Breast Cancer: Symptoms, Screening and Surgical Treatment

Breast cancer is the most common cancer in women. It is also among the cancers with the highest rate of successful treatment. The one thing that connects those two facts is early diagnosis. This article covers the risk factors, which symptoms should be taken seriously, the screening programme and how surgical treatment is planned.

What Are the Risk Factors?

Breast cancer has no single cause; several factors come together. Those that cannot be changed are:

• Female sex and increasing age
• A family history of breast or ovarian cancer
• Inherited gene changes such as BRCA1 and BRCA2
• Early menarche and late menopause
• Atypical cells found on a previous breast biopsy

The modifiable factors are obesity (particularly after the menopause), alcohol, inactivity, long-term hormone replacement therapy, and never having given birth or a first birth after the age of 30.

Note. Carrying a risk factor does not mean having the disease; a substantial proportion of women diagnosed with breast cancer have no known risk factor. Screening therefore applies to everyone, regardless of risk.

What Are the Symptoms?

There are usually no symptoms in the early stage, which is precisely why screening matters. When symptoms do appear, the following should be taken seriously:

• A firm, usually painless lump in the breast or armpit
• Pulling, dimpling or an orange-peel appearance of the skin
• Retraction of the nipple or a change in its direction
• Discharge from a single duct, particularly if bloodstained
• Persistent redness, warmth or a sore on the skin of the breast
• A one-sided change in the size or shape of the breast

Most lumps are benign: cysts and fibroadenomas are the commonest causes. That distinction cannot be made by examination alone, however, so every new lump should be assessed.

Screening: Who, and When?

Under the Turkish Ministry of Health national screening programme, screening in women without symptoms begins at age 40 and continues to 69 with mammography every two years.

Earlier screening and an individually tailored programme are advised in the following situations:

• A first-degree relative with breast cancer, particularly if diagnosed young
• Carriers of a BRCA1 or BRCA2 gene change
• Previous radiotherapy to the chest
• Dense breast tissue, where ultrasound is added to mammography

Breast self-examination does not replace screening, but by making a woman familiar with her own breasts it helps changes to be noticed early.

Diagnosis: Triple Assessment

The diagnosis of breast cancer rests on three components assessed together:

• Examination. The size, consistency and mobility of the lump and the axillary lymph nodes are assessed.
• Imaging. Mammography and ultrasound, with breast MRI where indicated.
• Biopsy. Most often a core (tru-cut) biopsy under ultrasound guidance. The pathology result gives the tumour type and grade along with hormone receptor and HER2 status.

Where one of the three is suspicious and the others normal, the process does not stop; assessment continues until the suspicion is resolved.

When Is Surgery Needed?

Breast-conserving surgery. In suitable cases only the tumour and surrounding healthy tissue are removed and the breast is preserved. It is generally completed with radiotherapy. Suitability depends on the ratio of tumour size to breast volume, the number of foci and the site of the tumour.

Mastectomy. Where disease is multifocal, the tumour is large, radiotherapy is not possible or in certain genetic situations, all the breast tissue is removed. Reconstruction can be immediate or delayed.

Sentinel lymph node biopsy. The first node reached by lymph draining from the tumour is marked, removed and examined during the operation. If it is clear, the remaining axillary nodes are left in place. This approach has markedly reduced the risk of lymphoedema of the arm.

Oncoplastic surgery. After the tumour is removed, the remaining tissue is reshaped to preserve the appearance of the breast. It improves the aesthetic result without compromising oncological safety.

Treatment Is Not Surgery Alone

The need for chemotherapy, hormone therapy, targeted treatment and radiotherapy is set by the tumour type, stage, hormone receptor status and HER2 result. That decision is not taken by one doctor but at an oncology board, where surgical, medical oncology, radiation oncology, radiology and pathology doctors assess the case together.

In some patients chemotherapy is given before surgery. The aim is to shrink the tumour so that breast-conserving surgery becomes possible, and to see the response to treatment in advance.

What Happens After Surgery?

Once treatment is complete, follow-up continues with examination at set intervals, annual mammography and further imaging where needed. In hormone receptor positive patients, hormone therapy generally continues for 5 to 10 years.

If axillary nodes have been removed, lymphoedema can develop in that arm; protecting the arm and, where needed, physiotherapy support are part of follow-up. Long-term recovery rates in early-stage breast cancer are high, which is why not missing the screening age and not putting off noticed changes matter so much.

Disclaimer. This article is provided for general information only. It does not constitute medical advice, diagnosis or a treatment recommendation, and it is not a substitute for examination, diagnosis and treatment by a physician. The content is not tailored to any individual and is not intended as advertising. Do not start, change or stop any treatment on the basis of the information here. Consult your own doctor about any decision concerning your health and see a healthcare provider about your symptoms. The site owner accepts no liability for any consequences arising from use of this content. Last updated: 2026-08-11.