Dr. Ertan Beyatlı

Sugar and Breast Cancer relationship

(Update: ) - Skin and soft tissue diseases

Breast cancer develops from the cells lining the milk glands or the ducts that carry milk to the nipple. Although the cause is not known exactly, the gene mutation that creates a genetic predisposition increases the risk of cancer in the breast.


What is Meme CA?

Breast CA is a tumoral formation consisting of cells that grow uncontrolled as a result of various factors and have the potential to spread to other organs in the mammary glands of the breast and between the cells that line the ducts that carry the produced milk to the nipple.

It is not known exactly which factors cause cancer in the breast. However, in studies conducted to date, some factors that show high probability have been identified. In some women, gene mutations that cause genetic predisposition (disorders that cause cancer in the genes) increase the risk of cancer in the breast, while others do not have a risk factor other than being a woman.

The greatest risk of breast cancer is in Northern European women

Countries with the highest breast cancer death rates are in Northern Europe. In these countries, the rate is 100 per 22.6 thousand. Chinese and Japanese women have the lowest breast cancer death rates, in contrast to Northern European women. While this rate is 100 per 5.6 thousand in China, it is 8.3 in Japan.

In the US, one in 8 women in their lifetime will develop breast cancer. In 2008, more than 182 women in the USA were diagnosed with malignant breast tumors, in other words cancer. About 40 thousand women also died of breast cancer. But besides all these sad statistics, there are also gratifying results.

Today, there are 2.5 million healthy breast cancer patients living in the USA who have been treated.

It is thought that the increase in mammographic screening programs in women over the age of 40 and the gradual decrease in hormone replacement therapies recommended for menopausal women increase the success of breast cancer treatment.

Breast Cancer Risk Factors

Many factors play a role (multifactorial). The most important factor among these factors is the patient's family history of breast cancer.

People in this group should be followed up periodically and specifically. Breast cancer patients diagnosed at an early stage can lead a normal life after adequate surgical intervention.

breast exam
BREAST CANCER
  • Gender. Breast cancer is most common in women. The incidence in men is less than 1 percent.
  • Age. It is mostly seen over the age of 50. The frequency of occurrence is less at the age of 35 and under. The incidence of breast cancer in American women between 2000-2004 was 30 per 34 thousand in the 100-25 age group, while it increased to 45 per 49 thousand in the 100-190 age group and 70 per 74 thousand in the 100-455 age group. Breast cancers caused by hereditary breast cancer or genetic disorders are more common in young women.
  • Family story. Especially having a history of breast cancer in a first-degree relative (mother, aunt, grandmother, daughter) from the mother's side is considered an important risk factor. The risk of these relatives getting breast cancer before menopause and / or bilateral breast cancer increases even more.
  • Estrogen hormone. The earlier a woman has her first menstruation (e.g. before age 12) and the later she enters menopause (e.g. age 55), the greater her risk of developing breast cancer. Using birth control pills is also thought to increase the risk of cancer, even at a very low rate.
  • Postmenopausal hormone therapy. Combined hormone drugs containing estrogen and medroxyprogesterone acetate, prescribed by gynecologists and obstetricians for a long time (for 5 years or more) to prevent problems such as hot flashes during menopause, increase the risk of breast cancer more than hormone drugs containing only estrogen.
  • Previous breast biopsy. Moderate hyperplasia detected in breast biopsies is 1,5-2 times the risk of breast cancer (mild), atypical ductal hyperplasia 3-5 times (moderate) and lobular carcinoma in situ (non-invasive) or atypical ductal hyperplasia with family history or The presence of lobular hyperplasia increases the risk 8-10 times (to a high degree).
  • Breast cancer history. Having cancer in one breast of a woman increases the risk of developing cancer in the other breast approximately twice.
  • Irradiation (radiotherapy). The incidence of breast cancer increases in those who have undergone breast irradiation due to other cancers (lymph cancer, etc.) in childhood.
  • Nutrition and environmental factors. A diet rich in fat and weight gain increase the risk of breast cancer, especially in menopausal women. While alcohol use (more than one glass a day) again increases the risk, the effect of smoking is still being debated. Regular exercise and physical activity are known to reduce the risk of breast cancer.
  • Genetic disorders. Hereditary breast cancer genes (BRCA1 and BRCA2) make up 5-10 percent of all breast cancers.

