Among the diseases that threaten the female breast, breast cancer (breast cancer, (Latin: mammary carcinoma)) can probably be considered the most dangerous. Fortunately, however, both the treatment results and the chances of early detection of this disease have improved quite considerably since the last 30 years. Nevertheless, knowledge of one’s own body remains the surest protection for women against the spread of disease. From it derives the ability to recognize changes rightitig and to distinguish the diseased from the healthy.
Incidence and distribution of breast cancer
Schematic diagram showing the anatomy and structure of female breasts in breast cancer. Click to enlarge. The conditions are particularly favorable in breast cancer. Because of its superficial localization, for example, the physician is in the clear during screening examinations, but also in the office when the woman seeks treatment for
Because of its superficial localization, the physician is able to detect breast cancer in its earliest stages with simple examination methods and to initiate appropriate treatment. The statistical overview of the frequency of breast diseases at different ages shows that breast cancer is not only a disease of older women, as is often assumed. It can occur, even if such cases are seiten, already in the third decade of life. It can even be assumed that breast cancer could be detected even more frequently in the younger age groups if more women were to monitor themselves more attentively and if screening examinations were to be intensified further. The risk of developing the disease increases with age. In Germany, for example, approximately 150 new cases are reported for every 100,000 women aged 50 years. In women aged 70, the same number of new cases is even registered at around 250 per year. These figures alone make clear the need for comprehensive education about breast cancer, as well as the possibilities available to every woman for “self-monitoring“.
Symptoms and signs
The female mammary gland consists of the mammary gland tissue itself and about 15 to 20 larger mammary ducts that meet in the nipple area. The mammary gland tissue can extend up into the armpit as a so-called axillary process. More or less abundant fatty tissue is found between the individual mammary gland lobes. Pathological processes in the area of the mammary gland can now cause certain changes that can already be recognized by simple palpation. Not so rarely, however, they reveal themselves to the eye even more impressively than to the palpating hand. Such visible changes include: Inflammation of the nipple, fluid or blood secretion from the nipple, protrusion or retraction of a nipple, skin retraction, skin redness or skin swelling. Some women suffer from inflammation of the nipple during the breastfeeding period, which is often quite painful and only heals after medical treatment. However, if such changes occur outside the breastfeeding period and do not show any tendency to heal, a check-up for cancer is urgently required. Older women in particular often trivialize such inflammations of the nipple and treat them themselves with ointments or compresses, without knowing about the cancer risk. Another quite serious sign of a possible disease are fluid or blood secretions from the nipple. They indicate pathological processes within the milk ducts or in their immediate vicinity. This does not, of course, include normal milk secretion during the breastfeeding period. Pathological secretions from the nipple are yellow, brown or bloody in color. It is not uncommon for them to be noticed only intermittently. In most cases, there is hardly any palpation. This is also the reason why women with such symptoms go to the doctor late. Protrusion or retraction of a nipple, which may also be due to cancer, are difficult to recognize as early findings on ordinary observation. They may be visible when the arms are raised or the hands are placed on the hips. Sometimes skin retractions also occur. However, differences in the size of the breasts with or without the protrusion of a nipple, as well as retractions of one or both nipples (so-called slippery nipples) do not necessarily have to be symptoms of disease. They can also be hereditary.Then above such deviations from the norm are usually known to the woman since her youth. In contrast to different breast sizes and retracted nipples, skin retractions are a relatively typical sign of the presence of cancer. They are caused by scar-like shrinkage of the connective tissue elements in the breast. If they are already visible on simple inspection, it is often even an advanced disease. Reddening of the skin and swelling of the skin are consistently an expression of an inflammatory process. Since they are very painful, patients usually go to the doctor very quickly. If, on the other hand, there is no pain, such changes are easily overlooked, although this is precisely when there is a heightened suspicion of cancer and a doctor should be consulted as soon as possible. It is also essential to consult a doctor if a woman feels lumps and more or less well-defined indurations in the mammary gland. They can occur alone or be accompanied by visible changes. A problem in itself are the changes of the mammary gland under the influence of the female sex hormones. Thus, many women observe hardening in the mammary gland one or two weeks before the monthly bleeding, which then disappears. They are related to the rhythmic process of building up and breaking down of the mammary gland tissue. Therefore, they cannot be considered directly pathological, even if sometimes severe pain requires treatment.
