Breast Health & Breast Cancer Center
Most people arrive having already decided which operation they want. The operation is rarely the first decision and never the one that decides most.
About This Center
Most people arrive having already decided which operation they want.
That is understandable. The operation is the part you can picture, the part with a date attached and the part every website leads with. It is also rarely the first decision, and it is not the decision carrying the most weight. What sets the treatment is a single page of the pathology report, written in a laboratory before any surgeon touches anything, and what carries a great deal of the long-term benefit is a tablet swallowed every morning for the next five to ten years by somebody who feels perfectly well and would rather stop.
Get the order right and the operation becomes a detail. Get it wrong and the operation turns out to have been the easy part of a plan that nobody ever finished assembling, which is a discovery people usually make months later and at home.
Free consultation
Send the biopsy report with the receptor results on it
If a biopsy has been done, send the full pathology report and not the summary letter, because the oestrogen receptor, progesterone receptor, HER2 and proliferation results sit on a page most people never forward and they decide more than anything else you could send us. Add the mammogram, ultrasound and any MRI as images on a disc, since reports cannot be re-read. Tell us the size of the lump if it can be felt, how long it has been there, and whether anything has changed in the skin or the nipple. List relatives with breast, ovarian, pancreatic or prostate cancer with their ages at diagnosis, on both sides of the family. Say whether you are still having periods, what medications you take, and whether you hope to have children, because all three change what is offered.
The order of the decisions
Breast cancer is not one disease. It is at least four. They are distinguished by biology and not by size, and the four behave so differently that two women with identical lumps can need entirely different treatment in a different sequence.
A hormone-driven cancer grows slowly, responds to tablets that switch oestrogen off, and frequently needs no chemotherapy at all, while a HER2-driven cancer was once among the most dangerous kinds and is now among the most treatable, because targeted antibodies changed it, and those drugs usually come before surgery instead of after it. A triple negative cancer responds to nothing hormonal, is treated with chemotherapy and immunotherapy, and is generally given those before the operation so that the response can be watched. And ductal carcinoma in situ has not yet invaded anything at all, which changes the conversation completely, since a disease that cannot spread through the body is being treated for entirely different reasons.
Which of those four you have is settled by the biopsy. Not by the surgeon.
The practical consequence for anybody planning to travel is uncomfortable and worth saying early. Booking an operation before the receptor results are known means booking a step whose timing has not yet been decided, and in a meaningful proportion of cases the correct first move turns out to be drugs rather than a theatre list, which leaves a patient having travelled for the wrong thing at the wrong point in her own treatment. Any service willing to give you a surgical date before it has read your pathology is selling a slot and not a plan.
So this page runs in the order the decisions actually arrive, which is almost exactly the reverse of the order in which most people research them, and that reversal is the single most useful thing on it.
Finding a lump, and the day after
Speed is the most valuable thing a breast unit can offer. It has nothing to do with machines. It is an answer in one visit instead of three appointments spread over a month.
The approach has a name. Triple assessment. It means examination, imaging and a tissue sample done on the same day by people standing in the same corridor. The imaging is chosen by age, so ultrasound leads in younger women whose tissue is dense and mammography joins it above forty, and where anything needs sampling a needle takes it there and then, in the same room, on the same morning. The point of compressing all of it into a single visit is not convenience. It is that the fortnight of waiting between steps is the part patients describe afterwards as the worst of the entire illness, and much of it is avoidable.
How accurate a same-day answer actually is
A French cancer centre reported its first three years of running a one-stop breast clinic in which a pathologist sat in the clinic and read the needle sample immediately, instead of sending it away. The series covered 1,820 breast masses in 1,740 women, two thirds of them already classified as suspicious or highly suspicious on imaging, with cancer eventually confirmed in 62 percent. Every case was checked either against the final surgical pathology or against eighteen months of ultrasound follow-up. Sensitivity was 97.4 percent and specificity 95.0 percent. The sample was inadequate to read in 3.1 percent, false negatives ran at 1.5 percent, and across the whole series there was exactly one false positive, which is 0.06 percent. Overall accuracy was 96.5 percent. The authors concluded that this approach reliably identifies who needs a larger core biopsy and who does not, while cutting both the inadequate sample rate and the waiting time.
Two things in that paragraph deserve holding onto. A same-day assessment is not a lesser version of a proper work-up, provided the right people are in the building. And 1.5 percent false negatives is not zero, which is why a lump that still worries you after a reassuring result is re-examined and never dismissed, and why anything clinically suspicious goes to core biopsy regardless of what the first sample showed.
