The standards of excellence of our clinics in Turkey and the use of state-of-the-art technology are fully reflected in our Breast Surgery Centre, where women over the age of 40 are strongly advised to have a regular mammography scan. Even if they do not have any signs of disease.
Breast cancer death rates are known to have dropped by 19-64% (and by an average of 30%) in countries where regular scans are performed. Younger women should also benefit from self-examination, physical examinations, and ultrasonography.
Women who notice the formation of any hardening, lumps or the like should seek medical advice immediately, even if their previous mammogram tests have been normal. Family history of breast cancer in first- and second-degree relatives is an indication of risk of hereditary breast cancer.
Moreover, hereditary breast cancer may be associated with ovarian cancer in young women between the ages of 20 and 30. Having a mother or sister with breast cancer is an indication of high risk.
The first treatment option for breast cancer that is detected at an early stage is surgery. Either the tumour is removed, leaving the unaffected tissue in place, or the entire breast is removed. The axillary lymph glands are also removed to see if metastasis (spread of the cancer) has occurred.
Surgical intervention makes it possible to determine the stage which the cancer has advanced to and the additional treatments needed (treatment with radioactive substances, hormones, chemotherapy). Modern advances in breast cancer surgery and complementary treatments give excellent results.
Breast surgery – minimal intervention for maximum results
Although in the past there was no option other than removal of the entire breast and lymph glands, today early diagnostic cases are increasingly rarely treated in this way. In half of the cases, it is possible to treat the cancer with removal of the tumour itself and subsequent breast-conserving radiotherapy.
This is because there is no real difference in the effectiveness of the treatment between preserving and removing the whole breast. Today, we can now explore in more detail the approach that affects surgical intervention, the breast, and the lymph nodes.
What is the breast-conserving operation?
Rather than removing the entire breast, excision of the tumour itself is preferred in some cases of a single tumour, since fatal cases of breast cancer are caused not by complete recurrence but by metastases.
Breast-conserving surgery involves removing the tumour tissue along with about 1 to 2 cm of surrounding normal breast tissue (wide excision, tumorectomy and lumpectomy). Other techniques involve removing tissue from a wider area and are called 'quadrantectomy' or 'partial mastectomy'.
After the removal, using a radionuclide-guided hidden lesion detection (ROLL) technique, the mass that the mammography or ultrasound-guided metal-string test has indicated may be malignant or palpable, is radiographed to determine whether it has been successfully removed.
Who is suitable?
Breast-conserving surgery is best applied in early-stage cases (stage I-II) in which the tumour is small and with a single focus and in patients who are suitable candidates for postoperative radiotherapy. The rate of postoperative recurrence varies according to the specific nature of the tumour, but is usually 0.5 - 1 percent recurrence in the same breast.
It is important to ensure that the patient is fully informed about the operation before the operation itself and to be sure that she will be able to attend the follow-up radiotherapy and further examinations and tests.
This is done because the patient will need to be monitored very closely over an extended period of time. If the patient requires postoperative chemotherapy, this is administered before the radiotherapy.
The treatment plan in our hospitals is multi-disciplinary. Specialists in general surgery, radiology, pathology, medical oncology, and radiation oncology work together to provide the right treatment plan that fits the patient's disease and condition.
Usually, the first specialist to make an assessment is the surgeon. Psychological and psychiatric assessment before and after surgery is also important.
Breast PET - Positron Emission Mammography/PEM
Breast cancer is the most common cancer in women worldwide. Early diagnosis of cancer and proper staging are critical factors in determining the course of the disease and patient survival.
Other more commonly used methods, such as ultrasonography, mammography, and magnetic resonance imaging, can sometimes prove inadequate in the evaluation of suspicious lesions in the breast and in confirming the correct stage of a malignant disease.
PEM technology emerged only a few years ago. It has the capacity to detect very small lesions in the breast that have not yet reached anatomical visibility. Such equipment is only found in a few centres worldwide and is one of only two in Europe.
Just as with other nuclear medicine examinations and PET scans, after waiting about 60-90 minutes for the intravenously introduced radioactive material to penetrate the body, unnatural tissue involvement in the breast is accurately determined with high-resolution PEM imaging with sensitivity up to 1.6 mm.
In addition, the procedure is far more comfortable for the patient as it is designed to operate in a stationary state without squeezing or compressing the breast.
The sensitivity of positron emission mammography in showing lesions in the breast has been reported to be over 90%. Therefore, in this way it facilitates more accurate staging and surgical planning without unnecessary biopsies and repeat incisions and allows for preventive and protective breast surgery.
It is also more accurate and specific than anatomical imaging methods in terms of assessing patient response to treatment and detecting local recurrences.
Indicators for breast PET (PEM)
- Diagnosis of patients with mammographic or MRI results that identify a suspicious lesion in the breast.
- Planning and staging before surgery for breast cancer
- Investigation of contralateral malignancy in multicentric/multifocal tumors
- Investigation of metastases in axillary lymph nodes
- Re-staging of locoregional recurrence
- Evaluation of treatment response