts. Therefore, you need to be familiar with the appearance of your breasts to be able to detect any possible changes in them.
Looking involves several steps:
1- Hang your hands on either side of your body and look at your breasts.
2- Raise your hands flat from the side of your head.
3- Bend your arms at the elbows and press against your waist.
4- Stretch your arms straight forward and lean forward slightly.
In each of the above positions, look closely at the breast. Any changes, including sagging skin or nipple, redness or soreness of the breast, nipple scaling, nipple deviation, bulge in one part of the breast, or bulge of blood vessels in part of the breast are important. Breast asymmetry is not a problem if it has been before (congenital, puberty or after breastfeeding), but any recent changes in breast size should be considered.
• Touching
For proper examination of the breasts when touching, it is best to use the end of the last 3 paragraphs of the middle fingers (not the fingertips). This part is called finger softness, which is more sensitive to touch than other parts. Never squeeze the breast between your fingers because you falsely feel a lump. While there really is no mass.
What areas should be examined?
The area between the collarbone at the top, the sternum and armpit at the sides, and the two fingers below the lower edge of the breast at the lower extremity elastic should be examined.
To touch the breast, it is best to lie down. To examine the right breast, place a small pillow under the left shoulder and place the right hand under the head. Always use the left hand to examine the right breast and always the right hand to examine the left breast.
Touch the entire breast with short circular motions. To touch, rotate your fingers on the chest with low, medium, and high pressure to make a superficial, deep touch in each area. To examine everywhere, it is best to examine the entire breast in concentric circles from around to the nipple. After examining the entire breast, examine the tail of the breast in the axilla and then the axilla for a breast or underarm mass.
After a complete breast examination, be sure to see your doctor if you have any of the following:
1- Touching the lump in the breast
2- Increasing the size of the mass that already existed
3- Skin symptoms such as sunken skin or nipple, nipple deviation, redness, sores, etc.
4- Scaling, redness and itching of the nipple
5- Abnormal discharge from the nipple
Is there a way to prevent breast cancer?
The most important risk factors for breast cancer are age and family history, which can not be controlled and prevented. However, some risk factors can be prevented. These include avoiding long-term use of hormonal therapies, getting pregnant before the age of 30, breastfeeding, preventing weight gain with proper exercise and diet, and limiting alcohol consumption.
Regular checkups and mammography tests are also recommended to detect any initial changes in breast tissue. Women over the age of 40 should have this test once a year.