Every year in Germany, 50,000 women and their families are confronted with the frightening diagnosis of “breast cancer“. Once the initial shock is over, the affected women are faced with a seemingly insurmountable “mountain” of unanswered questions: “What happens now? Does every minute count or do I have enough time to choose a clinic? What are the treatment options? Can my breast be preserved?” For many women affected by breast cancer, confusion and uncertainty reign.
What are the causes of breast cancer?
The exact causes of breast cancer are not yet known. In most women who develop breast cancer, no specific risk factor can be proven to be a sure trigger for the cancer. Breast cancer is a malignant tumor of the mammary gland. A tumor usually starts from a single degenerate cell. What changes this cell is still not known.
Are there risk factors?
Probably several points play a role in the development of breast cancer. For example, hereditary and hormonal components are considered general risk factors. If a mother or sister has breast cancer, the risk of also developing breast cancer increases 2- to 3-fold. In addition, an early first menstrual period (before the age of 12) and a late menopause (after the age of 55) as well as a late (after the age of 30) or no pregnancy are considered possible risk factors. Personal lifestyle (alcohol, smoking, obesity) may also play a role.
Do I have an increased risk of breast cancer?
However, the possible presence of several of these factors need not upset you. Careful observation of your own body and regular screenings are the best ways to detect changes in your breasts early and have them clarified or, if necessary, treated.
What can I do for preventive care?
Once a month (preferably right after menstruation, when breast tissue is soft), every woman should carefully examine her breasts herself. To do this, stand in front of a mirror and look at your breast from all sides, including with your arms raised. While doing this, pay attention to any changes. Then palpate both breasts with the fingers of the flat of your hand in a clockwise direction. Then gently squeeze both nipples between your thumb and index finger to see if any fluid is leaking. Then, while lying down, palpate the breast again as described above. Finally, the armpits should also be examined for any swollen lymph nodes. It is important that you take advantage of the offer of regular gynecological screening. The doctor will also palpate your breasts and may recommend a complementary mammogram.
What are the symptoms?
The following symptoms may indicate breast cancer:
- A palpated fuzzy lump.
- Indurations or a rough spot on the breast
- One breast is suddenly larger or shaped differently than the other
- A sudden redness that does not subside
- Skin retractions or “orange peel skin”
- Nodes in the armpit
- Secretions from the nipple
If you notice one or more of these changes in yourself, you should see your gynecologist.
What is the diagnostic process? What is a mammogram?
First, the gynecologist will carefully palpate the breast. If a lump is palpated, this is usually followed by what is called a mammogram. This is an X-ray examination of the breast in which the breast is gently squeezed for better fluoroscopy. This is often perceived as unpleasant, but is crucial for the quality of the X-ray image, on which an experienced doctor can detect even the smallest changes.
What other examinations are available?
Complementary to mammography, an ultrasound examination can be performed. However, this does not replace mammography. Rather rarely, an MRI is performed if breast cancer is suspected. For final confirmation of the diagnosis, a tissue sample is taken in the hospital. Various procedures are available for this purpose.
Can breast cancer be cured today?
Yes, breast cancer can be cured if it is detected in time before it metastasizes, that is, settled tumor cells spread to other parts of the body.
What happens after diagnosis?What is the usual procedure? Does every minute count?
After the diagnosis is confirmed, the physician will admit his patient to a hospital to begin surgery as the first step in treatment, as a rule. In most cases, surgery is performed promptly after the diagnosis is made. However, if you feel that everything is happening too quickly, take your time. Get a second opinion if you are unsure. Even if there are a few weeks between the diagnosis and the start of therapy, this is not decisive for the further course.
How do I find the right clinic? What should I look for when choosing a clinic?
Of course, it is pleasant to be a patient in a nearby hospital. However, it is more important to pay attention to the qualifications of the clinic and the doctors. In general, university hospitals, tumor centers or breast centers are considered the best addresses. Here, the doctors are specialized in the disease breast cancer and participate in current therapy studies.