One word about how results are given, because it matters more than the logistics. Bad news is delivered in a room with a door and a chair, by the person who will be responsible for what happens next, with whoever you brought present if you want them there and absent if you do not. Never by telephone while you are at work, and never as a document you open alone.
Most of what a breast clinic sees
Is not cancer. Most of it is not even close. A unit that treats every referral as an oncology case does its patients a disservice in both directions.
This table scrolls sideways on a narrow screen. Swipe or drag to see every column.
| What it is | What happens about it |
|---|---|
| Fibroadenoma | A smooth mobile lump, commonest in women under thirty-five, harmless and often left alone once confirmed. Removal is offered where it is large, growing, or where living with it is worse than the small scar. It does not become cancer. |
| Cysts | Fluid-filled and extremely common in the years around menopause. A simple cyst on ultrasound needs nothing. A painful one is drained with a fine needle in clinic and the relief is immediate. Only complex ones on imaging need sampling. |
| Breast pain | The commonest reason women come, and on its own an unreliable sign of anything sinister. Pain alone with normal examination and imaging is treated as pain, with attention to bra fit, cycle pattern and simple measures, and not investigated indefinitely. |
| Nipple discharge | Milky discharge from both sides is usually hormonal and prompts a blood test and not a scan. Discharge from a single duct on one side, particularly if bloodstained, is taken seriously and imaged properly. |
| Infection and abscess | Treated with antibiotics and, where pus has collected, drained with a needle under ultrasound instead of cut open, which heals faster and leaves less behind. Redness that fails to settle on antibiotics is biopsied, because one rare cancer imitates infection exactly. |
| Gynaecomastia in men | Breast tissue enlargement in men, usually hormonal or caused by a medication, and usually not cancer. The work-up looks for the cause first, since stopping the responsible drug fixes a good number of cases without an operation. |
Discharging people properly is the skill in this half of the clinic. A woman told her lump is a fibroadenoma and sent away with nothing written down will worry about it for a decade, and will check it every few weeks for most of that time. The same woman given the diagnosis in writing, told plainly that it will not turn into cancer, and shown what change would warrant coming back, generally stops thinking about it within a week.
The page that sets the treatment
If you read only one document about your own illness, read this one. It is usually a single page. It is written in abbreviations, and almost every decision that follows is contained somewhere in it.
This table scrolls sideways on a narrow screen. Swipe or drag to see every column.
| The line | What it means | What it changes |
|---|---|---|
| Invasive or in situ | Whether the cells have broken out of the duct they started in. | In situ disease cannot spread to the body, so the armpit is usually left alone and the conversation is about local control rather than survival. |
| Ductal or lobular | Which structure the cancer arose from and how it grows. | Lobular cancer spreads in single files instead of as a lump, so it is harder to see on mammography and more often needs MRI before any operation is planned. |
| Grade one to three | How disordered the cells look, which reflects how fast they divide. | Feeds into whether chemotherapy is considered and into the genomic test result itself. Grade is not stage. The two are confused constantly, including by clinicians. |
| ER and PR | Whether the cancer is fuelled by oestrogen and progesterone. | A positive result opens the whole hormonal treatment route, which is the single most effective long-term intervention in this disease and the reason the years of tablets exist. |
| HER2 | Whether the cells carry too much of a particular growth receptor. | Positive means targeted antibody treatment, which transformed the outlook for this group, and it usually means drugs before surgery rather than after. |
| Ki-67 | The proportion of cells actively dividing at the moment the sample was taken. | Helps separate the slow hormone-driven cancers from the fast ones, which is the distinction the rest of the plan turns on. Measurement varies between laboratories, so it informs the decision without making it. |
| Size and nodes | The anatomy, meaning how big it is and whether lymph nodes are involved. | Still matters, and matters less than it used to now that biology can be measured directly. The next section is about exactly that shift. |
Ask for that page. Keep it. Any oncologist anywhere in the world will want those seven lines before anything else you can tell them, and a patient who arrives holding them has saved herself weeks of repeated tests and repeated waiting.
Who can safely avoid chemotherapy
For decades the decision about chemotherapy was made on anatomy. Big tumour, involved nodes, therefore chemotherapy. A great many women were given it who would have done exactly as well without.
