Breast cancer centers in Turkiye shifted toward biopsy-led diagnosis and less invasive surgery over 10 years
A decade-long comparison of tertiary breast centers in Turkiye shows a care network in transition: more patients, more specialized surgeons, broader imaging access, and a diagnostic pathway that moved decisively away from excisional and incisional sampling. The multicenter survey compared aggregated center-level data from 2009 and 2019, capturing structural and procedural change across tertiary institutions rather than individual patient trajectories. In 2009, 38 centers contributed data; by 2019, that number had risen to 44. Confirmed breast cancer cases increased from 4,808 to 6,550, a rise that likely reflects both greater service capacity and a heavier clinical burden on referral centers.
The shift in diagnostic practice was especially clear. Core needle biopsy largely replaced excisional and incisional procedures, a move that aligns with modern breast oncology practice because tissue diagnosis can now be secured with less morbidity, faster turnaround, and better preoperative planning. In practical terms, that change matters at the bedside: once the lesion is sampled percutaneously, teams can stage, subtype, and plan therapy before the first operation rather than using surgery as the diagnostic test. For breast cancer, that is more than a procedural preference; it changes the order of treatment decisions and can reduce avoidable operations.
More neoadjuvant therapy and more breast-conserving surgery signal a different treatment sequence
The treatment pathway changed in parallel with diagnosis. Use of neoadjuvant therapy increased between the two time points, suggesting that more patients were being treated before definitive surgery, likely to improve operability, downstage the tumor, or expand the option of breast preservation. Surgical management also shifted toward breast-conserving surgery, which fits a broader oncologic movement toward anatomically sparing procedures when tumor biology and response permit it.
A single sentence captures the magnitude of the change: the surgical default no longer centered on maximal tissue removal. In modern breast care, that transition depends on earlier diagnosis, better imaging, multidisciplinary review, and the ability to sequence systemic therapy ahead of the operating room. Those elements were all more visible in the 2019 dataset than they had been in 2009.
Specialized staffing changed as well. The number of specialized breast surgeons increased across participating centers, a structural gain that matters because breast cancer care depends heavily on procedural volume, coordinated decision-making, and familiarity with evolving axillary and breast-preserving techniques. More specialists in the system generally means fewer fragmented pathways and more consistent application of evidence-based surgery, imaging, and systemic treatment.
Axillary staging improved, but the data stop short of proving appropriateness
The reported proportion of sentinel lymph node biopsy increased from about 48% to 55%. At first glance, that suggests a move toward less morbid axillary staging, which is consistent with the broader effort to avoid routine full axillary dissection when sentinel mapping is appropriate. Yet the dataset did not include clinical nodal status or patient-level indications for sentinel lymph node biopsy, so the proportion alone cannot tell whether the procedure was used in the right patients, the wrong patients, or simply more often.
That limitation is substantial because axillary surgery has direct consequences for lymphedema, shoulder function, and long-term quality of life. Without nodal status, tumor stage detail, or individual treatment rationale, the data cannot distinguish a clean adoption of modern staging from a simple rise in procedure frequency. The same caution applies to the rise in breast-conserving surgery: more conservative treatment is encouraging, but the available data do not allow assessment of margins, recurrence risk, or oncologic equivalence at the patient level.
Imaging and supportive services expanded unevenly across centers
The infrastructure side of the survey tells its own story. Availability of diagnostic imaging improved, as did access to medical oncology and chemotherapy units and lymphedema services. These additions matter because breast cancer care does not begin and end in the operating room. Imaging drives detection and staging, systemic therapy depends on oncologic infrastructure, and lymphedema management directly affects survivorship after axillary intervention.
Even with those gains, progress was uneven across multidisciplinary and supportive-care domains. Some centers advanced faster than others, leaving a heterogeneous national picture rather than a uniformly upgraded system. In breast oncology, uneven infrastructure can translate into unequal timing of diagnosis, variable access to neoadjuvant treatment, and inconsistent rehabilitation after surgery. A center with imaging, oncology, and lymphedema support can assemble a much more complete care pathway than one that still relies on limited referral networks.
What the survey can prove, and what it cannot
The largest strength of the study is its multicenter scope across a 10-year interval. It documents a real-world shift in how tertiary breast centers in Turkiye diagnose and manage breast cancer, and the direction of change matches contemporary oncology practice. Core needle biopsy replaced more invasive diagnostic operations, neoadjuvant therapy became more common, breast conservation increased, and sentinel node staging rose modestly.
What the study cannot do is just as important. Individual recurrence and survival outcomes were unavailable, so there is no way to determine whether these structural changes improved disease-free survival or overall survival. Patient-level indications were also missing, which means the appropriateness of axillary procedures cannot be judged. The survey therefore describes system evolution rather than oncologic efficacy.
Even so, the data point toward a breast cancer network that has become more specialized, less invasive, and more multidisciplinary over time. The remaining question is not whether the center-level system changed; it clearly did. The unresolved issue is how evenly those changes were implemented across institutions and whether that procedural progress translated into measurable gains for patients with breast cancer over the same decade.