FALSE
If the person does not have a family history of breast cancer, there is no risk of cancer.

TRUE
75 percent of women with breast cancer have no family history of breast cancer. Being a 'woman' alone means carrying the risk of breast cancer.

Hereditary Breast Cancers

Hereditary (hereditary or familial) breast cancer syndromes are a condition seen in approximately 5-10 percent of breast cancer patients. There are two genes responsible for 80 percent of hereditary breast cancers: BRCA-1 and BRCA-2. Women with a defect (mutation) in the BRCA-1 gene have an 70 percent risk of developing breast cancer by the age of 85, and a 45 percent risk of ovarian cancer. 2.

How is the diagnosis made?

The diagnosis for BRCA-1 and BRCA-2 is made by genetic testing. People in this group are recommended breast examination from the age of 18, mammography at the age of 25-35, clinical breast examination every 25 months or annually from the age of 35-6, and annual breast MRI. In addition, these people should not disrupt the tests for ovarian cancer every 30 months from the age of 35-6.

What measures are taken?

Among the risk reduction methods that can be applied to these people; The use of estrogen-suppressing drugs such as tamoxifen or raloxifene, or preventive surgical interventions to reduce risk. These surgical procedures are listed as removal of bilateral ovaries and breasts (bilateral salpingo-oophorectomy and prophylactic bilateral mastectomy). The use of tamoxifen and raloxifene cuts the risk of breast cancer in half. Removal of the ovaries for protective purposes can reduce the risk of breast cancer by 50 percent in these patients, and prophylactic mastectomy can reduce the risk of breast cancer by 90 percent.

Who should get genetic counseling?

Especially, women who are Ashkenazi Jews of Eastern and Central European origin, where hereditary cancers are common, and women with first degree, one or more young relatives or bilateral breast cancer should definitely seek genetic counseling. Genetic counselors inform people with these risks about whether BRCA-1 and BRCA-2 gene mutation screening tests are necessary for them, the medical and psychosocial advantages and disadvantages of these tests.

Who are at risk?

The presence of breast cancer in one or more first or second degree relatives in the family suggests hereditary breast cancer. However, the fact that breast cancer is seen at a very young age, such as 20-30, especially with ovarian cancer, brings to mind hereditary breast cancer. The presence of breast cancer in the mother or sister is considered a serious risk factor.

Types of Breast Cancer

There are various types of breast cancer. However, it is basically divided into two main groups;

  1. noninvasive or in other words in situ (non-spreading)
  2. invasive (potentially spreading) group.
Types of Breast Cancer
Types of Breast Cancer

Noninvasive cancers

Cancers that do not spread (in situ) are also divided into two groups as 'ductal carcinoma in situ' and 'lobular carcinoma in situ'. Especially after the 1980s, with the prominence of screening mammographies, the incidence of non-spreading (in situ) cancers in all breast biopsies increased from 1.4 percent to 10 percent, and the rate in all breast cancers from 5 percent to 15 percent. draws attention.

Classical lobular carcinoma in situ

An important finding that increases the risk of breast cancer 8-10 times in both breasts. In addition to close monitoring, some protective drugs such as tamoxifen can be given to such patients or surgical interventions such as removing both breast tissues (simple mastectomy) can be performed for protective purposes. Cosmetic results can be obtained with the addition of breast prosthesis and similar surgical reconstructive procedures with plastic surgery.

In situ ductal cancers (PSDC, intraductal cancer)

Often it does not show itself during the examination. Symptom; Irregular small-sized calcification finding detected in mammography and / or (pleomorphic microcalcification) is in the form of a jet stream from a bloody / transparent single channel. ISDK is considered as the transition from normal cells to potentially invasive cancer cells. Since it does not create mass, it is removed by wire or labeling with radioactive materials. If the cancer is in a unifocal state, sufficient clean tissue is left around it.

When radiotherapy (RT) is applied to the remaining breast tissue, the disease has a good clinical prognosis. If it is commonly found in the breast, all breast tissue needs to be removed (simple mastectomy), with up to 100 percent complete recovery. In pure ICHD, involvement of the armpit lymph nodes is rarely encountered in 1-3 percent. For this reason, patients whose whole breast will be removed; In some types with worse features (high grade etc.), it may be necessary to remove the guard lymph nodes most likely to retain cancer cells in the armpit lymph nodes (sentinel lymph node biopsy).