Then the biology became measurable directly. Running a panel of genes across the tumour itself produces a score estimating both the risk of recurrence and the likely benefit from chemotherapy, which are two different questions that had previously been answered with one guess. For hormone receptor positive, HER2 negative disease, which is the largest group of all, that score can now spare chemotherapy in a substantial share of women. A 2025 analysis shows how completely the ground has shifted.
Biology against anatomy, in 71,235 women
Researchers queried a national cancer database for women with non-metastatic hormone receptor positive, HER2 negative breast cancer who had a genomic recurrence score available and were treated with surgery first between 2018 and 2019. The question was blunt. Which predicts survival better, the score or the number of positive lymph nodes. Both did predict it, and both mattered. But a score above 25 was a stronger predictor of death than the number of involved nodes, and within almost every node category, women with a high score did worse than women with a low score carrying the same nodal burden. The paper is titled Biology is Queen. Its authors are careful to add that the model combining both was stronger than either alone, and that this does not yet remove the need for surgical assessment of the armpit, so the finding is a shift in emphasis rather than a demolition.
An honest counterweight belongs immediately alongside it, because a page that only publishes the reassuring half is doing the same thing in the opposite direction.
A separate 2025 study looked specifically at women with four to nine involved nodes, a group where the genomic score is much less established. Among 1,658 such patients, two thirds received chemotherapy and a third did not. Chemotherapy was associated with better five-year survival in every score category, including the low-risk one, where survival was 95.5 percent with chemotherapy against 87.4 percent without, and the gap widened dramatically in the high-risk group. The authors concluded that the standard of offering chemotherapy holds for this population, with the qualification that women over seventy appeared to benefit comparatively less. So the rule is not that genomic testing lets people skip chemotherapy. The rule is that it answers the question properly in the group it was validated in, and that outside that group the old evidence still governs. Knowing which group you are in is the entire point of the meeting where this gets decided.
The tablet, and the years
Here is the part nobody photographs. It carries an enormous share of the benefit.
For hormone-driven disease, which is most of it, treatment continues for five to ten years after everything visible has been dealt with, in the form of a daily tablet that removes oestrogen or blocks it. Hot flushes, joint stiffness, sleep disturbance, low mood and effects on sexual function are all common, and the woman taking it feels entirely well otherwise, which is precisely the problem, because nothing about her day tells her the tablet is doing anything at all. Stopping early is understandable. It is also the commonest way a treated cancer comes back. Managing those side effects seriously, instead of telling somebody to persevere, is the difference between a plan that exists on paper and a plan that actually happens in a kitchen every morning for a decade.
In higher-risk hormone-driven disease a second tablet is now added, and the numbers around it show the whole problem in miniature.
A real benefit, and the reason people stop taking it
In the trial that established it, adding a targeted tablet to standard hormonal treatment for node-positive high-risk early breast cancer improved survival free of invasive disease by 3.5 percentage points at two years, 6.4 at four years and 7.6 at five years. Those are real gains. In the same trial, 16.6 percent of women stopped the drug because of side effects. Interruptions were needed by 56.9 percent and reductions by 41.2 percent, with diarrhoea the leading cause of both. A 2026 real-world study of 164 women then tested a different way of starting it, beginning at a low dose and titrating upwards instead of starting at full dose. Dose interruptions fell from 65 percent to 25 percent and dose reductions from 43 percent to 14 percent, both significant, while discontinuation was numerically lower at 18 against 27 percent. Diarrhoea prompting a dose change fell from 38 percent to 9 percent. Four women who had already abandoned the drug on the standard approach successfully restarted it this way.
Read that twice. How the drug is started decides whether she is still taking it in a year, and therefore whether she gets any of the benefit the trial measured at all. A small qualitative study published in 2026 following five women through their first eight weeks found diarrhoea reported by four of them and described as the most bothersome symptom by three, with one stopping treatment entirely because of its effect on ordinary life. All of them said the belief that the drug lowered their risk helped them tolerate it, alongside support from their clinical team.
Which is the argument for staying in contact after you fly home.
Men have breast tissue too
Roughly one breast cancer in a hundred occurs in a man. Almost everything about how that is handled is worse than it should be.
A 2026 review sets out why. The belief that breast cancer is exclusively a female disease is held by the public and by clinicians alike. It produces delayed presentation, diagnosis at a later stage and poorer outcomes. There is no screening programme and there are no male-specific protocols, so nothing catches these cancers early. Clinical management is extrapolated from trials conducted in women, despite biological and hormonal differences that plausibly affect both response and side effects. Men also carry a real psychosocial burden, including stigma, isolation and a threat to identity, with almost no support services designed for them. And inherited gene faults including BRCA1, BRCA2, CHEK2 and PALB2 are relatively common among affected men, yet genetic counselling and testing of their relatives remain underused, which means an opportunity to protect the rest of the family is being missed repeatedly.
