The medical history represents an important component in the diagnosis of breast carcinoma. Family history
- Are there any tumor cases in your family that are common?
- Have your sisters, mother or grandmother had breast cancer?
Argue for a genetic strain if in a line of the family:
- At least 3 women have breast cancer.
- At least 2 women have been diagnosed with breast cancer, 1 of whom was diagnosed before the age of 51
- At least 1 woman with breast cancer and 1 woman with ovarian cancer are sick.
- At least 2 women are suffering from ovarian cancer
- At least 1 woman is suffering from breast and ovarian cancer
- At least 1 woman aged 35 or younger has developed breast cancer
- At least 1 woman aged 50 or younger has had bilateral breast cancer
- At least 1 man has breast cancer and 1 woman has breast or ovarian cancer
These women should be offered multidisciplinary counseling and genetic testing at specialized centers (6). Social history
- What is your occupation? Do you work in shifts?
Current medical history/systemic history (somatic and psychological complaints).
- Have you noticed any changes in the breast? Redness, retraction of the nipple?
- Have you noticed a lump in the breast?
- Do you have discharge from the nipple (breast)?
- Have you noticed any changes in the skin on the nipple?
- Did these symptoms occur on one side or both sides?
- Did you notice any other accompanying symptoms, such as lymph nodes or other changes in the axilla?
Vegetative history including nutritional history.
- Are you overweight? Please tell us your body weight (in kg) and height (in cm).
- At what age did you have your menarche (first menstrual period)?
- At what age did you have your menopause (last menstrual period)?
- Have you given birth to children? If so, how old were you at the time of the first birth?
- Did you breastfeed? If yes, how long did you breastfeed?
- Do you eat meat and fat rich?
- Have you lost body weight unintentionally?
- Do you smoke? If so, how many cigarettes, cigars or pipes per day?
- Do you drink alcohol? If yes, what drink(s) and how many glasses per day?
- Do you use drugs? If yes, what drugs and how often per day or per week?
Self history incl. medication history.
- Pre-existing conditions (mastopathy – most common breast disease between the ages of 35 and 50, is associated with cystic or fine- or coarse-nodular changes in breast tissue, respectively).
- Operations
- Radiotherapy
- Allergies
Medication history
- Calcium antagonists: long-term therapy > 10 years increases the risk of ductal and lobular breast carcinomas
- Ovulation inhibitors:
- The use of hormonal contraceptives, in contrast to the protective effect on the emergence to the protective (protective) effect on the emergence of endometrial and ovarian cancer (endometrial and ovarian cancer) increases the risk of developing breast cancer by a factor of 1.2 to 1.5 when taken for more than five years. 5-10 years after stopping ovulation inhibitors, this effect is no longer detectable.
- The risk of breast cancer increases with duration of use, according to a population-based study, normalizing within 5 years after cessation of hormonal contraception: the relative risk was 1.20 and was statistically significant with a 95 percent confidence interval of 1.14 to 1.26; the relative risk increased from 1.09 (0.96-1.23) for duration of use of less than one year to 1.38 (1.26-1.51) for duration of use of more than 10 years.
- Hormone replacement therapy (HRT):
- According to the current state of science (2013), there is a slight increase in breast cancer rates under hormone replacement therapy. After taking hormone replacement therapy for more than five years, the risk of breast cancer increases by less than 0, 1% per year (<1.0 per 1,000 women per year of use). However, this only applies to combination therapy (estrogen-progestin therapy), not to isolated estrogen therapy.In the case of estrogen-only therapy, the mean risk was even lowered after a mean application time of 5.9 years. In addition, when discussing the risk of breast carcinoma, it must be taken into account that hormone application is not responsible for the development of breast carcinoma, i.e. it does not have an oncogenic effect, but merely accelerates the growth of hormone receptor-positive carcinomas. Note: However, the increase in risk is lower than that due to regular alcohol consumption and obesity.
