Pink October 2024 – 14 Questions and Answers for Breast Cancer Awareness Month

Pink October

Breast cancer is the most frequently diagnosed cancer among women worldwide. According to the World Health Organization (WHO), approximately 2.3 million women were diagnosed in 2022 and more than 685 thousand died from the disease. These figures show how vital annual breast cancer awareness campaigns are.

Breast Cancer Awareness Month (Pink October) provides an important opportunity to improve women's lives by explaining the disease's causes, the importance of early detection, and treatment options.

Screening uptake for early detection remains below the desired level. Although breast cancer is the most common cancer among women worldwide, mammography and other screening methods can reduce breast cancer death rates by up to 40%. In the United States, 2021 data show that approximately 76% of women aged 50-74 had undergone mammography within the previous two years. In Turkey, OECD reports show lower uptake: approximately 35% of women aged 50-69 had undergone mammography within the previous two years. 

As awareness campaigns continue in 2024, the goal is for every woman to understand advances in breast cancer treatment, know her personal and family risks, and benefit from early detection through regular checkups.

Be a Friend, Remind a Friend!

"Be a Friend, Remind a Friend!" is a campaign to raise breast cancer awareness and encourage regular screening. Talking with loved ones about breast cancer and encouraging them to be screened can make a major contribution to their lives. A brief reminder or help arranging an appointment can make a big difference. Join our campaign and remind a friend to get screened. Together, a small step can produce big results!

Frequently Asked Questions About Breast Cancer

Question 1: How common is breast cancer worldwide?

Answer: Approximately 2.3 million women worldwide were newly diagnosed with breast cancer in 2022. It is the most common cancer among women and the second most frequently diagnosed cancer overall after lung cancer. Early detection and improved treatments have substantially increased survival. For example, when detected early, 5-year survival can reach 99%, compared with 90% across all stages.

Question 2: What increases breast cancer risk?

Answer: The two biggest risk factors are being female and aging. Family history and reproductive factors such as starting menstruation early, late menopause, never having children, or giving birth later in life also increase risk. Lifestyle factors, including excessive alcohol consumption, smoking, postmenopausal weight gain, and obesity, can increase risk too.

Question 3: How is breast cancer detected early?

Answer: The most effective recommended method for early detection is regular mammography. In 2024, the United States Preventive Services Task Force (USPSTF) recommends screening for all women every two years starting at age 40 to reduce the risk of dying from breast cancer. Previously, women in their 40s were advised to decide individually with their doctors when to begin. The new guideline recommends that all women start at 40.

Question 4: What can I do to reduce my risk?

Answer: A healthy lifestyle is highly effective in reducing breast cancer risk. Research shows that positive changes can substantially lower risk. A healthy diet, regular physical activity, and maintaining an ideal weight are critical. For example, losing weight and avoiding excess weight can reduce risk by lowering estrogen levels. Excess fatty tissue can increase estrogen and breast cancer risk. Smoking and alcohol consumption are other important risk factors.

Mediterranean Diet: Studies show that a Mediterranean diet is highly effective in reducing breast cancer risk. Its key elements include olive oil, fresh vegetables and fruit, whole grains, legumes, fish, and nuts. Women following this diet have been reported to have up to a 30% reduction in risk. The diet also helps control weight and lowers cancer risk by regulating insulin and estrogen levels.

Alcohol Consumption: Alcohol is a risk factor for breast cancer. Consuming 1 serving daily may increase risk by 7%. Limiting alcohol or avoiding it completely is therefore recommended.

Regular Exercise: At least 150 minutes of moderate exercise weekly can substantially lower breast cancer risk. Research shows that regular physical activity reduces risk by 20-30%.

Breastfeeding: Studies show that breastfeeding lowers breast cancer risk. Women who breastfeed have been found to have a 4% to 5% reduction in risk. Longer breastfeeding (6 months or more) is reported to reduce risk further.

Question 5: What are common misconceptions about breast cancer?

Answer: "One in every 8 women will develop breast cancer" is often misunderstood. It means that one in every 8 women is at risk of developing breast cancer at some point in her lifetime, not that one in every 8 will develop it each year. Risk increases with age: it is lower in younger women and rises substantially over time. Lifetime risk should therefore not be confused with annual risk within a particular age range.

Breast cancer does not affect only women; it also occurs in men, although rarely. The proportion of male cases is very low, but 1 man for every 100 women is at risk of developing this cancer. Lower awareness in men can lead to later diagnosis and make treatment more difficult.

Another common misconception is that breast cancer occurs only in people with a family history. In fact, approximately 80% of women who develop it have no family history. Although family history is important, many other factors can cause breast cancer, including age, genetics, hormones, environmental influences, and lifestyle.