Are there different forms of therapy?
Today, the state of science makes it possible to provide a “tailor-made therapy” for each patient. The first therapy step is usually surgery to remove the tumor tissue from the breast. During this procedure, the lymph nodes under the armpit are also removed and then examined for the presence of cancer cells. Further therapy is then based on the so-called lymph node status.
What happens after surgery?
Surgery is followed by radiation treatment of the affected breast. In patients whose lymph nodes were tumor-free, either no further therapy is given or hormone therapy or chemotherapy is recommended. If the lymph nodes contain cancer cells and hormone receptors can be detected in the tumor tissue (hormone dependence), a combination of chemotherapy and hormone therapy is advised. Without the presence of hormone receptors, only chemotherapy is recommended.
What is a therapy study?
Studies of new therapies for breast cancer are very important for medical progress. Different therapies are compared with each other at so-called study centers. This often involves dividing patients into two groups, one of which receives the most effective standard therapy and the other a new, promising therapy.
Will I benefit from participating in a trial?
Absolutely. Trials are conducted at specialized clinics and offer those affected improved chances of recovery and survival. Even in the preliminary stages, it is checked whether the study therapy is suitable for the patient. New drugs that have already been confirmed by clinical trials are compared with proven standard therapies. In this way, it can be assumed that each patient will receive one of the best treatments currently available. In other words, patients receive the highest quality of care as well as treatment in trials – compelling reasons to participate in a trial.
What is the approach to surgery today? Can the breast be preserved in the process?
Surgery is usually performed immediately after diagnosis and is done as gently as possible. The entire tumor and a “safety margin” of about one centimeter around the affected tissue are removed. Often, the operation can also be performed in a breast-conserving manner. This depends on the type and extent of the tumor and the size of the breast, among other factors.
What is chemotherapy? When is it used?
Chemotherapy uses drugs that inhibit cell division (called cytostatics). It is a systemic treatment, meaning one that affects the entire body. Whether chemotherapy is appropriate depends on the type and stage of the tumor disease and the patient’s general condition. The therapy is administered at specific intervals, known as cycles. Each treatment phase is followed by a break. The earliest possible use of chemotherapy is the so-called primary systemic use (formerly also called “neoadjuvant”). Its purpose is to reduce the size of the lump before surgery in order to make breast-conserving surgery possible. In addition, this early intervention can be used to check whether the therapy is working and the tumor is shrinking. The goal is to cure the breast cancer.
What does adjuvant chemotherapy mean?
In Germany, so-called adjuvant chemotherapy, which means chemotherapy that prevents a relapse, has been performed as standard for many years. Several drugs are available for this purpose.Adjuvant chemotherapy is intended to prevent metastases from forming or the patient from relapsing. The goal of this therapy is also cure. A recent study showed that women treated with the modern cancer drug Taxotere (active ingredient docetaxel) were 32 percent less likely to relapse than patients who received standard therapy with conventional drugs. In women who had only minor lymph node involvement, survival increased by more than 50 percent.
What is palliative chemotherapy?
When the disease has already progressed, meaning the tumor has already metastasized, so-called palliative chemotherapy is used to halt further progression of the disease and bring about rapid relief of potential symptoms. The patient’s quality of life is the primary focus of this therapy.
What is hormone therapy?
Hormone receptors are found in a large proportion of all breast cancers, which means that the growth of the tumor can be additionally stimulated via female sex hormones. In these cases, tumor growth can be stopped or slowed down by intervening in the woman’s hormone balance. There are various options available for hormone therapy: So far, the standard therapy consists of the administration of tamoxifen. This is a so-called antiestrogen that occupies the hormone receptors and thus displaces the body’s own estrogen, which would stimulate tumor growth. Tamoxifen is usually taken for five years. So-called GnRH analogues are available as a therapeutic option for pre-menopausal women. These are hormones that inhibit the body’s own hormone production in the ovaries. Removal of the ovaries thus becomes unnecessary.