What follows from that is short. A firm lump behind the nipple in a man, particularly if it is on one side only, hard, fixed or associated with any change in the skin or nipple, is assessed the same day and by the same pathway as it would be in a woman. Delay in this group is social rather than clinical. Pretending otherwise helps nobody.
What we do not offer
Breast disease attracts more alternative treatment and more supplement marketing than almost any other diagnosis, and it does so to people making decisions under considerable fear.
Proven treatment is not postponed here while somebody tries an unproven one. Anybody is entitled to decline treatment, and that decision is respected and documented without argument, but a plan that involves postponing surgery or chemotherapy for a course of intravenous vitamins, ozone, mistletoe, thermography or a metabolic diet is one where the delay is the treatment being given. We will say that plainly and we will still see you afterwards.
Nor do we perform surgery before the receptor results are known, except in the small number of situations where clinical urgency genuinely demands it. Operating first and finding out afterwards that the correct sequence was drugs first is a mistake that cannot be undone, and it is the single most avoidable error in breast cancer care delivered to travelling patients.
We do not use thermography or any imaging device sold as a radiation-free alternative to mammography for detecting cancer. And we do not offer prophylactic removal of a healthy breast on request alone, since that decision belongs with a genetic assessment and a proper conversation about what it does and does not change, and never with a booking form.
One boundary is worth naming for completeness. The operations themselves, meaning breast conserving surgery, mastectomy, the handling of the armpit and reconstruction in all its forms, are covered in detail on their own pages and not here, and hereditary testing sits with the genetics service. This page exists to get you to those pages in the right order and with the right information in your hand.
What a first appointment involves
Everything in one day, wherever that is possible.
History and examination, both breasts and both armpits
How long the change has been there, whether it varies with the cycle, what has altered in the skin or nipple, and the family history taken properly on both sides with ages. A chaperone is present, and anybody who wants a female clinician is given one.
Imaging chosen by age and by tissue
Ultrasound first in younger women and alongside mammography in older ones, with the armpit examined at the same sitting because nodal status changes the plan. MRI is added where lobular cancer is suspected or where the extent on standard imaging does not fit the examination.
A needle, on the same day
Under local anaesthetic and guided by ultrasound, with a marker clip left behind so the site can be found again if drugs shrink the tumour before surgery. A suspicious node is sampled at the same time, since that single result changes the sequence of everything that follows.
The wait, kept as short as the laboratory allows
Receptor and HER2 testing takes days and not hours, and no honest service promises a full answer the same afternoon. You are told exactly when the result will exist, and who will give it to you. That is the part that makes the wait survivable.
A meeting, then a plan you can read
Surgeon, medical oncologist, radiation oncologist, radiologist and pathologist review the case together and agree the sequence. You receive that recommendation in writing, with the reasoning, in a form your own doctor can act on, and with the alternatives named rather than implied.
Coming to Istanbul
The length of the stay depends entirely on which decision you are travelling for, and that is a very different answer depending on where you are in the sequence.
For a second opinion on a diagnosis you already have, no travel is needed. Send the pathology slides or blocks and the imaging, and the material is re-read here, which changes something in a meaningful minority of cases and is worth doing before consenting to anything irreversible. For assessment of a new lump, two to three days covers examination, imaging, a needle and a results appointment in person. For surgery, five to seven nights in Istanbul is typical, though the surgery pages set that out properly. And where the plan begins with drugs rather than an operation, treatment is usually delivered at home under a protocol written here, with the operation timed for a later trip. Most nationalities enter Turkey visa-free, or on an electronic visa completed online in minutes. A letter of invitation is issued where an application needs support. Interpreters cover Turkish, English, Arabic, Russian and German as standard with other languages arranged in advance, and a female interpreter is offered by default. Airport transfer and a hotel near the hospital are arranged alongside appointments, so the assessment falls inside one working week. A companion is welcome throughout, including into the results conversation, which is when most people stop hearing anything.
One honest limitation belongs here. Radiotherapy after breast conserving surgery runs daily over weeks, and travelling for it makes little sense when it is available where you live. We write the prescription, specify the technique and the dose, and correspond with the department that will deliver it, which is a better use of a hospital in another country than asking somebody to live in a hotel for a month.