Finally, some people believe mammography is needed only after finding a lump or developing symptoms. Breast cancer can often be detected by mammography before symptoms appear, making regular screening critical for early detection.

Question 6: What should happen after a breast cancer diagnosis?

Answer: Treatment is planned according to the cancer's stage and type and the patient's general health. Options include surgery, chemotherapy, targeted drugs, immunotherapy, radiotherapy, and hormone therapy. Advanced approaches such as targeted drugs and immunotherapy have brought important improvements in cancer treatment.

Question 7: How can I support someone with breast cancer?

Answer: Supporting someone diagnosed with breast cancer can help them through a difficult time. Reminding them about checkups, accompanying them to mammography appointments, offering emotional support, and helping them access accurate health information can make a major difference.

• Related topic: What Should You Say—and Not Say—to Someone with Cancer?

Question 8: How does breast cancer affect sexual life?

Answer: Treatment can alter hormone levels and adversely affect sexual life. Physical discomfort, breast tenderness or numbness, psychological effects, and treatment side effects can make this difficult. Pelvic floor exercises, vaginal moisturizers, and psychological support may help.

Question 9: What are dense breasts, and how do they affect risk?

Answer: Dense breasts have dense breast tissue, which increases breast cancer risk. Dense tissue can make cancer harder to detect on mammography because both it and tumors appear white. Dense breasts occur in 50% of women. Women with dense breasts should continue mammographic screening. Their doctors may recommend additional imaging such as ultrasound or magnetic resonance imaging (MRI).

Question 10: What happens to the other breast after diagnosis? What are its risks? Should both breasts be removed?

Answer: After a breast cancer diagnosis, the risks to the other breast and the steps needed depend on many factors, including general health, genetic predisposition, and cancer type and stage.

Risks to the Other Breast: A woman diagnosed with breast cancer may have an increased risk in the opposite (contralateral) breast. This varies according to several factors:

• Genetic Predisposition: BRCA1 or BRCA2 mutations, for example, place women at high risk of cancer in the second breast. The probability may range from 40% to 60%. Other mutations also increase hereditary risk: changes in TP53, PTEN, PALB2, and CHEK2 significantly raise breast cancer risk.

• Age and Cancer Type: Risk in the opposite breast may be higher if cancer was diagnosed young or the hormone receptors are not positive.

• Cancer Subtype: Particularly aggressive subtypes such as triple-negative breast cancer may increase the risk of cancer in the opposite breast. Risk may be lower in low-risk, slow-growing hormone receptor-positive cancers.

Should Both Breasts Be Removed? Removing both breasts (bilateral mastectomy) is a difficult decision and may not suit every patient. It is generally recommended in high-risk groups, particularly women carrying genetic mutations, but is not necessary in every case.

• Who might benefit? For women with BRCA1 or BRCA2 mutations in particular, removal of both breasts may be considered to reduce recurrence or a new cancer in the opposite breast. This preventive (prophylactic) mastectomy can substantially reduce risk. Studies show reductions of up to 90% in this high-risk group.

• Benefits and Risks: Although removing both breasts can substantially reduce cancer risk, it is major surgery, and physical and emotional recovery may take a long time. Each patient therefore needs comprehensive counseling based on her own risk factors.

Question 11: How quickly does breast cancer grow and spread?

Answer: Growth and spread vary with many factors, including subtype, age, hormone receptor status, tumor genetics, and general health. Most breast cancers tend to grow slowly, with tumor size increasing more gradually over time. Some aggressive types, particularly triple-negative breast cancer or HER2-positive breast cancer, may grow and spread faster.

The speed of spread also depends on type and stage. A tumor generally reaches 2-3 centimeters before spreading to lymph nodes, although some can spread to nodes or other body sites while still smaller. Inflammatory breast cancer and certain other aggressive forms can spread more quickly and affect a wide area even at an early stage.

Spread through the body (metastasis) generally first involves the underarm lymph nodes. At later stages, distant organs such as the lungs, liver, bones, and brain may be affected. The speed of growth and spread is directly related to how early treatment starts.

Question 12: Is chemotherapy always necessary?

Answer: Not every breast cancer patient needs chemotherapy. Genomic tests now assess recurrence risk and indicate whether chemotherapy is needed. In particular, chemotherapy has been found unnecessary in 70% of patients with early-stage, hormone receptor-positive, HER2-negative disease. These patients can receive hormone-suppressing treatment alone.

Question 13: What is hereditary breast cancer, and who is at risk?

Answer: Hereditary breast cancer results from genetic changes passed between generations through mutations. Approximately 10% of all breast cancers are hereditary. About 5-10% of hereditary breast cancers arise from mutations in particular genes such as BRCA1 and BRCA2. These greatly increase risk: lifetime breast cancer risk ranges from 50-85% for women carrying BRCA1 mutations and 40-70% for BRCA2 carriers.

