Breast cancer

Breast cancer is a malignant tumour of the breast and the most common cancer in women.

In men, however, breast cancer is rare. The average age for developing this disease for women is around 64 years and for men around 72 years.

Symptoms

Causes

Diagnosis

Treatments

Aftercare

FAQs

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Diagnosis of breast cancer

Breast cancer means that certain cells in the mammary gland undergo genetic mutation and subsequently multiply uncontrollably. They proliferate into the healthy tissue and destroy it. In addition, cancer cells can spread throughout the body via the blood and lymph pathways and form new tumours (known as metastases) elsewhere.

In the case of breast cancer, a distinction must be made between invasive (ductal) breast cancer without a specific type (the tumour originates from the milk ducts) and invasive lobular breast cancer (the tumour originates from the glandular lobules). There are also some rarer forms of breast cancer, such as inflammatory breast cancer, which is associated with an externally visible inflammatory reaction.

It is important to know that every breast cancer is fundamentally different, which is why only detailed tests can provide information about the respective breast cancer and its prescribed therapy.

Symptoms

There are certain signs that may indicate breast cancer, although not every change in the female breast should be a cause for concern. However, in order to ensure that the cancer is detected in good time if it does occur – and therefore early enough to be successfully treated – women should seek clarification from their gynaecologist for the following symptoms:

Lumps or hardening of the breast
Changes to the nipple
Watery or bloody secretion from the nipple
Changes in breast size and shape
Noticeable changes in the colour or sensitivity of the skin on the breast,areola or nipple
Redness or flaking of the skin on the breast
Swellings in the armpit
Differences in the movement of the two breasts when lifting the arms

Causes

Like many other types of cancer, the actual cause of breast cancer is unknown. What we know, however, is that numerous risk factors influence the development of breast cancer. These include:

Gender: 99% of all breast cancer patients are female
Age: the older a woman is, the higher her risk of developing breast cancer
Hormones: breast cancer usually increases depending on the female sex hormones (i.e. oestrogen and progestogen), which is why early first menstruation, late onset of menopause or even long-term intake of the contraceptive pill can lead to breast cancer.
Excess weight and lack of exercise
High-fat diets (oestrogen levels increase with increased consumption of animal fats)
Smoking and alcohol
Genetic predisposition
Dense breast tissue (the more mammary gland tissue there is, the more cells there are that can degenerate)

Diagnosis

Women who discover a lump in their breast or other symptoms that may indicate breast cancer should consult their gynaecologist immediately. There, a breast examination (palpation) and an ultrasound of the breast are carried out and, if a tumour or tumours are suspected, a mammogram is ordered.

As not every tissue change in the breast is malignant, a tissue sample (biopsy) is also taken. This determines whether the tissue change is actually breast cancer or not. The type and stage of breast cancer can then be determined during the examination of the biopsied tissue. For effective, successful therapy, it is important to know how much the cells have already changed and whether they require hormones to multiply.

Finally, under certain conditions, the treating doctor may perform magnetic resonance tomography (MRI) in order to be able to distinguish the changes in the tissue even better.

Once it has been established that the patient has breast cancer, further tests will be carried out to show whether – and if so, to what extent – the cancer has already spread in the body. These include, but are not limited to:

an X-ray examination of the chest to detect secondary tumours in the lungs (pulmonary metastases)
an ultrasound examination of the liver
a nuclear medicine imaging of the bones (bone scan or skeletal scintigraphy) to determine whether cancer cells have settled in the skeleton or computed tomography (CT) using contrast agents

Treatments

In the event of breast cancer, every woman receives a tailored therapy plan from her treating doctors, which is based on the type and stage of the breast cancer. The individual characteristics of the cancer cells, i.e. whether they have hormone receptors on their surface and/or growth factors, are also taken into account. Other factors which determine the therapy plan are the patient’s age, general state of health and hormone levels.

In principle, the following treatment options are available to doctors for breast cancer, whereby those treatment methods are usually combined in a way that offers the greatest possible chances of success in terms of a full recovery of the patient:

surgery
chemotherapy
radiation (radiotherapy)
radio-oncological procedures
(anti-) hormone therapy
targeted therapies such as antibody therapy
immuno-oncological therapies to activate the body’s own immune system to fight the cancer

Aftercare

After treatment is completed, i.e. after surgery, chemotherapy and/or radiotherapy, breast cancer patients will continue to receive medical care for several years as part of their follow-up care. The treating doctor carries out regular check-ups in order to be able to detect any relapses in good time and then treat them.

Another aspect of breast cancer follow-up care is to treat patients with anti-hormone therapy, which usually lasts for several years. Rehabilitation is also important in patients who have overcome breast cancer. This is intended to make it easier for patients to return to everyday life.

In addition, as part of the follow-up care, any side effects of breast cancer therapy should be identified and treated and the patient should also be supported from a mental health perspective.

FAQs

Can a woman detect breast cancer herself?

Doctors recommend that a woman carefully examine her own breast at least once a month in order to detect any changes early on. If one of these changes is actually caused by breast cancer, early detection and timely treatment of the tumour can significantly improve the chances of recovery.

Is breast cancer painful?

Pain is a significant alarm signal for many illnesses – but not in the early stage of breast cancer. In advanced breast cancer, however, the metastases can cause pain, for example in the case of bone metastasis.

Is chemotherapy always required?

No, this depends on the type, size and aggressiveness of the tumour(s). As soon as doctors have all the information about the cancer, they can define the treatment combination with the best chances of success for each individual.

What should you bear in mind when receiving a diagnosis of breast cancer?

A breast cancer diagnosis is an emotional shock for many women. Grief and anger are often the first reactions and patients can also feel that their self-esteem as a woman is hurt. Questions such as “Why me?” or “What did I do wrong?” arise and put additional strain on the patient’s mental health. There are many existential questions and additional concerns about families arise, especially when breast cancer affects younger women. In such situations, it is important to seek expert advice and thoroughly analyse the diagnosis and further course of action with your partner or a trusted person. You need to act quickly, but you have plenty of time to find the necessary information and, if necessary, obtain a second opinion.