Who knows how long life will last-.

Special formsA special form of breast cancer is the
Paget carcinoma. In this case, the tumor is located near the nipple, so that individual tumor cells reach the tie layers of the nipple and areola, where they cause an inflammatory, itchy skin change (eczema). Breast-conserving surgery cannot be performed for this type of tumor. Amputation is necessary.

Another special form is the inflammatory breast carcinoma, which is difficult to distinguish from mastitis in terms of appearance (reddened, overheated and painful breast region).

Confirming the diagnosis

Left: High-speed punching device for obtaining punch biopsies of the breast. The device yields the best tie cylinders with relatively few complications, which is essential for a correct diagnosis. The doctor performs the biopsy under ultrasound guidance. Right: Mammotome; the patient lies on her stomach on an examination table. GTVL

Medical history. Here the doctor asks for important information that helps him to make a diagnosis, for example, underlying diseases such as high blood prere and diabetes mellitus, but also existing cancers in the family.

Palpation. In many cases, the physician already finds clues during palpation as to whether a palpated lump is suspicious of cancer or not. He looks and feels for swelling, redness, inflammation and changes in the shape of the breast and nipple. It also examines the areas around the key-. sternum as well as the armpits.

Blood and urine tests. Results of the test indicate whether kidney, liver and other organ systems are functioning.

Genetic test. Women whose sister(s) or mothers have breast cancer have twice the risk of breast cancer. This is especially large if the cancer was diagnosed in relatives before the age of 35. This is because around one third of breast cancers in these early cases are hereditary.

Two genes are responsible for half of hereditary breast cancers: BRCA-1 and BRCA-2. Those who carry the BRCA-1 gene in their genetic makeup have a 60% risk of developing breast cancer by the age of 50. The risk of developing cancer until the age of 70 is 80%. The risk of developing breast cancer at the age of. Other so-called breast cancer genes are probably responsible for the other half. One of these genes, the RAD51C gene, has recently been identified. Experts also talk about the BRCA-3 gene.

That is why the German Cancer Aid Consortium recommends to the following risk groups a BRCA genetic test:

– Affected persons and relatives who are not ill 1. (children, siblings) and 2. A person with a family history of breast cancer of the 2nd degree (grandchildren, cousins) from a family with 2 or more breast cancer patients, at least 2 of whom were diagnosed before the age of 50. year of life – affected and non-affected relatives 1. and 2. The following are exceptions to the rule: all women with breast cancer and ovarian cancer in the first and second degree from a family with at least one case of breast cancer and one case of ovarian cancer – affected and unaffected relatives. 1. Grade from a family with 3 or more family members suffering from breast cancer – regardless of the age at which the disease occurred.

However, the genetic tests also have a downside. Many doctors and psychologists are critical of them, because apart from the high costs, a negative result does not mean an all-clear. And in the event of a positive diagnosis, pre-diagnosed women are advised to do exactly what women are advised to do anyway: To take advantage of all opportunities for early detection and to reduce risk factors as much as possible.

Genetic subtype determination. Compared to genetic tests, which detect a familial predisposition, genetic subtyping identifies molecular factors that are decisive for the course of the disease and the success of the therapy. Due to varying genetic characteristics, the disease manifests differently in each breast cancer patient. Also, how malignant the cancer is depends on the type of breast cancer, d.h. with the present molecular subtype. Also, the subtype determines whether the patient has a good or poor prognosis and also provides clues as to whether chemotherapy is working or not. Scientists have now developed a method that makes it possible to determine a patient's molecular subtype, her gene signature, as scientists call it. They were also able to identify patients who had a good prognosis, even though they had a very aggressive breast tumor – triple-negative breast cancer (TNBC).

Biopsy. If the suspicion of breast cancer is confirmed, a tie sample (biopsy) is taken from the suspected breast region. This is done under local anesthesia, which is usually achieved by a cream applied to the skin. The biopsy is performed with a thin hollow needle. The needle either fills with tie when it is inserted (punch biopsy), or a tie sample is aspirated by vacuum (vacuum biopsy). Under ultrasound guidance, the biopsy needle is pushed to the suspicious focus that the patient or the doctor has felt. If the change is only visible in the mammogram, several tie samples are taken and examined by vacuum biopsy under a special mammography device (mammotome) for further clarification.

