Breast cancer: Overview of the most common tumor disease in womenBreast cancer is the most common type of cancer in women. For early detection, gynecological screening is therefore of particular importance. You can read about what the risk factors are, what symptoms occur and what the treatment, chances of recovery and prognosis are here.
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Breast cancer (mammary carcinoma) is the most common type of cancer in women in Germany. Every year, there are almost 70.000 new cases. Three out of ten women are younger than 55 years of age. The chances of cure are better than ten years ago. Although the number of cases is increasing, fewer women are dying of breast cancer today. This is due to advances in the treatment of breast cancer.
Breast cancer can also occur in men, but is much less common. The lifetime risk of breast cancer for women is about 12.8 percent (about one in eight women will develop the disease in her lifetime), while for men it is only 0.1 percent (one man in 790 men will develop the disease in his lifetime). This is why men are not recommended any special early detection measures, but women are.
Prognosis and chances of cure
As diagnostics and therapy for breast cancer have improved significantly in recent years, the so-called 5-year survival rates have also risen. Most women are alive five years after diagnosis of breast cancer (83%), and many are alive ten or 15 years later. The earlier breast cancer is detected, the better the chances of cure. Early detection measures, such as the mammography screening introduced in Germany in 2005 have contributed to this.
Causes and risk factors for breast cancer
The exact causes of breast cancer are not yet clear. But there are a number of factors that can increase the risk of breast cancer. Risk factors include:
– increasing age – early first period – late onset of menopause – childlessness or first pregnancy after age 30. age – regular alcohol consumption – hereditary predisposition, family history of hereditary breast cancer (for example, mutation of the BRCA1 and BRCA2 genes) and lack of exercise after menopause – hormone replacement therapy during and after menopause (especially with the combination of estrogens and progestins)
Even though the pill has been discussed as a cause of breast cancer, the latest findings show that it only minimally increases the risk of breast cancer. The longer the period with cycles and thus with hormone fluctuations in a woman's life, the higher the probability of breast cancer. In turn, some factors appear to lower the risk of breast cancer:
– longer periods of breastfeeding – early first pregnancy (before the age of 30). age) and several bir.
Symptoms: Detecting breast cancer
In the case of breast cancer, the symptoms are often not even present in the early stages. Indications of a lump, but it does not have to be malignant, it can also be benign (fibroadenoma):
– size and shape of the breasts have changed in different ways – retractions in the breast or nipple – fluid leaking from the nipple (outside pregnancy and breastfeeding) – sudden indentations in one part of the breast (orange peel skin) – noticeable lumps on palpation
As part of the annual gynecological screening, the breast is also palpated to detect possible induration or other changes. Women should also regularly palpate their breasts themselves in order to detect changes at an early stage. This is important because breast cancer can be detected as early as possible. In most cases, the earlier the breast tumor is detected, the better the chances of cure.
Diagnosis: Focus on early detection for breast cancer
When breast cancer is diagnosed, the emphasis is on early detection, since it is usually an incidental finding. It is recommended that all women take advantage of regular cancer screening examinations.
The statutory early detection, for which the health insurance companies cover the costs, provides for the following examinations:
Women over 30 years of age: once a year a screening examination of the breasts (palpation, instructions for self-examination, counseling) Women from 50 to 70 years of age: every two years invitation to mammography screening in a certified center
Women who have a clear family history of breast cancer can be tested for an increased risk of breast cancer. Palpation is the most important examination in the diagnosis of breast cancer. If the doctor discovers any abnormalities, further examinations will be arranged. As a rule, this will first be a mammogram. Further examination methods in case of suspected breast cancer are:
– Tie sample (biopsy) of the suspicious tumor in the breast
In the case of a tumor in the breast, it is ultimately always important to examine the tie to determine whether the tumor is benign or malignant. If it is malignant, the tumor must be precisely identified, as this also determines treatment. For example, it is important for therapy planning whether the tumor is hormone receptor positive. In a hormone receptor positive tumor, the cancer cells have receptors for estrogen and progesterone, which means that these hormones promote tumor growth. 70 to 80 percent of breast cancer tumors are hormone receptor positive.
There are also different types of benign tumors of the breast. However, some of them are classified as so-called precancerous or increase the risk of breast cancer. Therefore, they sometimes need to be removed or at least closely controlled.
Therapy options for breast cancer
Breast cancer therapy depends on the type and size of the tumor and whether or not it is hormone receptor positive. However, the first measure is almost always to surgically remove the breast carcinoma. Breast-conserving surgery can be performed or reconstruction can take place directly during the operation in which the tumor is removed. Sometimes reconstruction of the breast is also performed in a second, later operation.