What moves the cost
Quotations describe an operation, which is the smallest component of a treatment that runs for years.
Diagnosis comes first. The variables there are whether existing slides can be re-read or whether the biopsy must be repeated, whether MRI is needed on top of mammography and ultrasound, and whether a genomic recurrence test is ordered, which is a laboratory sent abroad and priced accordingly. The operation itself then varies by what is done, and the three surgery pages set out those drivers in detail. Beyond theatre, the components that move a figure most are the systemic treatment, meaning how many cycles of chemotherapy and whether targeted antibody treatment is part of it, since that runs for a year. Radiotherapy where it is given here. And the years of tablets afterwards, which most quotations exclude entirely and which you will be buying somewhere. Your own situation moves it as much as the menu. A small hormone-positive cancer with a low genomic score, treated with a wide local excision and tablets, is a modest piece of work. The same size lump that turns out to be HER2 positive with involved nodes involves a year of antibody treatment and a completely different figure, and neither of those facts is known on the day somebody asks for a price.
Four questions make a quotation comparable. Ask whether it covers diagnosis, surgery, systemic treatment and radiotherapy, or only one of the four. Ask what happens to the figure if the pathology comes back HER2 positive, since that adds a year of antibody treatment to everything else. Ask whether a genomic recurrence test is included where indicated, since it is a laboratory sent abroad. And ask what the follow-up covers, and for how long. Those four are answered in writing before anything is booked.
Follow-up once you are home
Almost all of this treatment happens after the wound has healed. That makes the handover more important here than in any other operation this hospital performs.
You leave with four documents. The pathology report in full, the multidisciplinary recommendation with its reasoning, the systemic treatment protocol written so that another oncologist can continue it without ever telephoning us, and the surveillance schedule with intervals and modality stated plainly. Video review runs at six weeks, then at three, six and twelve months, and more often during the first year of tablets because that is when people stop taking them.
Side effects from hormonal treatment are treated as a clinical problem rather than as something to endure. Hot flushes, joint pain, sleep and mood all have options, switching between drug classes is legitimate, and bone density is monitored because some of these tablets thin bone. If a drug is intolerable, the correct response is to change it and never to lose the patient from treatment altogether, and that conversation happens by video without anybody flying anywhere.
Surveillance itself is simpler than most people expect. Annual mammography of the remaining breast tissue. A clinical review, and investigation of any new symptom that persists. Routine whole-body scanning and repeated tumour marker blood tests form no part of follow-up for early breast cancer. They have never been shown to help, and they reliably generate a great deal of alarm about findings that turn out to be nothing at all.
Keep the pathology report somewhere permanent. In ten years, whoever is looking after you will want those seven lines. Reconstructing them from memory is not possible.
Frequently asked questions
Can I book the operation before I travel?
Do I definitely need chemotherapy?
How quickly can I get an answer about a lump?
Is breast pain a sign of cancer?
Why do I have to take a tablet for ten years?
I was offered an extra tablet but the side effects sound awful.
Can men get breast cancer?
Do I need regular scans after treatment?
Written by the Biruni Hospital medical editorial team.
Reviewed by Dr Yunus Emre Yavuz, Breast Surgery and Breast Oncology.
References
- Marin C, Strawderman M, Peterson D, et al. Biology is queen, the Oncotype DX 21-gene recurrence score has stronger prognostic ability than lymph node burden for patients with breast cancer. Annals of Surgical Oncology. 2025;32(13):9825-9835.
- Haque W, Verma V, Mangalampalli N, et al. Utilization and outcomes of the 21-gene recurrence score in pN2 breast cancer patients. Anticancer Research. 2025;45(3):1055-1061.
- Suciu V, El Chamieh C, Soufan R, et al. Real-world diagnostic accuracy of the on-site cytopathology advance report procedure performed in a multidisciplinary one-stop breast clinic. Cancers. 2023;15(20):4967.
- Lad N, Blocker S, Monson T, Grauer D, O'Dea A. Real-world outcomes of abemaciclib dose-escalation strategy in high-risk early breast cancer. Clinical Breast Cancer. 2026;26(5):57-62.
- Harder H, Jenkins V, Fallowfield L. Perceptions and lived experiences with abemaciclib and endocrine therapy for early breast cancer, a rapid communication. Future Oncology. 2026;22(13):1533-1539.
- Omari SK. Male breast cancer, bridging the gaps of neglect, a global call for equitable care and inclusion. Health Science Reports. 2026;9(7):e72687.
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