If the biopsy does not provide an adequate assessment, the suspicious nodule is removed completely under general anesthesia. Fine tie examination of the nodule is usually done during surgery as a frozen section examination. If breast cancer is detected, the operation is extended while the patient is still under the same anesthesia. This procedure also used to be widely used for biopsy to spare the patient the burden of two procedures – one for the biopsy and one for surgery. However, it is now used less frequently because the accuracy of frozen sectioning is limited and the psychological burden is difficult to bear, at least for some patients.

Imaging techniques

Mammography. The best time for mammography is the days after menstruation, because that is when breast tie can be best assessed. During the examination, both breasts are pressed one after the other between two plates, so that the structures inside the breast can also be precisely visualized. The clenching is not painful, but uncomfortable. The doctor needs one image from above and one from the side of each breast. Depending on the findings, further images may be necessary. stages of breast cancer occur. Not to be palpated are. In addition, the shape of tie changes as well as their extension into neighboring ties can be assessed.

Two techniques are used for mammography: analog mammography captures the image on a film sheet, while digital mammography stores the image data electronically and examines it on a computer screen. The difference is not so much in the quality of the image as in the radiation exposure, which is half as much with digital mammography.

Note: The younger the woman, the more cautiously mammography should be used because of radiation exposure. For this reason, only women between the ages of 50 and 69 are invited for screening.

Breast ultrasound. In addition or as an alternative to mammography, many gynecologists recommend an ultrasound examination of the breasts. It is sometimes called a "soft" mammogram. Risk-free alternative designated especially for younger women. The prevailing opinion is that breast ultrasound is only of sufficient value in combination with mammography – it does not replace mammography at any stage of life. According to one study, a combination of mammography increases. Ultrasound best the detection rate of tumors.

MRI. An MRI or MRI of the breast is very informative, but expensive. For this reason, the health insurance company only covers the costs (upon request) if the mammography results are unclear or in high-risk cases (breast cancer in the family). A disadvantage of MRI is that microcalcifications are not detected.

Women between the ages of 24 and 49 whose mother or sister has breast cancer are recommended by medical associations to have an MRI of the breast every year, among other things to avoid the radiation exposure of the otherwise very often necessary mammography. However, the additional costs are considerable.

Breast cancer in core spin. The findings in the left image suggest a malignant tumor (arrow). In the right image, the tumor accumulating contrast agent clearly stands out from the rest of the mammary gland tie and confirms the suspicion of breast cancer. Georg Thieme Publishing House, Stuttgart

Galactography. If one of the milk ducts secretes bloody or brownish secretions, the doctor makes these very fine ducts visible during the mammogram. For this purpose, the physician injects contrast medium into the milk duct and its ramifications via a probe (Galactography). If the bright liquid encounters an obstacle, z. B. If the contrast medium flows past a tumor, it flows laterally; if the tumor obstructs the entire milk duct, the contrast medium flow is "interrupted". The doctor sees where the lump or tumor is located and later removes it surgically.

Ductoscopy. During ductoscopy, the doctor inserts a thin endoscope with a maximum diameter of 1 mm into the milk duct using a light source and a saline solution. While the saline solution flushes the milk duct, the doctor follows the course of the duct and its branches on a screen. If he sees something conspicuous, he inserts a thin wire. This can be used to mark a very small tumor. The patient receives a short anesthesia during the examination.

Elastography. Elastography is a special form of ultrasound that measures the elasticity of breast tie. This method helps physicians confirm breast cancer diagnosis and protect patients from unnecessary biopsies. Because malignant cancer tie is less elastic than benign cancer tie. Doctors use the elasticity value to determine exactly how elastic the tie is. If the value is above 4, the tie is not very ductile. The probability that a malignant tumor is present is thus high. In such a case, a subsequent biopsy is necessary. A value below 4, on the other hand, indicates that the cancerous tie is elastic and benign. A biopsy is not indicated. In practice, this means that if doctors detect a tumor (tie proliferation) in the mammogram, they should first check it with elastography. Only if the indications of a malignant tumor are confirmed should doctors perform a biopsy.

Ultrasound, X-ray and/or CT. When breast cancer is diagnosed, an additional test is performed to determine whether the tumor has spread to the other breast or to another part of the body. An ultrasound or X-ray is performed on the unaffected breast, the chest is also X-rayed. The liver is examined either with an ultrasound or with a CT scan.