Invasive cancers

Ductal carcinoma, which develops in the cells lining the breast ducts that carry milk out of the nipple, is the most common type of breast cancer. This is differentiated according to its spreading feature: It is known that ductal carcinoma is in in situ form if it has no spreading feature, and in invasive form if there is a potential to spread.

Cancer that develops from the milk-producing glands (lobule) is called lobular carcinoma. Lobular carcinoma is divided into two according to its spreading feature. If there is no spreading feature, it is in invasive form if there is a potential to spread in situ.

Inflammatory breast cancer

It is considered the worst and fastest-progressing type of breast cancer. It can be confused with inflammatory diseases of the breast that completely surrounds the breast. It progresses with widespread redness and hardness without any signs of mass. In inflammatory diseases of the breast that do not heal despite antibiotic treatment, breast cancer should be considered and biopsy should be taken.

What are the Symptoms of Breast Cancer

It takes a long time before a cancerous cell in the breast forms a tumor and is understood by a specialist during the examination or becomes apparent on radiological examination. Women are usually at least 1 cm. They can detect a mass that has reached its size, thanks to the manual control method. Today, most of the breast cancers are found by the person himself.

Cancerous masses are relatively hard, with irregular edges, the surface looks rough and cannot be moved comfortably within the breast tissue. If the cancer has metastasized (spread) to distant organs, these spreads rarely constitute the first finding of breast cancer. Areas where breast cancer spreads frequently are the hip and spine bones, and the lung and liver.

However, some patients do not have any of these symptoms, and breast cancer can only be detected by mammography. If at least one of the following symptoms is present, a specialist should be consulted immediately.

  • Palpable mass (firmness, swelling) in the breast or armpit
  • Discharge from the nipple (bloody or transparent color from a single channel)
  • Withdrawal, collapse or deformity of the nipple
  • Changes in the nipple skin (peeling, crusting)
  • Sores or redness on the skin of the breast
  • Edema, swelling and ingrown breast skin (orange peel appearance) (related article: What is edema?)
  • Growth, deformity or asymmetry or change in color (redness, etc.) of the breast
Breast Cancer Symptoms
Breast Cancer Symptoms

Deaths due to breast cancer rank second among deaths due to all types of cancer. Lung cancer is in the first place. According to the Turkish Statistical Institute (TUIK) 2007 data, in our country, which exceeds 70 million, 100 out of 22 thousand women develop breast cancer. The death rate from breast cancer is stated as approximately 100 people per 10 thousand women. (http://www.tuik.gov.tr)

FALSE -Breast cancer does not occur in young women

RIGHT -Breast cancer is more common in women over the age of 50, but can occur in women of all ages.

Diagnosis and Stages of Breast Cancer

Diagnostic Methods of Breast Cancer

  • Mammography
  • Ultrasonography (breast USG)
  • MR
  • Breast Biopsy

Stages of Breast Cancer

In order to determine cancer treatment, the stage of the disease must be known. The stage of the disease is related to the size of the tumor and how far it has spread. In staging, x-rays and laboratory tests are used to find out whether the cancer has spread, and if so, to which parts of the body.

Breast cancer usually spreads first to the axillary lymph nodes. The extent of the cancer is often unknown until surgical removal of the breast tumor and underarm lymph nodes.

Patients diagnosed with breast cancer may ask their doctor to answer the following questions.

  • What kind of breast cancer is mine?
  • What did the hormone receptor test show? What other laboratory tests have been done on the tumor tissue and what appeared?
  • At what stage is the disease? Has the cancer spread?
  • How will this information guide my treatment?

How many stages does breast cancer consist of?

