Breast Diseases

Breast Anatomy and Function

The breast is a complex organ consisting of milk-producing lobules, milk ducts, fat tissue, connective tissue, and lymph vessels. Its main function is milk production and breastfeeding. Breast structure undergoes significant changes throughout a woman's life: puberty, pregnancy, breastfeeding, and menopause.

Classification of Breast Diseases

Breast diseases are divided into two main groups: benign and malignant.

Benign Breast Diseases

Fibrocystic Breast Changes

The most common benign condition in the breast. Frequently seen in women aged 30-50. Cysts and dense tissues form in the breast, and pain may increase during menstrual period. Does not increase cancer risk.

Breast Cysts

Fluid-filled sac structures. Usually soft and movable, may be painful or painless. Easily recognized with ultrasound. Large cysts can be drained with a needle.

Fibroadenoma

The most common benign mass in young women (20-30 years). Firm, round, movable, and painless. Grows slowly. In some cases, surgically removed.

Breast Abscess

An inflammatory mass usually seen in breastfeeding women. There is pain, redness, and warmth. Requires drainage and antibiotic treatment.

Intraductal Papilloma

Small, benign tumors formed in milk ducts. Causes bloody or clear discharge from the nipple. Usually surgically removed.

Mastitis (Breast Inflammation)

Inflammation of breast tissue. Frequently seen during breastfeeding. Manifests with pain, swelling, and redness. Resolves with antibiotic treatment.

Malignant Breast Diseases (Breast Cancer)

Breast cancer is the most common cancer type in women.

Ductal Carcinoma in Situ (DCIS)

Stage 0 cancer confined to milk ducts. Has not spread to surrounding tissue. High recovery rate.

Invasive Ductal Carcinoma

Most common type of breast cancer (70-80%). Has spread from milk ducts to surrounding tissue.

Invasive Lobular Carcinoma

Starts from lobules. Accounts for 10-15% of all breast cancers.

Other Types

• Triple Negative Breast Cancer: Hormone receptor and HER2 negative, more aggressive
• HER2 Positive Breast Cancer: Targeted treatment options available
• Inflammatory Breast Cancer: Rare but aggressive
• Paget's Disease: A special form on the nipple

Symptoms of Breast Diseases

Common Symptoms

• Newly developing mass or firmness in the breast
• Change in breast size or shape
• Change in breast skin color or orange peel appearance
• Skin retraction or dimpling
• Nipple retraction or direction change
• Bloody or clear nipple discharge
• Pain in the breast or armpit

Symptoms Requiring Urgent Evaluation

• Sudden redness and swelling of breast skin
• Hardened lymph nodes in the armpit
• Wound or crust on the nipple
• Bone pain (sign of widespread disease)

Breast Cancer Risk Factors

Non-Modifiable Risk Factors

• Gender: Much more common in women
• Age: Risk increases over age 50
• Family history: Breast cancer in first-degree relatives
• Genetic mutations: BRCA1, BRCA2 gene mutations
• Early menarche: Menstruation before age 12
• Late menopause: Menopause after age 55

Modifiable Risk Factors

• Excess weight and obesity (especially post-menopausal)
• Sedentary lifestyle
• Alcohol consumption and smoking
• Long-term hormone replacement therapy
• Not giving birth or late childbearing
• Short breastfeeding duration

Diagnostic Methods

Breast Self-Examination (BSE)

Personal examination performed at the same time each month. Performed 5-7 days after menstruation ends, on a fixed day of the month for postmenopausal women. Includes both visual and manual examination. Important for detecting abnormal changes early.

Clinical Breast Examination

Professional examination performed by a physician or nurse. Part of annual physical examination.

Imaging Methods

Mammography

Low-dose X-ray imaging of the breast. Used for screening in women over 40. Digital mammography is currently standard. 3D mammography (tomosynthesis) offers more detailed imaging.

Breast Ultrasound

Effective in dense-breasted and younger women. Can differentiate between cystic and solid masses. Provides guidance for needle biopsy.