Treatment

Successful treatment of breast cancer depends on many factors, u. a. from:

– Size, location and fine tie type of the tumor – Number of tumor foci – Influence of hormones on tumor growth – Presence of distant metastases – Breast cancer or other cancer in the past.

Operative

At the beginning of breast cancer therapy, except in incurable cases, there is always complete surgical removal of the tumor. In addition, axillary lymph nodes must be removed and examined for tumor involvement in order to determine the spread of the cancer and for further therapy planning.

Wire marking. In some cases, a cancerous focus in the breast is not palpable. In order for the surgeon to still operate on the correct site, it must be treated by a Wire marking be marked beforehand. This is done with 1 or 2 thin, soft wires placed with the help of a hollow needle. In order to properly target the node, the breast tie is visualized by mammography or ultrasound during needle marking. The patient receives a local anesthetic for this five to ten minute procedure.

Breast-conserving surgery. In about 70% of all breast cancer cases, a Breast-conserving surgery possible if the tumor is only small in relation to the size of the breast, is in a favorable location and has not grown into the skin or muscles. During the operation, the tumor is removed together with the overlying skin. A safety distance of at least 5 mm taken out on all sides. In detail, a distinction is made:

Tumorectomy or Lumpectomy (pure tumor removal with safety distance) Segmentectomy (an entire breast segment is removed) Quadrantectomy (removal of a quarter of the mammary gland body).

Breast-conserving surgery can, however, mean that the appearance of the breast is altered. Therefore, if large tie defects are expected, a plastic surgeon is involved in the operation to achieve the best possible result.

Radical surgery. In the past, radical removal of the breast (Mastectomy, mastectomy) along with the axillary lymph nodes was the norm, but today it is limited to cases where the cancer is very large in relation to the breast (˃ 5 cm), involves multiple nodes, or the patient requests it. According to new scientific findings, the procedure also protects patients suffering from familial breast cancer. Women who have mutations in the breast cancer genes BRCA-1 and BRCA-2 have a significantly lower risk of developing the disease again after a mastectomy.

Usually, after a mastectomy, plastic surgery breast reconstruction (breast reconstruction) with autologous tie or implants is possible. The implants are either made of saline or silicone. Both variants are harmless to health. Silicone also no longer poses any risks since it has been used as a gel. The only difference is in the comfort of wearing them. In a US study, patients with silicone implants were significantly more satisfied than those with saline implants. Breast reconstruction is performed either at the same time as breast removal (simultaneous radical-modified mastectomy) or after 3-6 months interval. combination with a special bra can be worn. Available in medical supply stores.

The costs for all procedures are usually covered by health insurance companies.

Lymph node removal. For further treatment and to assess the prognosis, several axillary lymph nodes on the affected side are removed and examined for fine tie. To avoid unnecessary lymph node resections in this case, if the cancer does not exceed a certain size, only a single one (sentinel or guard lymph node) is removed and examined first. For this purpose, the physician injects dye and/or a radionuclide around the tumor, which shows the lymphatic drainage and thus also the first lymph node station of the cancer spreading area. This is used to specifically remove this first station of the lymphatic drainage from the tumor. If this is affected by cancer cells, the remaining lymph nodes are operated out in a second operation.

If these lymph nodes contain cancer cells, this indicates that the cancer is no longer confined to the breast alone. This nodal-positive finding is a bad sign and usually prompts physicians to recommend the most aggressive subsequent chemotherapy, hormone therapy or antibody therapy possible. Conversely, a node-negative finding means that the examined lymph nodes do not contain malignant cells.

Chemotherapy

Currently, chemotherapy is necessary in over 90% of all patients. This often involves treatment with a three-drug combination according to the so-called FEC regimen (5-fluorouacil, epirubicin and cyclophoshamide) or the TEC regimen (docetaxal, epirubicin and cyclophoshamide). The treatment is carried out in several cycles. Chemotherapy is available on an outpatient basis in oncology clinics or day clinics, except in cases of severe side effects.

In certain cases, it is useful to administer chemotherapy prior to surgery, primary or Neoadjuvant chemotherapy: This is used if the tumor is so large that the entire breast would have to be removed. Doctors try to reduce the size of the tumor in this way so that breast-conserving surgery can be performed.

Radiotherapy

Postoperative irradiation. After any breast-conserving surgery, and often after mastectomy, radiation (radiotherapy) is given to the affected area to kill any remaining cancer cells and reduce the risk of new tumor growth.

