Misconceptions about Breast Cancer and the Truth…

During the diagnosis and treatment process of breast cancer, individuals can acquire a lot of misinformation or resort to treatment methods that have no effect. This can lead to unnecessary anxiety or progression of the cancer. Here are the truths from experts at Anadolu Health Center...

1. "A mass in the breast always indicates cancer."

Not every mass in the breast is cancerous. Most patients who visit a doctor due to a breast mass have benign lesions. Of course, a woman who notices a mass in her breast should not think, "These masses turn out to be benign; there’s no need to see a doctor." However, perceiving every mass as cancerous is also extremely incorrect. Whether the mass is cancerous can only be determined through a clinical examination by a doctor and, if deemed necessary, through radiological investigations. If there is suspicion of cancer, the diagnosis can only be confirmed through a biopsy.

2. "Those at risk of breast cancer will definitely get cancer."

Some women may have a higher risk of breast cancer compared to their peers. This risk is slightly increased, especially in women with a family history of breast cancer, those who have previously been diagnosed with precursors to breast cancer in biopsies, heavy alcohol consumers, those who do not engage in regular exercise after menopause, and women with increased fat volume in the abdominal area. Women who have undergone long-term hormone therapy, those who have never given birth, or those who have their first child after the age of 35 also fall into this group. Therefore, we recommend a screening program tailored to women's specific risks. Ultimately, it is impossible to say that a woman who carries risk factors for breast cancer will definitely develop the disease, or conversely, that women without such risk factors will never have breast cancer.

3. "Breast cancer affects older women."

While the incidence of breast cancer increases with age, we also see breast cancer in younger women in their 20s and 30s. There are some common characteristics often seen in breast cancer diagnosed at a young age. In particular, hereditary breast cancers can occur at earlier ages and may be biologically more aggressive. However, since breast cancer is generally considered a disease of women aged 40 or even 50, it is meaningful for screening to begin after the age of 40 or 45 for women without risk factors. Therefore, while we can say that breast cancer can occur at any age, we must emphasize that its frequency increases in older ages.

4. "If no one in your family has had breast cancer, you won't get it."

While hereditary breast cancer is part of the breast cancer group, it only accounts for about 5 to 8% of this group. If a person has a genetic mutation that causes hereditary breast cancer in their family, their risk significantly increases. However, it would be incorrect to say that just because there is breast cancer in a family, a person will develop breast cancer. Conversely, not having a history of breast cancer in a person's family does not mean that breast cancer will not occur.

5. "Using birth control pills causes breast cancer."

This is also a highly misleading belief. Breast cancer is often a hormone-dependent cancer. The comment about the increased risk of breast cancer in women who must use high doses of hormones, especially estrogen, can be made for this reason. However, studies conducted so far have not provided any evidence that the low hormone-containing birth control pills used today increase the risk of breast cancer.

6. "Self-breast examination is sufficient for breast cancer diagnosis."

Self-examination is a very valid method for early diagnosis of breast cancer, enabling individuals to seek medical attention earlier. Women should spend 5 to 10 minutes each month examining their breasts starting from their reproductive age and consult a doctor if they notice any abnormalities. Patients who notice their own masses comprise a significant proportion of women diagnosed with breast cancer. Therefore, we place great importance on self-breast examinations. However, especially after the age of 40, self-examination alone is not sufficient. The size of the mass that a person can notice during self-examination will differ significantly from the effectiveness of a clinical examination by a general surgeon. There is a substantial group of cases diagnosed through additional radiological examinations alongside clinical breast exams, which may not be evident during a self-examination but have different radiological images. Women should regularly check their breasts, and after the age of 40-45, they should be evaluated through clinical breast examinations, mammograms, and ultrasounds.

7. "I am at high risk for breast cancer. There's nothing I can do."

The risks of developing breast cancer differ between a woman at high risk for breast cancer and one with no risk factors. However, discussing these risks with a physician can help a woman at high risk for breast cancer assess potential problems in breast examinations and radiological images, as well as determine the appropriate screening program. This can lead to the detection of cancer at a very early stage, potentially preserving the person's lifespan and quality of life, even if cancer could develop. We know that certain lifestyle factors can increase or decrease breast cancer risk. After menopause, the primary source of estrogen in the body is adipose tissue. Fat tissue, especially around the abdomen, produces high levels of estrogen. Gaining weight or having increased fat after menopause raises the risk of breast cancer, as it is often associated with estrogen. If a person is gaining weight, this will increase the risk of breast cancer. A person who maintains their weight or loses excess weight through exercise and healthy eating will reduce this risk. Similarly, alcohol increases breast cancer risk through both fat accumulation and its own toxic effects.

8. "Men do not get breast cancer."

This is also a false belief. One in every 100 breast cancer patients is male. Breast cancer is seen more frequently in men, especially those in families with hereditary breast cancer. Therefore, if men notice a mass in their breasts, they should seek medical attention without delay.

9- “Those with breast cancer will lose their breast in surgery.”