Treatment and therapy
Not all lumps in the breast, indicate breast cancer. Nevertheless, they should be clarified in the mammogram. Treatment outcomes of breast cancer have improved significantly since the last 30 years. Undoubtedly, intensive education of the population, new technical treatment and detection options, and better diagnostics by physicians have played a significant role in this favorable development. In parallel, the number of cases detected in the favorable early stages is increasing. Similarly, the proportion of patients with benign processes has increased considerably in recent decades. Only about every twentieth patient who comes to a hospital because of a pathological change in the mammary gland has breast cancer. However, this shows that women are monitoring themselves better, which on the other hand enables doctors to detect cancers in their early stages and treat them more successfully than in earlier decades. For this very reason, it seems all the more incomprehensible to us that some women still come to the doctor very late with an already advanced breast cancer. They often report that they discovered the suspicious lump in the breast purely by chance, usually while washing. However, it is not uncommon for this initial discovery to have taken place weeks or even months ago. Carelessness or false shame prevented them from seeing a doctor for a long time. Significantly reduced chances of recovery and a correspondingly larger surgical intervention are now the consequence of such behavior, which is basically irresponsible towards oneself and the family. It is precisely the superficial localization of breast cancer mentioned at the beginning of this article that enables an extremely important and promising precautionary measure that every woman can take herself, namely regular monthly self-examination. Unlike the majority of all other organic cancers, it is possible to discover pathological changes in the mammary gland, behind which cancer is sometimes hidden, by oneself.
Self-examination and self-diagnosis
Thus, by using certain self-examination methods, every woman can help to detect cancers of the mammary glands in time to initiate with certainty a successful treatment that will not harm the body. Perhaps the following discussion of breast self-examination may seem too complicated to some women. But this is only due to the fact that in the past years too little attention was paid to the possibilities of active assistance of the individual in the early detection of breast cancer. Our current efforts are aimed at familiarizing women with the practice of self-examination, because only in this way is it possible for them to monitor themselves and detect pathological changes at an early stage. Certainly, it will be obvious to every woman that the small effort connected with self-examination is worthwhile in any case. After all, the earlier a cancer is detected, the greater the chances of a cure.The most favorable date for self-examination is the third or fourth day after the start of monthly bleeding (menstruation). At this time, the swelling of the mammary gland associated with the menstrual cycle has subsided and no longer makes breast palpation difficult. Women in menopause, i.e. after the cessation of monthly bleeding, are best to examine themselves every month on a fixed date. Self-examination begins with a close look at the breasts in front of the mirror, followed by a thorough
in front of a mirror, followed by thorough palpation. When looking at the breasts, one should focus on possible changes in the nipples, i.e. breast protrusion or retraction, skin bulges and retractions or skin redness. However, it is not enough to perform such inspection only from the front. Since some changes are only visible in profile, it is recommended to thoroughly check both side views as well.
Early detection and palpation
Mammography is an examination method for the early detection of breast cancer (mammary carcinoma), the most common cancer in women in Germany. Some pathological changes in the skin or nipples are very difficult to detect in their early stages. However, they become visible when the breasts are moved from their normal position. For this reason, the visual inspection is continued with the hands firmly placed on the hips and the arms raised above the head. Here, too, a lateral view is required in addition to the front view. Only now does one proceed to palpation. All sections of the breast should be examined from the outside in. The mammary gland tissue is pressed lightly against the chest wall with the hand placed flat. It is important that the left breast is always palpated with the right hand and the right breast with the left hand. In the case of large breasts, it is sometimes difficult to reach the lower edge of the breast. In such cases, the other hand is used and, while bending the upper body forward, the left breast, for example, is pressed with the right hand against the left hand placed underneath and this is repeated in the reverse order for the right breast. Finally, it is necessary to repeat the procedure just described once again in a lying position. There are certain changes in the breast tissue that can only be felt in this position. Fortunately, the vast majority of findings detected by self-examination or during a serial examination turn out to be benign processes that can be further examined in the specialized clinic at regular intervals. However, if a breast cancer is discovered during such a screening examination, these are invariably early-stage tumors that are still confined to the site of origin and can therefore be easily cured. In individual cases, however, a reliable diagnosis by mere visual or test findings is not always possible. Therefore, microscopic examination of tissue sections obtained from a small incision becomes necessary. The fear of disfiguring scars is unfounded here. Such wounds usually heal without irritation. However, even if minor scars remain from such incisions, they are smaller and less visible than scars generally left after cosmetic surgery of the breast. Every woman today should know that breast cancer is curable if detected and treated early enough. Regular screening and self-examination greatly increase these favorable prospects for cure.