Intraoperative radiation. Several studies have shown that after tumor removal, the breast can be irradiated once intraoperatively, i.e. during surgery, instead of postoperatively. The results are equivalent, at least in strictly selected cases. The advantage is that intraoperative irradiation is much less stressful for the patient than postoperative irradiation, which lasts for weeks. However, it is still unclear in which cases patients should be offered intraoperative radiation without disadvantage to the success of therapy.

Preoperative radiation. Radiation therapy prior to surgery is only justified in the case of extensive tumors that cannot be completely removed by primary surgery, i.e. without pre-treatment. This is intended to reduce the subsequent breast-. Tumor removal more likely to succeed. Surgery usually takes place 3-4 weeks after completion of radiation therapy.

Palliative (palliative) radiation. If the tumor is already so large or has grown so much with the surrounding area that it can no longer be operated on, the breast is irradiated immediately. In the case of tumor recurrence or metastases in the breast region, irradiation of the metastases also relieves pain. Reduces tumor growth in these areas for several weeks to months.

Hormone therapy

The term "hormone therapy is misleading, because it is actually an "anti-hormone therapy". Treatment consists of reducing the size of the tumor by administering antiestrogens (z. B. Tamoxifen , raloxifene , fulvestrant ) to stop the tumor growth.

Recently, instead of antiestrogens, aromatase inhibitors such as exemestane , anastrozole or letrozole are increasingly given, which bring better survival rates, but are very expensive. The prerequisite is that the tumor reacts to the female sex hormones estrogen and progesterone with increased growth.

Since 2016, palbociclib ( Ibrance ) has been approved for the treatment of advanced hormone receptor-positive breast cancer. The active substance is combined with an aromatase inhibitor or the antiestrogen fulvestrant as part of an anti-hormone therapy. Treatment is given to women who can no longer be cured by further surgery, radiation therapy or chemotherapy. It is not yet clear whether the new drug can extend the life of patients with advanced breast cancer.

Note: In the doctor's letter hormone-sensitive Tumors (hormone-sensitive tumors) with ER+ (estrogen receptor positive) or. PR+ (progesterone receptor positive) abbreviated.

Whether a tumor is hormone sensitive is only determined during the fine tie examination after surgery. The result will be evaluated by a scoring system (Immune Reactive Score, IRS).

Antibody therapy

Antibodies act against foreign substances that have entered the body, i.e. bacteria, viruses or toxins, but also against "foreign" substances that have developed in the body Substances such as components of cancer cells. Antibodies can also be produced in the laboratory. Use as a drug.

The monoclonal antibody trastuzumab ( Herceptin® ) is of particular importance in the treatment of metastatic breast cancer. This antibody binds to the HER2 receptor and thus prevents the growth of breast cancer cells that carry precisely this receptor. HER2 is detectable in one in four breast cancer patients. The result of this targeted therapy ("targeted treatment"): cancer cells with HER-2 do not continue to divide but perish. According to study results, the risk of a relapse is reduced by up to half.

Because of its recurrence-preventing effect, Herceptin® is approved for treatment in early breast cancer to prevent breast cancer recurrence.

Other monoclonal antibodies against breast cancer (recurrence) are in development.

Psycho-oncological care

In every phase of the cancer disease, a psychooncologist is recommended as a contact person who cares for both the affected woman and her relatives. This happens during the inpatient stay or in the post-inpatient setting. During psycho-oncological counseling, questions about the disease and treatment, problems in everyday life and at work can be discussed. It also clarifies what support family and friends can provide or even need themselves.

Psycho-oncological offers are led by different occupational groups, above all by psychotherapists, psychologists, social workers, social pedagogues, physiotherapists or coworkers from the care range.

Follow-up care

One of the key factors for successful treatment of breast cancer is follow-up, especially within the first five years after diagnosis. If a tumor reappears (recurrence), it can be detected and treated at an early stage through follow-up care. Follow-up care includes regular check-ups to detect early relapse and the appearance of metastases, as well as long-term effects of cancer therapy:

– In 1. until 3. year every 3 months – In 4. and 5. From the 6th year onwards, once a year as part of the. year once a year as part of the cancer screening program.

The time intervals can vary from case to case and depend on the stage of the disease, type of therapy, individual risk of relapse, long-term consequences of the therapy and possible concomitant diseases.

