Synonyms in a broader sense
English: breast cancer
- Breast carcinoma
- Mamma-Ca
- Invasive ductal mamma-ca
- Invasive lobular breast cancer
- Inflammatory breast cancer
Definition Breast Cancer
Breast cancer (breast carcinoma) is a malignant tumour of the female or male breast. The cancer can originate either from the ducts of the glands (milk ducts = ductal carcinoma) or from the tissue of the glandular lobules (lobular carcinoma).
Occurrence in the population
Breast cancer (Mamma-Ca) is the most common malignant tumour disease in women. Every year in the industrialised countries about 50,000 women are newly diagnosed with breast cancer. In other words, this means that almost every 8th-10th woman in the industrialised countries will develop such a tumour during her lifetime.
The time of the new occurrence of breast cancer is more often around the age of 40. Another time at which women increasingly develop breast cancer is after the menopause (climacteric). However, young women around the age of 20 can also get breast cancer.
Around the age of 40, breast cancer is the most common cause of death for women in industrialised countries. If we look at the number of new cases of breast cancer over the course of a few years, we come to the conclusion that the rate of women who develop breast cancer each year increases from year to year (rising incidence of breast cancer). The situation is quite different in developing countries. There breast cancer is a rarity.
Breast cancer of the nipple
Breast cancer of the nipple is also called Paget’s disease. This cancer can grow either locally or invasively. In contrast to classical breast cancer, Paget’s disease shows some characteristic symptoms.
Typical symptoms are itching, burning and scaly skin changes on the nipple. There may also be retractions on the nipple or a bloody section may emerge from the nipple. In the diagnostic work-up a small piece of tissue is removed with a punch and this is examined by the pathologist.
A mammography and sonography are also performed. Breast cancer of the nipple resembles various skin tumours or benign skin changes that can also occur in this area. If possible, the therapy is carried out surgically, with subsequent systemic therapy.
The exact cause of the development of breast cancer is still unknown. However, in about 5% of all breast cancer patients a connection between breast cancer and a change in a gene (autosomal – recessively inherited gene mutation) could be found. More about the causes: Causes of breast cancer The change (mutation) in patients is either on the BRCA-1 gene (Breast Cancer 1 gene = breast cancer gene 1) on chromosomes 17 or the BRAC-2 gene (Breast Cancer 2 gene = breast cancer gene 2) on chromosomes 13.
If a patient inherits such a change in a gene, he or she has an increased risk of developing breast cancer. Other risk factors that can promote the development of breast cancer are Other risk factors are Likewise, some benign changes in the breast tissue (connective and/or glandular tissue) (mastopahty grade 2 and 3) may be an increased risk for breast cancer. Smoking also increases the risk of developing breast cancer.
- An early onset of menstruation (menarche)
- And a late onset of the menopause (menopause)
- No children (Nullipara)
- Women who have born their first child beyond the age of 30 (late primipara)
- Overweight (obesity)
- Ovarian cancer (carcinoma of the ovary)
- Uterine cancer (endometrial carcinoma)
- Cancer of the colon and rectum (colorectal cancer)
Risk factors are divided into hormonal, hereditary and other risk factors. In the case of hormonal risk factors, the longer the active hormonal period, the higher the risk. This means that women with early menstrual bleeding and late menopause have an increased risk.
This is also the case for women with no or few pregnancies, as well as women who have taken hormonal contraceptives in the last 5 years or hormonal preparations after the menopause. Hereditary risk factors for breast cancer include, above all, the mutation in the BRCA gene, the breast cancer gene. However, there are a whole range of other mutations which are risk factors for the development of breast cancer.
In addition to these two large groups of risk factors, there are other factors that are grouped together under other risk factors. These include old age, high breast tissue density, low physical activity, lack of sleep, smoking or diabetes mellitus type 2. A positive history of breast cancer is also one of the risk factors for breast cancer.