In addition to surgery, other treatment methods are available. Which ones are used and how much tie is removed can vary greatly and depends on the patient's individual breast cancer and also whether or not she is already in menopause. In Germany, there are medical guidelines for the treatment of breast cancer. Patient guidelines are also available for patient information and can be found here.
The following therapy options are available:
Mastectomy (complete removal of the breast) in the presence of certain factors, such as inflammatory (inflammatory) breast cancer.
Removal of axillary lymph nodes: This is usually done together with the operation of the tumor. Examination of the axillary lymph nodes provides further information about the tumor stage and its spread. If tumor cells are contained in the lymph nodes, the risk increases that metastases are already present. In such cases, surgery is followed by adjuvant (supportive) chemotherapy or hormone therapy, which can kill tumor cells that have already migrated.
Medication: These include anti-hormone therapy, chemotherapy and targeted therapies such as antibody therapy. It is usually used after breast surgery to prevent recurrence and metastasis. All three therapies can also be combined if there is a particularly high risk.
Adjuvant chemotherapyChemotherapy (adjuvant) with cytostatics following surgery reduces the risk of recurrence and metastasis.
Neoadjuvant chemotherapyChemotherapy with cytostatics prior to surgery is used less frequently, for example in the case of advanced, inoperable or inflammatory breast cancer.
Anti-hormone therapySome tumors are stimulated to grow by hormones. This is where anti-hormone therapy comes in, blocking the receptors so that the growth of the tumor cells is stopped. These include aromatase inhibitors and tamoxifen.
Targeted therapies: Antibody therapy counts as a targeted therapy (Targeted Therapies). Antibodies are used to target the cancer cells directly and block their growth. This is not possible for all women with breast cancer. The structures against which the targeted therapy is to act must be detected in the tumor tie for its use to make sense.
Radiation therapy: Radiation is usually used after breast-conserving surgery to kill any remaining cancer cells.
Palliative treatment: If the breast cancer is very advanced and can no longer be cured, palliative treatment is given. This means that the tumor itself is no longer treated, but only symptoms are relieved and an attempt is made to prevent further progression and to maintain the quality of life. Psychological support should also be provided.
Treatment in special breast centers is recommended in order to be able to carry out the ideal therapy and also to be able to treat the side effects of the therapies if necessary. Before the start of therapy, a treatment plan is drawn up, the content of which depends on various factors. The treatment plan is determined in a so-called interdisciplinary tumor conference. Doctors from various disciplines, such as gynecology, oncology, and radiology, consult with each other about the individual procedure. In addition to the breast cancer specialists, a psycho-oncologist is usually available to support the woman during this difficult phase.
Breast cancer progression and aftercare
Breast cancer has a good chance of being cured if it is detected early and treated according to guidelines. The chances of cure are also best if the tumor can be completely removed. A special feature of breast cancer, however, is that unlike other cancers, new tumors (recurrences) or tumors in other areas of the body (metastases) can occur even years after the disease has been overcome. Therefore, regular aftercare for breast cancer is of particular importance. New tumors or metastases can be detected at an early stage. Aftercare for breast cancer should be carried out by a doctor for at least ten years. In the case of familial (hereditary) breast cancer, follow-up should be carried out even more closely.
If metastases already exist, the life expectancy of the woman affected depends on the type of metastases. The prognosis is relatively good for bone and skin metastases, but worse for metastases in the lungs, brain and liver.
Prevent breast cancer
Since only a few mechanisms that lead to breast cancer have been deciphered so far, targeted prevention is also difficult. Some factors may be congenital. Are not to be influenced with it. Women with an increased risk of breast cancer should definitely take advantage of regular preventive examinations.
The hormonal situation of a woman influences the risk of breast cancer. However, this is individual. Can only be influenced to a limited extent. Taking the pill only slightly increases the risk of breast cancer. However, hormone replacement therapy during menopause significantly increases the risk of breast cancer. Plant phytoestrogens (plant estrogens, for example contained in soft milk or tofu) are still controversial, as it is unclear from the studies whether they can reduce or even increase the risk.
For the general prevention of cancer, a healthy lifestyle with a balanced diet and sufficient exercise is recommended. However, research in recent years on the prevention of breast cancer can only partially confirm this:
Fresh fruits and vegetablesIt seems to have no influence on the risk of breast cancer whether a woman eats a lot of fresh fruit and vegetables or not. Sufficient exercise and normal weightObesity and lack of exercise have been shown to increase the risk of breast cancer. Obesity after menopause in particular increases the risk of hormone receptor-positive tumors. Moderate alcohol consumptionThe risk of breast cancer increases the more alcohol a woman drinks. Not smokingSmoking is unhealthy, but the connection with the development of breast cancer has not been clearly proven.