Follow-up examinations include:

– The discussion with the gynecologist or oncologist – The examination of the breast including the surgical scars, the armpits and the arms, as well as a weight check – For early detection of recurrences or metastases, a physical examination, mammography and ultrasound are necessary – Examination and treatment of lymphedema, which often occurs as a result of axillary lymph node removal.

Not all physicians consider this sufficient, but additionally recommend regular ultrasound of the liver and X-rays of the lungs. We authors concur: Liver, pleura, or lung metastases do not cause symptoms for a very long time. Treatment possibilities exist, however, which is why it is worthwhile to use all possibilities of early diagnosis.

Complications

After surgery. As with all surgeries, wound healing problems and/or infections occur in rare cases. Since skin is also removed, there are temporary feelings of tension after the operation until the remaining skin has stretched. During the removal of the axillary lymph nodes, small nerves are cut, so that in rare cases the mobility of the shoulder and arm is impaired. Other late effects of lymph node removal include lymphatic drainage disorders (lymphedema) and sensory disturbances.

After chemotherapy. During treatment with natural or synthetic substances, which are supposed to inhibit cell growth and cell division (cytostatics), especially the rapidly renewing tie is damaged: Hair roots, mucous membranes of the stomach and intestines, and the hematopoietic system in the bone marrow. Possible accompanying symptoms are hair loss, nausea, vomiting, diarrhea and increased susceptibility to infections. The side effects are largely alleviated by appropriate medication. After the end of chemotherapy, they usually disappear completely. After radiotherapy. Acute consequences occur days after radiation treatment. Usually disappear within a few weeks. Acute consequences occur days after irradiation. Usually disappear within a few weeks. These include diarrhea and/or irritable bowel syndrome. These can be avoided, according to one study, if women take selenium as a sodium salt during treatment: Thanks to this supplement, only 21% of treated women experienced diarrhea compared to 45% of women without selenium supplementation. For example, selenium reduced radiation-related symptoms without compromising the benefits of radiation therapy.

After hormone therapy. Treatment with hormones also leads to undesirable side effects – especially if the treatment lasts for many years. Nausea and weight gain are most common, but disappear after treatment ends. The risk of blood clots (thrombosis. Pulmonary embolism) increases under therapy with hormones.

Due to the administration of GnRH analogue (z. B. Enantone Gyn® , Trenantone® , Zoladex® ), the hormone production of the ovaries is suppressed. This puts (even young) women into menopause – with the typical menopausal symptoms that start abruptly.

The antiestrogen tamoxifen is suspected of increasing the risk of hormone-insensitive second tumors. In one study, the active substance was shown to reduce the incidence of hormone-sensitive tumors by 60%, as expected – but the risk of the more aggressive hormone-insensitive tumors was 4 times higher after 5 years of use.

After antibody therapy. The antibody trastuzumab ( Herceptin®) often leads to diarrhea and headaches. In about 1% of cases, there is severe damage to the heart muscle, which is why the heart function must be checked (especially cardiac ultrasound) before the start of treatment and at three-month intervals during treatment. After treatment, monitoring should be continued at 6-month intervals for at least 2 years. The simultaneous use of anthracyclines is contraindicated.

Prognosis

Many advances in therapy have significantly improved the chances of survival for breast cancer patients. 1 out of 3 women in Germany still die from the consequences of their breast cancer disease. Prognosis depends on whether and how many lymph nodes in the armpit are affected and how early or late the tumor is detected. On average, over 80% of women with breast cancer survive the next 5 years and over 70% survive the next 10 years. The 5-year survival rate after breast-conserving surgery is as high as after a mastectomy. If the lymph nodes are not affected, the 5-year survival rate is about 95%.

There is never a definitive cure for breast cancer: Late recurrence, So the recurrence of the tumor or breast cancer metastases (daughter tumors) after 5 to 30 years of symptom-free, are unfortunately common, v. a. among women under the age of 40 at the time of initial diagnosis of breast cancer. While recurrences are treated according to similar rules as the initial tumor and can be treated well, there is usually no cure for metastases. If men get breast cancer, their prognosis is worse than women's: the 5-year survival rate is only 73%.

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What you can do yourself

The first days.

The diagnosis of breast cancer is a deep cut in the life of a woman. For relatives, friends and acquaintances, too, the diagnosis is usually a shock that has to be dealt with. The question "Why me?" The best doctor will not be able to answer your questions, and you must try to deal with the difficult situation and adjust to it.

