Breast cancer starts in the cells lining the milk ducts or lobules of the breast. It is the most common cancer in women and occasionally affects men. Many cases are now found on screening mammograms before any lump can be felt.
It is not one disease. Treatment is chosen according to the stage and the tumour's biology: whether it is hormone receptor positive, HER2 positive or triple negative. Most early breast cancers are treated with the intention of cure, but no team can promise an outcome for an individual.
Symptoms
- A new lump or thickening in the breast or armpit, usually painless
- A change in the size or shape of one breast
- Dimpling, puckering or an orange-peel look to the skin
- A nipple that turns inwards or changes position
- Bloodstained or clear discharge from one nipple
- A scaly rash or redness on the nipple or breast that does not settle
- No symptoms at all, with the change seen only on a mammogram
Causes and risk factors
Risk rises with age and with lifetime exposure to oestrogen: early periods, late menopause, having no children or a first child after 30, and combined hormone replacement therapy. Alcohol, excess weight after menopause and inactivity add to risk. About 5 to 10 percent of cases are linked to inherited gene changes, chiefly BRCA1, BRCA2 and PALB2; a strong family history of breast or ovarian cancer should prompt genetic counselling. Dense breast tissue and previous chest radiotherapy at a young age also matter. Most women who develop breast cancer have no strong risk factor.
How it is diagnosed
- Triple assessment: Examination, imaging and needle biopsy done together, ideally in a single visit to a breast clinic.
- Mammogram and ultrasound: Mammography is the main imaging over 40. Ultrasound is added for lumps and is the first test in younger women.
- Core needle biopsy: A sample taken under local anaesthetic confirms the diagnosis and gives the grade and the ER, PR and HER2 status.
- Breast MRI: Used selectively, for example in lobular cancer, dense breasts, BRCA carriers or before certain operations.
- Staging and genomic tests: CT, bone scan or PET-CT where spread is a concern. Gene expression tests on the tumour help decide whether chemotherapy adds benefit in some hormone-positive cancers.
Treatment options
- Breast-conserving surgery: Removal of the tumour with a rim of normal tissue, followed by radiotherapy. For suitable tumours it is as effective as mastectomy.
- Mastectomy with or without reconstruction: Advised for larger or multiple tumours, or chosen by the patient. Reconstruction with an implant or your own tissue can be immediate or delayed.
- Sentinel node biopsy: Removes the first few armpit glands to check for spread, avoiding full clearance in most women.
- Radiotherapy: Typically daily for 1 to 3 weeks after breast-conserving surgery, and after mastectomy in some cases.
- Chemotherapy and targeted therapy: Given before or after surgery depending on the biology. Trastuzumab-based treatment for HER2-positive disease continues for about a year.
- Hormone therapy: Tamoxifen or an aromatase inhibitor taken daily for 5 to 10 years for hormone receptor positive cancers.
When it is urgent
Breast cancer itself is rarely an emergency, but some things are. During chemotherapy, a temperature of 38 degrees or above, shivering or feeling suddenly unwell needs immediate hospital assessment near you. A hot, red, swollen breast that does not improve within a week on antibiotics should be reviewed urgently to rule out inflammatory breast cancer. New back pain with leg weakness or numbness needs same-day care.
Travelling to Türkiye for treatment
A new lump should be assessed quickly where you live. Travel can be reasonable for a second opinion on pathology and the treatment plan, for planned surgery with reconstruction, allowing about 10 to 14 days, or for a defined radiotherapy course. Chemotherapy lasting several months, a year of HER2 therapy and 5 to 10 years of hormone tablets need an oncologist near home, so agree the whole plan with both teams before you start. Bring your biopsy report, receptor results and imaging discs.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
Frequently Asked Questions
Do I need a mastectomy?
Often not. For many early cancers, removing the lump and having radiotherapy gives equivalent control. Tumour size relative to the breast, multiple tumours and gene status influence the advice.
Will I need chemotherapy?
It depends on the biology and stage. Many hormone-positive, node-negative cancers do not need it, and genomic tests help decide. Triple negative and HER2-positive cancers usually do.
Can reconstruction be done at the same operation?
Frequently yes. If radiotherapy is likely afterwards, your surgeon may advise a staged approach, since radiation affects implants and flaps.
Should my relatives be tested?
If you are diagnosed young, have triple negative disease or a strong family history, genetic counselling is worthwhile. A positive result has implications for relatives.