Quality Controls and Detection Methods: People at hereditary risk are usually identified when there is a strong family history of breast or ovarian cancer. Suspicion increases with diagnoses at a young age (for example, before 40), multiple affected relatives, male breast cancer, or mutations such as BRCA1 or BRCA2.

Genetic tests can then determine whether a person carries these mutations. Testing uses tumor tissue or a blood sample to examine BRCA1, BRCA2, or other breast cancer-related genes.

Who should have genetic testing? Testing may be recommended for people with the following features:

• A history of breast or ovarian cancer in first-degree relatives (mother, sister, father, brother);
• A family history of male breast cancer;
• Relatives diagnosed young, for example before age 40;
• Breast and ovarian cancer in the same person;
• Breast cancer across several generations;
• Aggressive types such as triple-negative breast cancer.

Risk Reduction: Preventive measures and monitoring are available for people at hereditary risk, including:

1. Regular Screening Starting Young: Mammography or magnetic resonance imaging (MRI) screening may begin at ages 25-30 for high-risk women.

2. Risk-Reducing Surgery (Prophylactic Mastectomy): Preventive removal of both breasts in high-risk women can reduce the risk of developing breast cancer by more than 90%. This measure attracted worldwide attention through Angelina Jolie's decision.

3. Risk-Reducing Medication (Chemoprevention): Drugs such as tamoxifen can substantially reduce the risk of developing breast cancer.

4. Genetic Counseling: Counseling helps people at hereditary risk understand their risks and make informed decisions about treatment or preventive steps.

Question 14: Which patients should have breast cancer biomarker (genetic and genomic) tests?

Answer: Genetic and genomic tests are important tools for personalizing breast cancer treatment decisions. They help establish recurrence risk, tumor biology, and the likelihood of treatment response. These tests broadly fall into three categories: inherited genetic tests, genomic biomarker tests, and recurrence score tests.

Inherited Genetic Tests (Germline Testing): These tests use blood or saliva to determine whether particular mutations increase cancer risk. Analyses of BRCA1, BRCA2, and other hereditary cancer genes reveal familial genetic predisposition. They are particularly recommended for women with a family history and those diagnosed young.

Tumor Genomic Tests (NGS - Next Generation Sequencing): Genomic tests help clarify tumor biology, usually using tumor tissue; blood can be used when tissue is unavailable. They identify genetic changes such as mutations, amplifications, and deletions, helping determine which treatments, including targeted therapies, may work. They are used particularly to investigate biomarkers relevant to targeted agents and immunotherapy.

• Who Are They For?

  • Patients with hormone receptor-positive, HER2-negative breast cancer, to determine treatment options.
  • Patients with metastatic or advanced breast cancer, to assess suitability for targeted treatment or immunotherapy.
  • Patients who have not responded to previous treatment, to evaluate new options.

• Examples:

  • NGS Panel Tests: Identifying mutations such as PIK3CA, AKT1, and PTEN can guide targeted treatment. For example, alpelisib (a PI3K inhibitor) may be recommended for patients with PIK3CA mutations.
  • Immunotherapy Biomarker Tests: Markers such as PD-L1 expression, TMB (tumor mutational burden), and MSI identify patients who may respond to immunotherapy. They are analyzed in some patients with advanced breast cancer to determine whether immunotherapy could be effective.

Cancer Recurrence Score Tests: These tests assess recurrence risk and treatment options, particularly in early breast cancer. They are generally used to decide whether chemotherapy is needed. Testing tumor tissue reveals the cancer's biological behavior and likelihood of returning.

• Who Are They For?
  • Patients with early-stage, hormone receptor-positive, HER2-negative breast cancer without lymph node metastases.
  • To assess whether chemotherapy is necessary in these patients.
• The Most Common Tests:
  • Oncotype Dx: This 21-gene test assesses recurrence risk and the need for chemotherapy. Chemotherapy is not given for a low Oncotype score; it may be recommended for a high score.
  • MammaPrint: This 70-gene test assesses recurrence risk, particularly in early breast cancer. Low-risk patients may avoid chemotherapy.
  • EndoPredict and Prosigna: These tests analyze breast cancer biology to assess long-term recurrence risk after hormone therapy and guide treatment decisions.

Conclusion

Breast Cancer Awareness Month offers an opportunity for women to understand their risks and the lifesaving value of regular screening. Starting screening at 40 under new guidelines could increase early detection and save more lives. In situations such as dense breast tissue, discuss additional screening options with your doctor. Remember, early detection saves lives!