  • Stage 0: carcinoma in situ
  • Stage-1: Tumor size <2 cm
  • Stage-2: Tumor size 2 - 5 cm
  • Stage-3: Tumor size> 5 cm or tumor smaller than 5 cm.Lymphnode (LN) and / or local metastasis
  • Stage-4: breast cancer has spread to other organs (distal metastasis)

Carcinoma in situ to stage 0 It called. What are impacted teeth? When one or more teeth fails to grow in the correct position and is therefore held below the normal gum line, it is called an impaction. This can be complete, such as completely unerrupted (buried) third molars (wisdom teeth) or partial when just part of the tooth is visible in the mouth. Why are impactions important? For best function and appearance the teeth should grow in a healthy alignment. When one or more teeth is impacted, this can affect the function of that tooth but also the function and appearance of other teeth. Whether all impactions should be treated is still controversial and your dentist and oral and maxillofacial team can explain the advantages and disadvantages or treatment for you, which is usually surgical.

Lobular carcinoma in situ (LCIS) refers to abnormal cells in the lobule. (You can see the picture of the lobule in the background section.) These abnormal cells are indicative of high risk. and means that a patient with LCIS has a higher risk of developing cancer that can spread to both breasts in the future (both breasts are at risk).
Ductal carcinoma in situ (DCIS) is a pre-cancerous condition in the canal. DCIS is also called intraductal carcinoma. The abnormal cells did not go out of the duct and spread to the surrounding breast tissue. But sometimes, if DCIS is left untreated, cancer that can spread can occur. This picture shows early breast cancer ductal carcinoma in situ.

breast cancer stages
breast cancer stages

Stage Iis the initial stage of spreading breast cancer. At this stage, the tumor size is 2 cm. and cancer cells have not spread beyond the breast (lymph nodes).

This picture shows that the cancer has spread out of the canal and spread to nearby breast tissue.

Each of the following situations Stage II is the phase.

- The diameter of the tumor in the breast is 2 cm. but the cancer has spread to the lymph nodes under the armpit.
- The diameter of the tumor is 2 to 5 cm. between and the cancer spread to the armpit. or not.
- The tumor is larger than 5 cm but has not spread to the lymph nodes in the armpit.

Stage III is divided into A and B:

Stage III A, The diameter of the cancer in the breast is less than 5 cm and it adheres to the lymph nodes in the armpit and the surrounding tissue, or the tumor diameter is 5 cm. It is a condition in which more than one and spread to the lymph nodes in the armpit.
III B phaseis a condition where the tumor has grown into the chest wall or breast skin or has spread to the lymph nodes under the breastbone (sternum).

Inflammatory breast cancer is a type of stage III B breast cancer. It is very rare. The breast skin becomes red and swollen because cancer cells have blocked the lymph ducts of the breast skin.

- Stage III C: It is the condition in which cancer has spread to the lymph nodes under the breastbone and armpit, or to the lymph nodes below or above the collarbone. At this stage, the diameter of the first breast tumor is not important.

Stage IV: It is distant metastatic cancer. The cancer has spread to other parts of the body.

Cancer that recurs is cancer that recurs after treatment. Cancer may recur locally (in the breast or chest wall) or in any part of the body (such as bone, liver, lung).

Treatment success rate according to the stages

Ratio according to stages
Stage 0%100
Stage I%98
Stage II%88
Stage III A%56
Stage III B%49
Stage III C%16


Tests Used in Breast Screening

Breast screening is the most important tool for early diagnosis of breast cancer. Breast cancer is the most common cancer in women and is increasing with sedentary living conditions. One in 8 women can develop breast cancer at some point in their life. Geographical variations in cancer frequency can be seen.

In 1970, the topic of Breast Screening came to the fore in order to diagnose breast cancer earlier and to administer the necessary treatment to patients. By the year 1980, breast cancer screening tests were started to be used in many countries.

As a result of these studies, it has been determined that early diagnosis of cancer with breast screening tests is effective in reducing the risk of death due to breast cancer. In some new clinical trials, death risk By 35% It has been observed that a reduction is possible.

Although scientific discussions on the subject continue today, in many countries around the world Between the ages of 40-50-69 breast cancer screening is applied.

Main methods used in breast cancer screening:

  1. breast self-examination (patient)
  2. clinical breast examination (physician)
  3. imaging methods (lab.)

here are the SCAN METHODS

Breast Self Examination (Patient Examination)

With this method, the patient performs his own complaints and a manual breast examination. Information and training should be provided by the physician about the complaints and findings that will occur in breast cancer.

Check with your own hands periodically how your breasts are feeling normally so it's easy to notice when something changes.