Don't suppress your feelings – despair, anger, sadness and fear of relapse are all part of dealing with such a disease. Most often, these feelings occur in phases. Lose intensity again. However, many women also report that the fear has never completely left them, even after successful therapy. Try to figure out what is essential to your emotional balance and avoid anything that will throw you off balance. Every woman will find her own way.

Choice of therapy center.

Every breast cancer patient wants to get rid of the tumor as soon as possible. However, only in rare cases is it medically necessary to operate immediately. Take about two weeks after diagnosis to decide whether you want to have the treatment and subsequent therapy in a hospital or rather in a breast center. Your quality of life later may depend greatly on which facility and surgeon you choose.

The German Cancer Society aims to achieve this goal by awarding the "Certified Breast Center" quality seal Ensure that patients can be sure that they will be treated in the certified center according to the current state of science. Goal is to significantly improve care for breast cancer patients. However, the term "breast center not protected and any clinic can use it without giving information about the quality of the offer. If in doubt, it is therefore worth asking whether this designation has been awarded by the German Cancer Society.

A balanced diet is v. a. important during chemotherapy. So-called cancer diets, however, have no proven success. Eat what you feel like. And if the desire is completely missing: Take it in your stride, the desire to eat will come again! Those who suffer from nausea and have no appetite should try to eat small meals and be sure to drink; small sips of tea or still water are best tolerated.

Nicotine.

If you haven't already quit smoking, you should do so after diagnosis at the latest. Women who continue to smoke after a breast cancer diagnosis have a 72% higher risk of dying from breast cancer recurrence in the following 11 years compared to nonsmokers.

Movement. Basically increases sport. Any active lifestyle the well-being. Exercise, practiced without overexertion, improves mood, boosts self-esteem and body image, and can improve immune response and tolerance to therapy.

To prevent lymphedema after axillary lymph node removal helps Exercise. Specially designed fitness classes with weights or just lifting weights relieve discomfort. Women do not need to rest their arm – as doctors often recommend in the past. You may also lift weights over 2.5 kg. A study shows that all breast cancer patients benefited from weightlifting – regardless of how many lymph nodes they were missing in total. As with weight training, compression bandages should always be worn during light weight lifting.

In case of exhaustion and fatigue, listen to your body, do not overexert yourself and, if necessary, refrain from exercise. Take frequent breaks in your daily routine and do strenuous activities while sitting rather than standing.

Relaxation techniques. For deep physical. Provide mental relaxation z. B. Progressive muscle relaxation according to Jacobson and autogenic training, but also yoga, mindfulness training, Tai Chi or Qigong as well as meditation. In addition, when used regularly, they improve body image and promote psychological balance. However, it takes 2-3 months for such a relaxation technique to take effect.

Skin, hair, body care.

Your skin will tolerate radiation better if you wear comfortable clothing that neither rubs nor pinches. Cotton or silk garments are well tolerated. During therapy, do not bring the irradiated region into contact with water (i.e., do not wash it either!), because this increases the locally damaging effect of the radioactive rays. As protection against sunlight, the very light-sensitive skin in the area of the irradiation field must initially be covered by opaque clothing. Later you can use sunscreen preparations with a high sun protection factor.

For many women, hair loss during and after chemotherapy is a symbol of the disease that is difficult to bear. Some women cut their hair short even before chemotherapy or manage with confidently worn baseball caps or scarves. Others take care of a suitable wig as early as possible. In fact, the purchase of a wig should be done during the time when you still have your own hair. Then it is easier to find an inconspicuous wig that matches the color of the skin type. Some women, however, prefer a wig that makes them a completely different type and has nothing to do with their natural tone. During the period of most severe hair loss, some women sleep with stretch turbans (available in drugstores) so that the fallen hair does not have to be laboriously picked up from the pillow. Some also shave off their hair in advance to avoid having to experience the slow loss of hair. About three months after the end of chemotherapy, a wig is usually no longer necessary, the hair has then grown back, after about six months you can talk about a short hairstyle.

During chemotherapy, personal hygiene is of great importance for many women. Take seriously the needs that your body signals to you and also take the time to pursue them. Try – according to the circumstances – to be good to your body. Allow yourself to stay longer in the bathroom, use body creams, cosmetics and wellness treatments.

Maintaining self-esteem.

