Professor Fatih Agalar, the Fellow of the American College of Surgeons (FACS) member, gave an interview specifically for Bookimed patients. In the interview, he spoke about the diagnostics and treatment of breast cancer.
How often do you need to undergo examinations? What are the tests for breast cancer depending on the woman age?
As far as we know, malignant breast growths are one of the most common breast pathologies worldwide. Despite the fact that in women this disease is diagnosed much more often, in men it also occurs. The older woman, the more significant risk of the disease incidence.
That’s why we recommend all women over 25 years old to undergo examination and palpation of their breasts and consult with a mammalogist and other specialists. The tumor is the lump in the breast, so regular self-diagnostics allows to detect breast cancer in time.
The earlier we detect the disease, the more effective treatment and the more chances for its success. On the risk of breast cancer developing, all women are divided into 2 groups:
- women who have a genetic predisposition;
- women without genetic risks.
How often should a woman perform palpation of the breast?
Palpation should be done every month, on the 8th day from the start of the menstrual cycle.
If a woman is at risk for developing breast cancer, she should provide palpation every 2 weeks. Patients over 40 years of age are recommended to undergo mammograms once a year (the primary method of research) and ultrasound (an auxiliary one).
It is essential to understand that not every lump in the breast is cancer. To differentiate the diagnosis, a woman should undergo:
- ultrasound;
- a biopsy and a histological examination (in case of a malignant tumor).
In women of 80 years old and over, the risk of developing cancer in the breast increases. According to statistics, breast cancer develops in 1 out of 8 women at this age.
What about complete breast diagnostics? What procedures can be unnecessary? For example, CT or biopsy?
We know that it is easy to diagnose breast cancer today. The first reason for visiting a specialist is the detection of lumps during the palpation. Sometimes even an experienced specialist cannot feel the lumps during the examination. So we recommend a patient to make a mammogram. The mammography helps to detect calcinates. After that, we perform trepan-biopsy (thick-needle biopsy) under the ultrasound control. Without results, we do not provide the further therapy.
If the biopsy has given a positive result, we check the extent of the tumor (the presence of metastases), since breast cancer can metastasize through the blood and lymph into other organs, most often into the lungs. Due to metastases detecting, we perform a full body screening, for example, PET-CT. Based on the results of this study, we can conclude the extent of the tumor and the stage of cancer. Diagnostics takes 1-2 days.
Is it necessary to undergo PET-CT if the breast tumor is small, for example, 1-2 cm?
The larger the size of the tumor, the higher the risk of metastasizing to the lymph nodes, lungs, and other organs. If the size of cancer is under 2 cm, PET-CT is not always necessary. Instead, you can make a computer tomography of the lung and abdominal cavity. Small tumors usually do not metastasize, but it is essential to consider the type of disease and how aggressive it is.
Is it possible to choose breast cancer therapy for each patient due to Oncotype DX or CTC?
Oncotype DX or CTC tests show us what type of treatment we can conduct. We use CTC in patients with metastases in the bones. The method helps to demonstrate the effectiveness of chemotherapy. The test shows whether the drugs are useful or not.
In the early stages of breast cancer, chemotherapy is not necessary (regarding side effects) due to the result of Oncotype DX test. The examination is very important because it shows the probability of a relapse. When the disease is on an early stage of development, we can find out whether it is necessary to do chemotherapy, and if so, which one.
Can mastopathy be considered as a precancerous disease?
No. It is not correct to call mastopathy an oncologic disease. It is a collective name for the pathology of the breast. For example, over 60% of women over 60 have a diagnosis of mastopathy. We do not even consider this as a disease. Only some types of mastopathy are related to oncology. Diagnostics can show exact kind of mastopathy that belongs to oncological disease.
Professor Fatih Agalar
The doctor is the Fellow of the American College of Surgeons (FACS) member. The professor is the laureate of 6 international and national scientific awards.
Professional interests:
- Laparoscopic and robotic surgery;
- Breast surgery;
- Soft tissue surgery;
- Complex reconstruction of the abdominal wall;
- Operation of the colon and rectum, anus;
- Thyroid surgery;
- Surgical preparation.
Read the part 2 of the interview with the professor on our website.