- Meta-analysis confirms breast cancer risks. Here, type of therapy, treatment duration and body mass index (BMI) are important influencing factors. The following are the most important findings in this regard:
- Women who started hormone therapy after menopause developed breast cancer more frequently; the risk was also detectable for monopreparations, although the risk was significantly higher for users of combination preparations.
- Type of therapy
- Primarily, the incidence of estrogen receptor-positive breast cancer is increased. Breast cancer risk increases with BMI because estrogens are known to be produced in adipose tissue. Regardless, the added risk from estrogens was greater in lean women than in obese women.
- Use of combined hormone preparations led to 8.3 cases of breast cancer per 100 women in women 50 years of age and older after more than 5 years of use (women who never took hormones and were between 50 and 69 years of age had 6.3 cases of breast cancer per 100 women), i.e., use of combined hormone preparations leads to one additional breast cancer in 50 users.
- When estrogens combined with intermittent progestin are taken, 7.7 per 100 users develop breast cancer, i.e., taking them leads to an additional breast cancer in 70 users.
- Taking estrogen monopreparations resulted in 6, 8 cases of breast cancer per 100 women (women who never took hormones and were between 50 and 69 years of age had 6.3 cases of breast cancer per 100 women) after more than 5 years of use, which means one additional cancer for every 200 users.
- Treatment duration
- 1-4 years: relative risk of
- 1.60 for estrogen-progestin combinations.
- 1.17 for estrogen-monopreparations
- 5 -14 years: relative risk of
- 2.08 for estrogen-progestin combinations.
- 1.33 for estrogen-monopreparations
- 1-4 years: relative risk of
- Age of the user at the time of the start of treatment.
- 45-49 years of age: relative risk of
- 1.39 for estrogen monopreparations.
- 2.14 for estrogen-progestin combinations
- 60-69 years of age: relative risk of.
- 1.08 for estrogen monopreparations.
- 1.75 for estrogen-progestin combinations
- 45-49 years of age: relative risk of
- Estrogen receptor-positive tumors (frequency related to duration of use).
- Intake 5 to 14 years: relative risk of.
- 1.45 for estrogen monopreparations.
- 1.42 for estrogen-progestin combinations
- Estrogen receptor-negative tumors.
- Intake 5 to 14 years: relative risk of.
- 1.25 for estrogen monopreparations.
- 2.44 for estrogen-progestin combinations
- Varia: For estrogen-only preparations, there was no heterogeneity of risk between equine estrogen and estradiol or between oral administration and transdermal administration.
- Intake 5 to 14 years: relative risk of.
- Type of therapy
- Conclusion: a careful risk-benefit assessment must be made when hormone replacement therapy is used.
- Women who started hormone therapy after menopause developed breast cancer more frequently; the risk was also detectable for monopreparations, although the risk was significantly higher for users of combination preparations.
Environmental history
- Aluminum?
- Dichlorodiphenyltrichloroethane (DDT) – insecticide banned in early 1970s; even prenatal exposure is associated with increased risk of breast cancer: Women in the top third of exposure showed an odds ratio of 5.42, with a wide 95% confidence interval of 1, 1 to 17.19, however; women who did not develop breast cancer until after menopause (menopause), aged 50 to 54 years, showed a dose-dependent increase in breast cancer risk; in the top third of exposure, the odds ratio was 2.17 (1.13 to 4.19)
- Hair dye
- Permanent hair dyes and chemical hair straighteners (risk increase for African American women: 45% if such products were used at least once within the preceding 12 months; 60% if dyeing was done every five to eight weeks; risk increases for white participants, however, were only 7% and 8%, respectively)
- Cumulative increased risk of estrogen receptor-negative breast cancer, progesterone receptor-negative breast cancer.
- High nighttime exposure to LED light both indoors and outdoors – highest light exposure was associated with a nearly 1.5-fold increased rate of breast cancer
- Polychlorinated biphenyls* (PCBs).
- Polychlorinated dioxin*
* Belongs to the endocrine disruptors (synonym: xenohormones), which even in the smallest amounts can damage health by altering the hormonal system.