Breast MRI

Used for screening in high-risk women, evaluation of cancer extent, and evaluation of breasts with silicone implants.

Biopsy

The definitive diagnostic method by taking tissue samples from suspicious masses.

• Fine Needle Aspiration Biopsy (FNAB): Cellular examination
• Core Needle Biopsy: Allows histopathological examination
• Vacuum-Assisted Biopsy (VAB): Preferred in microcalcification evaluation
• Surgical Biopsy: In cases where diagnosis cannot be made by other methods

Breast Cancer Staging

Breast cancer is divided into stages 0-IV. The TNM system is used in staging:

• T (Tumor): Size of the tumor
• N (Node): Lymph node involvement
• M (Metastasis): Distant organ involvement

Stages

• Stage 0: Carcinoma in situ (DCIS)
• Stage I: Tumor ≤2 cm, lymph node negative
• Stage II: Tumor 2-5 cm or lymph node positive
• Stage III: Locally advanced disease, multiple lymph node involvement
• Stage IV: Distant organ metastasis

In early stages, the 5-year survival rate is over 95%.

Treatment Methods

Treatment of Benign Diseases

• Follow-up: In asymptomatic fibroadenomas and small cysts
• Aspiration: In large or symptomatic cysts
• Medication: For pain and infection
• Surgery: In suspicious, growing, or symptomatic masses

Breast Cancer Treatment

Requires a multidisciplinary approach.

Surgical Treatment

Breast-Conserving Surgery (Lumpectomy)

Only the tumor and surrounding healthy tissue are removed. Preferred in early-stage cancers. Applied together with radiotherapy.

Mastectomy

Removal of the entire breast.

• Total (simple) mastectomy: All breast tissue
• Modified radical mastectomy: Breast + axillary lymph nodes
• Skin-sparing mastectomy: Supports cosmetic recovery
• Nipple-sparing mastectomy: In appropriately selected patients

Sentinel Lymph Node Biopsy

Evaluation of the first lymph node reached by tumor lymph flow. Prevents unnecessary lymph node dissection and reduces lymphedema risk.

Breast Reconstruction

The breast is rebuilt after mastectomy. Implants or the patient's own tissue is used. Can be performed in the same session or delayed.

Radiotherapy

Standard treatment after breast-conserving surgery. Reduces local recurrence risk. Lasts 3-6 weeks.

Chemotherapy

Systemic treatment method. Planned according to tumor size, stage, and biological characteristics. Can be applied before (neoadjuvant) or after surgery (adjuvant).

Hormonal Therapy

Applied in hormone receptor positive (ER+, PR+) breast cancers. Tamoxifen and aromatase inhibitors (anastrozole, letrozole, exemestane) are commonly used. Generally used for 5-10 years.

Targeted Therapies

Drugs targeting the characteristics of cancer cells.

• HER2-targeted: Trastuzumab, pertuzumab
• CDK4/6 inhibitors: Palbociclib, ribociclib
• PARP inhibitors: In patients with BRCA mutations

Immunotherapy

Targets cancer cells by strengthening the immune system. Used in triple-negative breast cancers.

Recommendations for Breast Health

Screening Recommendations

• Ages 20-39: Monthly self-examination, clinical examination every 1-3 years
• Ages 40-49: Annual clinical examination, mammography discussed
• Ages 50-74: Mammography every 1-2 years
• High-risk women: Earlier and more frequent screening

Lifestyle Recommendations

• Healthy weight control
• Regular exercise (at least 150 minutes per week)
• Mediterranean diet
• Reducing red meat and processed food consumption
• Limiting alcohol consumption
• Staying away from smoking
• Breastfeeding (preferably 6 months or more if possible)
• Stress management

Genetic Testing

Indications for testing for gene mutations such as BRCA1, BRCA2:

• Relatives with a history of breast cancer at a young age
• Multiple breast cancer cases in the same family
• History of male breast cancer
• Family history of ovarian cancer
• Triple negative breast cancer (especially under age 60)