In breast carcinoma – colloquially called breast cancer – (synonyms: Breast carcinoma; Carcinoma mammae; ICD-10-GM C50.-: Malignant neoplasms of the mammary gland [mamma]) is a malignant (malignant) disease of the mammary gland. Breast carcinoma is the most common tumor disease in women. It is the second most common malignant (malignant) disease worldwide. According to ICD-10-GM, a distinction is made between malignant, premalignant (tissue changes that are fine tissue signs of malignant degeneration), metastatic and secondary carcinomatous changes in the breast. In this context, only the premalignant and malignant diseases of the mammary gland will be presented, but not the secondary carcinomatous and the premalignant and malignant diseases of the skin, e.g. melanoma (“black skin cancer“). Premalignant changes of the mammary gland
- ICD-10-GM D05.- Carcinoma in situ of the mammary gland [mammary].
- ICD-10-GM D05.0 Lobular carcinoma in situ of the mammary gland.
- ICD-10-GM D05.1 Carcinoma in situ of the mammary ducts
- ICD-10-GM D05.7 Other carcinoma in situ of the mammary gland.
- ICD-10-GMD05.9 Carcinoma in situ of the mammary gland, unspecified.
Malignant changes of the mammary gland
- ICD-10-GMC50.- Malignant neoplasm of the mammary gland [mammary].
- Incl.: Connective tissue of the mammary gland
- Excl : skin of the mammary gland (ICD-10-GM C43.5, ICD-10-GM C44.5).
- ICD-10-GM C50.0 Malignant neoplasm: Nipple and areola (paget carcinoma).
- ICD-10-GM C50.1 Malignant neoplasm: Central glandular body of the mammary gland.
- ICD-10-GM C50.2 Malignant neoplasm: Upper inner quadrant of mammary gland.
- ICD-10-GM C50.3 Malignant neoplasm: Lower inner quadrant of mammary gland.
- ICD-10-GM C50.4 Malignant neoplasm: Upper outer quadrant of mammary gland.
- ICD-10-GM C50.5 Malignant neoplasm: Lower external quadrant of mammary gland.
- ICD-10-GM C50.6 Malignant neoplasm: Recessus axillaris of mammary gland.
- ICD-10-GM C50.8 Malignant neoplasm: Mammary gland, overlapping several subregions
- ICD-10-GM C50.9 Malignant neoplasm: Mammary gland, unspecified
Breast carcinoma arises from either the mammary glands (lobular breast carcinoma) or the mammary ducts (ductal breast carcinoma). Metastasis can be hematogenous (“by the bloodstream”) and lymphogenous (“by the lymphatic system”). Sex ratio: breast carcinoma can also occur in males – but very rarely (about 600 cases annually). The ratio of women to men is 150: 1. Therefore, only female breast carcinoma will be discussed below. Peak incidence: The disease occurs particularly in women between the ages of 45 and 70. The average age today is over 60 years. However, 30% of affected women are younger than 40. After childbirth, the risk of breast carcinoma increases and reaches a peak after about 5 years (HR 1.8; 95% confidence interval: 1.63-1.99). The increased risk was detectable only for estrogen receptor-positive breast carcinomas.The theoretical risk of developing breast cancer by the age of 74 years is approximately 8% for each healthy woman. In Germany, approximately 57,000 women are diagnosed with breast cancer each year. In only about 10% of cases are congenital genetic changes (mutation in the genes BRCA-1 on chromosome 17 and BRCA-2 on chromosome 13) responsible for the disease. In carriers of a BRCA mutation, the risk of disease is 60-80% higher than in the normal population. These women develop the disease significantly earlier (about 20 years). The risk of developing a contralateral (“on the opposite side”) breast carcinoma (up to 60 %) or an ovarian carcinoma (up to 40 %) is also increased. For the recently discovered RAD51C and RAD51D genes, the risks of developing the disease appear to be just as high. The prevalence of the disease is about 1 % of the female population in Germany. After the age of 50, approximately 2% of all women are affected. Lifetime prevalence figures vary worldwide between 3-22%; 12% (Germany).
The incidence (frequency of new cases) is approximately 123 cases per 100,000 inhabitants per year in Germany. The left breast is statistically more frequently affected than the right breast.Course and prognosis: In addition to the size and aggressiveness of the tumor, the decisive factor for the course is the involvement of the lymph nodes in the armpits. If these are free of tumor cells, there is a high chance of cure. The more lymph nodes are affected, the worse is generally the prognosis. Breast carcinoma may recur. About 7-20% of patients experience an intramammary recurrence. (Recurrence of disease after breast-conserving surgery). The recurrence rate (recurrence of the disease) is 5-10% in the first ten years after successful breast cancer treatment. Mortality (number of deaths in a given period, based on the number of the population in question) is 41 per 100,000 women per year. The 5-year survival rate is approximately over 90% in stages 0 and I. In stages II and III, it is between 82 and 44 %. In stage IV, it is approximately 14 %. Over the past 40 years, adjuvant therapy has reduced the risk of metastasis (risk of formation of mammary tumors) and significantly improved the survival of women with invasive breast cancer. Further references
- Women diagnosed with ductal carcinoma in situ (DCIS) have three times the risk of death as a result of breast carcinoma compared with women without DCIS.
- Young carriers of BRCA1 or BRCA2 mutations have the same survival chances as patients without BRCA mutations in the first 10 years after diagnosis of breast cancer.
- Men with breast cancer have higher mortality rates than women: the fully adjusted all-cause mortality (all-cause death rate) for men is 19% higher than for women.