For many women, breast cancer surgery also means a reduction in female self-esteem. Many women fear that they have lost part of their femininity and sexual attractiveness along with their breasts. Talk to your partner about these fears and, if necessary, consider separating if your partner is not able to support you in an appropriate way.

Dealing with sexuality.

Often the fear of no longer being sexually interesting after a mastectomy is transferred to the partner. Many women even tell themselves that men might be disgusted by them. Often, however, men are afraid of hurting their partners. Here, too, an open – also professionally accompanied – conversation prevents misunderstandings.

Renew your attitude to life.

Having breast cancer and having gone through breast cancer treatment also means taking a fresh look at your own life. Who knows how long life will last?? Perhaps you come at some moments to the conviction to "turn your life around" to have to. At other times, you are just grateful to have survived. Experience shows that these feelings are not so easy to sort out and they change quickly and unpredictably. Doctors speak of affective incontinence when the affected person cries, laughs or is angry in an uncontrollable way. But all these extreme feelings lose their poignancy again over time. Listen to yourself, be forgiving with yourself and also with your fellow human beings. Trust that ways will open up that, despite all the changes and limitations, will also open up new possibilities for you.

Pay attention to heart health.

Many patients survive breast cancer today. But in return, they run the risk of dying from cardiovascular disease. As a recent study found, this affects about two-thirds of all breast cancer patients. If secondary diseases such as diabetes or chronic bronchitis are added, the risk increases even more. Therefore, patients should pay more attention to their heart health. For example, exercise, a healthy diet, or even drug therapy can strengthen the heart. It is also advisable to abstain from alcohol and nicotine. Patients should discuss with their doctor what will help them best.

Complementary medicine

Alternative medical healing methods such as homeopathy, traditional Chinese medicine (TCM), Ayurveda and anthroposophy each have their own concepts for tumor therapy and should only be used in breast cancer as a supplement (= complementary) to the recognized conventional medical therapies.

Homeopathy

showed no efficacy in cancer therapy in controlled studies. However, many sufferers find the homeopathic remedies used helpful against therapy-related fatigue, physical weakness, dizziness, loss of appetite, feeling of fullness and nausea.

Ayurveda

May help prevent some cancers, but is largely unexplored therapeutically.

Acupuncture

Can help alleviate the accompanying symptoms of chemotherapy, such as nausea, but has no effect on the course of the disease.

Mistletoe therapy

against cancer has been known for 100 years. While many patients are convinced of treatment with mistletoe preparations, experts are rather critical, because there is still no reliable proof of effectiveness against tumor diseases. Studies only show that an improvement in the quality of life is possible. This is why therapy with mistletoe preparations does not play a role in the currently valid guidelines for cancer therapy.

Prevention

Mammography screening.

Currently, nationwide and free biennial mammography screening for early detection of breast cancer is offered throughout Germany to all women between the ages of 50 and up to 70. built up during the first year of life. The benefit of screening is controversial. The certainty with which breast cancer suspicious findings are detected by a mammography (sensitivity) is (only) about 80%. Especially in the case of large breasts, breast implants and mastopathy, the ability to assess is limited. Therefore, the doctor must also be informed in advance if breast implants are present. But also "false positive results Are more common than suspected, meaning women are treated for breast cancer even though they do not have it. And last but not least: Every mammography is associated with radiation exposure.

Nevertheless, mammography is recommended by many gynecologists as a preventive measure even outside the (German) statutory mammography screening program. The patient bears the costs. Every woman should critically reconsider this recommendation.

Further information

– V. Barth; A. Barth: Breast cancer: understand quickly – treat correctly. Triad, 2003. Practical guide in question-and-answer style. With overview plans on diagnostics and treatment. – H. Delbruck: Breast cancer. Advice and help for affected persons and relatives. Kohlhammer, 2006. Newly published, comprehensible, up-to-date reference book. Offers not only medical knowledge but also information on topics such as partnership, sexuality, career and social benefits. – L. Mountain: Breast cancer. Knowledge against fear. Goldman, 2007. Current, revised edition of the classic book. Critical presentation of traditional and alternative diagnostic and therapeutic methods as well as insightful discussion of psychological problems. With many practical tips, addresses and information for women in Austria and Switzerland. – O. Camara; J. Sehouli: Breast cancer: 100 questions – 100 answers. akademos, 2006. Answer questions formulated by women suffering from breast cancer in a clear and understandable way. Also topics such as nutrition. Finding space for sexuality.

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