5th day of the menstrual period every month It is appropriate to do it because there is less swelling and tenderness in the breast tissue. It is suitable for women entering menopause on the same days every month.

Daily or weekly breast examination and control NOT RECOMMENDED.

that the reason is A slow-growing audience is more likely to be overlooked and not noticed. We can compare this situation to this. If you look at a elephant every day, you may not realize it is growing, what if you look at it once a month !?

For example, uneven breast size, dimpling or prominence of the nipple, breast skin the formation of an orange peel image, discharge from the nipple, pain, swelling or stiffness in the armpits, palpable mass in the breast tissue, stiffness, etc. Especially not painful breast stiffness (painless mass) should be paid attention. Examination should be done standing, upper body naked and in front of a mirror.

Peau dorange orange peel image - Breast Cancer
orange peel appearance on meme skin

Outpatient breast examination

When the upper part is naked, you are faced with the mirror. The arms are released. The size and shape of both breasts are examined (usually breasts are not the same size, this is normal). In addition, skin discoloration, pitting, burial in the nipple, etc. are examined.

Breast examination in front of the mirror
Breast examination in front of the mirror

Then the hands are placed on the hips and pressed firmly. Turning sideways, the outer parts of the breasts are examined. Then lean forward and examine the contours of the breast. Finally, the hands are brought together at the neck and grasped tightly and the breasts are examined by turning to the sides. With the index and thumb, the nipple is gently squeezed and checked for discharge.

standing_examination

Inpatient breast examination

Sleep with a pillow under the right shoulder. The right hand is placed behind the head. For the examination, the inner part of the 2nd, 3rd and 4th fingers of the opposite hand should be used and the whole breast should be evaluated with circular movements, starting from top to bottom or from the outside and towards the nipple. In the meantime, cream or lotion can be used to feel the breast tissue better.

The most important point in this matter is that the breast examination is performed only once a month, because it is more difficult to notice the formation that grows slowly and insidiously in the examinations performed in a shorter time. Therefore, the shorter this period, the more difficult it may be to capture the findings.

It should also be emphasized that this method cannot replace other screening and diagnostic methods! So the patient "I looked at it myself, nothing is visible. No need to go to the hospital.”And should go to the physician control at regular intervals.

Sensitivity of breast self-examination is 60%, specificity is 70%. These rates may vary depending on the age and socioeconomic status of the patient. There can be serious differences between a rural aunt and a university teenager living in the city!

Clinical Breast Examination (Doctor Examination)

This method has a very important and important role in the early breast cancer diagnosis and treatment process. The examination should be done by a specialist physician, otherwise there may be unnecessary delays in the wrong treatment and diagnosis process. The number of patients who are followed up for early breast cancer with boils or cysts is not small! The sensitivity of clinical breast examination is 50% and specificity is 95% (it should be!).

Clinical breast examination, American Cancer Society By (ACS) 20 age every 3 years for the next women, From the age of 40 it is recommended to subsequent women once a year.

Clinical breast examination, screening, diagnosis and treatment of breast diseases; It is an important evaluation method that combines the risk factors and examination findings for breast cancer and requires serious clinical experience.

It can detect 15% of breast cancers that cannot be detected by mammography or are not included in the breast screening area of ​​mammography. Clinical breast examination is an inexpensive method that does not require special equipment. Therefore, its applications, especially in developing countries, are important.

Display Methods

Mammography

Screening mammography is a method applied to asymptomatic women in terms of breast diseases to provide early diagnosis of breast cancer. A good mammography film should allow the entire breast to be viewed. Films are taken while the patient is standing. The X-ray tube and cassette holder are placed at both ends of a C-arm device that can rotate 180 degrees. In screening mammography, two films are taken in craniocaudal and medial-oblique directions.

By changing the angles, it can be easier to define fluid levels in cysts containing milk calcium, to distinguish true breast masses with superposed shadows, and to locate lesions. The radiation dose of a standard bidirectional mammogram is 0.25 rad. With digital mammography, it is aimed to remove the image defects that may be in film scanning mammography and to increase the imaging quality.

The sensitivity of screening with mammography is 55% and the specificity is 95%. Mammography sensitivity increases with age. Sensitivity was determined as 40% for 49-66.9 years old, 50% for 59-72.2 years old, 60% for 69-75.9 years old and 70% for 84-82.7 years old.