This is a misconception. Nowadays, breast-conserving surgery is frequently possible in breast cancer surgeries. Simply removing the tumor and the surrounding healthy breast tissue can be sufficient treatment. For such a surgery to be feasible, the tumor must be localized, below a certain size, and there should be no findings on the mammogram suggesting cancer in other parts of the breast. Of course, there is a cost to preserving the breast, which is radiotherapy. When we remove the entire breast, we usually do not give radiotherapy to the chest wall; however, in patients from whom we preserve the breast, we perform radiotherapy on the remaining breast tissue to reduce the risk of disease recurrence. We plan the surgery by making the final decision in collaboration with the patient regarding surgical options.

10- “Women with breast cancer cannot become pregnant.”

Due to hormonal changes during pregnancy and the postpartum period, pregnancy can increase the risk of breast cancer recurrence. A patient who has undergone treatment for breast cancer should avoid hormone therapies as much as possible. The hormonal changes during pregnancy and the postpartum period can somewhat increase the local risk of disease recurrence in patients who have been treated for breast cancer. Especially in the early years of treatment, although there is no clear limit, it is generally not advisable for the patient to become pregnant for about 2 to 5 years. Once it has been observed that the disease has not recurred and there are no issues related to the disease, the patient can evaluate their situation with their doctor and may become pregnant and have healthy babies.

11- “Breast cancer must metastasize from one breast to the other.”

This is definitely a misconception. Metastasis to the opposite breast is extremely rare. If the disease recurs, it usually returns either locally in the same breast or in different, distant parts of the body, which we refer to as metastasis. Breast cancer can often return by spreading to the liver, lungs, and bones. While it is possible for breast cancer to spread to the opposite breast, this is generally an exception to the rule. However, women with a history of breast cancer are at risk for developing breast cancer again. The strongest risk factor is having previously undergone treatment for breast cancer. Therefore, a second focus of breast cancer may be present in either the same or the opposite breast. While this is a visible possibility, it does not mean that cancer present in one breast will necessarily spread to the other breast.

12- “After breast cancer surgeries, women’s arms will definitely swell.”

This is also a misconception. Especially with the help of newly developed technologies in recent years, we are intervening less with the lymph nodes under the armpit. In the surgery, we reach the first sentinel lymph node with a method known as "sentinel lymph node biopsy," using nuclear medicine (sometimes with special dyes), and we remove that lymph node and send it to pathologists during the surgery. The pathologist informs us whether there is any trace of disease in that lymph node. If there is no trace of the disease, we scientifically know that the likelihood of the disease spreading to deeper lymph nodes without affecting the first lymph node is negligible, so we finish the surgery by performing a biopsy only on the sentinel lymph nodes without touching the more advanced lymph nodes. By cleaning the lymph nodes under the armpit, we protect the patient from nerve-related side effects and pain, which can cause swelling and loss of sensation and movement. However, in patients where we detect that the disease has spread to the lymph nodes under the armpit, we completely clean out the lymph nodes. This can disrupt the integrity of lymph flow in that arm and hand. Therefore, we advise our patients to protect their operated arms as much as possible after surgery. We mention that there could be an acceptable amount of swelling in this arm, but it should not affect their quality of life. It is a misconception that all women will have their armpit lymph nodes removed and that all women’s arms will swell, but we also need to understand that swelling in the arm can be one of the acceptable side effects of the surgical treatment.

13- “After surgical intervention, the appearance will change.”

Now, we notice many breast cancers at very small sizes. Therefore, we only remove the tumor and a small amount of surrounding healthy breast tissue. Except for women with very small breasts, especially when the tumor is appropriately located, the difference in symmetry after surgical treatment due to breast cancer is often not noticeable to the naked eye. Sometimes even patients have difficulty perceiving the difference after surgery.

14- “It is possible to treat early-stage breast cancer without surgery.”

This is also a misconception. The most effective known treatment for breast cancer is surgery. In fact, surgical options can sometimes be sufficient on their own, even for early-stage breast cancers or the type of breast cancer we define as DCIS (Ductal Carcinoma In Situ). We do not operate on patients with advanced stage breast cancer or those in whom the disease has metastasized to different parts of the body, as we know that surgery will not provide any benefit. However, we recommend surgery for every early-stage breast cancer.

15- Silicone breasts can burst.

For a silicone breast to burst, it must endure a very serious impact. Silicone breasts can only burst or be punctured during penetrating trauma. Thanks to new technologies, the silicone structure inside the breast implant is not in a gel consistency, but rather jelly-like. Thus, even if there is a tear in this area, the silicone cannot spread into the body, and it is possible to remove it entirely without difficulty. It is beneficial to remove the silicone immediately after trauma; however, there are cases where patients have lived with burst silicone for an extended period.

16- Those with silicone breasts cannot breastfeed.

Silicone breast implants never affect the ability to breastfeed.

17- The risk of cancer increases after breast augmentation with silicone implants.

The risk of cancer absolutely does not increase. The main concern should be whether the silicone implant obscures the observation of a potential breast cancer. With today's advanced techniques, this concern has been eliminated. Therefore, breast implants can be used safely.

18- Breast size increases with fat injection.

Fat injection is a new and challenging method. Currently, this application is being tested, but it cannot guarantee a standard successful result in every case. It is not as easy a method as breast implants, but it is used for breast reconstruction. After creating a breast with the patient's own tissue or an implant, some touch-up procedures need to be applied. One of these procedures is to fill in any missing tissue with fat injection. Such applications also yield good results.