When the long-term results of the studies were explained and meta-analyzes were created, it was concluded that the efficiency of mammography screening in reducing breast cancer-related mortality was 15%.

Other Viewing Methods

Although ultrasonography is a method that can be used in the diagnosis of breast diseases; Because it is user dependent and the implementation time can take a long time, its use for scanning purposes is generally not recommended.31

Magnetic resonance imaging (MRI) is increasingly used in the diagnosis of breast cancer. Sensitivity of magnetic resonance imaging is 88-100%; Its specificity has been reported to be 37-70%. Therefore, while its power in defining malignant breast diseases is high; It can define benign breast diseases as malignant.

Excess Sugar and Breast Cancer

With the increase in the amount of sugar consumed daily, it turned out that not only was excessive weight in question, but it increased the risk and spread rate of breast cancer in women.

Assoc.Prof. Dr. Peiying Yang
Associate Professor Peiying Yang - University of Texas MD Anderson Cancer Center

This work Assoc. Dr. Peiying yangWas held by PhD et al at the University of Texas MD Anderson Cancer Center and published last week in Cancer Research.

According to the team's study, a relationship was found between the amount of daily sugar intake and breast cancer, and it was thought to be due to a high rate of inflammation. The study was carried out experimentally on mice, and 3 groups of animal models were applied in the study:

Rich sucrose diet group, rich fructose diet group and starch control diet group. Highly refined sugars, saturated fat and red meat, and a low percentage of fresh fruits and vegetables and whole grains, which are especially present in the daily western diet, were applied in the study.

Breast Cancer Risk with Excess Sugar

Breast cancer developed in 50-58% of mice fed a diet rich in sucrose

Sugar and Breast Cancer
Sugar and Breast Cancer

The likelihood of breast cancer was significantly higher in mice fed a rich sucrose and rich fructose diet (30-50%) compared to the starch control group (58%). In addition, cancer cells detected in the lungs of mice in the last two groups were thought to be related to the increase in the spread rate of breast cancer.

According to this study, fructose and sucrose (combination of glucose and fructose) increased the 12-lipoxygenase (12-LOX) signaling and thus 12-hydroxy-5Z, 8Z, 10E, 14z-eicosatetraenoic acid (12-HETE) levels to increase breast cancer risk and increases the rate of metastasis.

glucose + fructose → 12-LOX ↑ → 12-HETE ↑ → breast cancer ↑

Working in MD Anderson cancer center and participating in this study, especially high daily table sugar and high fructose corn syrup consumption led to an increase in 12-HETE. It caught the attention of Lorenzo Cohen. However, the mechanism as to how the high glucose and fructose ratio increases the 12-LOX level is not yet clear.

This study is particularly important as it is associated with rising sugar consumption in the US (sugar consumption per capita> 100kg / year).

Does breast prosthesis cause cancer?

Breast prosthesis was banned in France because it causes a rare type of cancer. France is the first country to ban breast prostheses.

According to the information provided by the French National Pharmaceuticals and Health Products Agency (ANSM: Agence nationale de sécurité du médicament et des produits de santé), it was stated that breast prostheses are prohibited as a precaution because they may cause a cancer type that poses a serious risk, although it is rare. According to the news of the BBC channel, the ban, produced by six companies Prostheses with a rough surface stressed that it applies to.

59 breast cancer status detected, 3 patients died

59 cancer patients associated with breast prosthesis were detected in France, and it was informed that three of these patients died.

breast prosthesis and cancer risk

Why does breast prosthesis cause cancer?

As the roughness on the outer surface of breast implants increases, anaplastic It was stated that the risk of large cell lymphoma increased.

The ANSM agency also pointed out that the number of cases of anaplastic large cell lymphoma associated with uneven surface breast implants has increased markedly since 2011.

CANADA is next

With this decision, France became the first country to ban breast prostheses with uneven surfaces. But MSNAdid not comment on the women undergoing an operation to remove these prostheses. ANSM cited 'the rare risk' as its justification.

Canada has announced that it aims to stop the use of the same prostheses. Canada announced that it detected 28 cases on this issue.

Source: Medical News Today   Translation: Dr. Ertan BEYATLI

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