A positive history means that there is already breast cancer on one side or other lesion that has not yet degenerated. . The breast cancer gene is a mutation, i.e. a change in the genetic material, in the BRCA genes.
There are many other genes associated with a higher risk of breast cancer, but the BRCA gene is the best studied. The mutation is inherited autosomal-dominantly. This means that if one parent is a carrier of the mutation, children have a 50% risk of inheriting the mutation and therefore an increased risk of cancer.
People who carry a mutation in this gene have a 60-75% lifetime risk of developing breast cancer and, depending on the exact mutation, a 10-60% lifetime risk of developing ovarian cancer. The early age of the breast cancer gene is typical for the breast cancer gene and time tumours occur more frequently than in the normal population. If a mutation in the BRCA gene is suspected in the family, genetic testing can be performed.
First, an already ill person is tested and if the result is positive, the direct family can be offered genetic testing. The breast cancer gene is also found in a quarter of all men with breast cancer. Because the risk of cancer is so high, all persons at risk are included in an intensified early detection programme in order to detect a possible tumour as early as possible.
Age is a risk factor for breast cancer. The risk of developing breast cancer increases with age, younger women are rarely affected. The majority of women only develop breast cancer after the age of 40 and especially after the age of 50.
Most diseases occur after the menopause. The average age of breast cancer is 64 years. All other cancers occur on average only at a higher age.
The risk of developing breast cancer is further increased if a late growth spurt occurs in adolescence or the menopause (climacteric with subsequent menopause) starts late. Statistically, women who were over 30 years old when their first child was born are also more likely to suffer from breast cancer. Smoking is a major risk factor for breast cancer.
Studies have shown that smoking women have a 17% higher rate of breast cancer. In strong women this rate is even increased by 21%. It is also interesting to note that women who smoked more than 5 years before their first pregnancy are particularly at risk.
This has to do with the fact that the breasts only become fully differentiated after the first pregnancy and are very vulnerable to harmful influences before that. The consumption of alcohol is a risk factor for breast cancer or other cancers. Alcohol has probably its most harmful effect when consumed daily.
Then even small amounts of alcohol (5-15 grams) are sufficient to have harmful effects on the breast gland tissue. Therefore, abstaining from alcohol is much more effective than just reducing the dose. Taking the pill can increase the risk of breast cancer.
This is due to the hormones contained in the pill. In a recent study it was shown that the risk of breast cancer can be up to twenty percent higher if you are currently taking the pill or took it up to five years ago. The risk increases the longer you take the pill.
In absolute numbers this means 13 additional women out of 100. 00 who get breast cancer, which can be converted into 0.013%. However, the increased risk of breast cancer should always be weighed against the benefits of taking the pill.
Studies have shown that low vitamin D levels are associated with higher overall mortality from breast cancer. However, it is not clear whether advanced cancer leads to lower vitamin D levels, i.e. whether it is the result of the cancer or the cause of the more severe course. So far, however, it is not recommended to take vitamin D preparations as a general rule, as it has not yet been sufficiently investigated what effects the preparations have on the course of the disease.
Breast cancer develops over several years from preliminary stages. Initially still normal cells (differentiated cells) change over time, they de-differentiate so to speak (undifferentiated cells). They are then usually no longer controlled by the body’s regulatory mechanisms, but continue to grow and change independently.
Eventually, the cancer cells lose their original function. The preliminary stage (precancerosis) of breast cancer of the ducts (invasive ductal mamma carcinoma) is a so-called surface carcinoma of the milk ducts (Ductal Carcinoma in situ = DCIS). It accounts for 90% of all precancerous stages of breast cancer.
In this surface carcinoma the cells are already changing, but do not grow destructively into the depth of the tissue. Surface carcinomas therefore grow superficially, as the name suggests. They cross a certain line (basement membrane), which does not separate the superficial cells from the surrounding tissue.
Also, the cancer cells of the surface carcinoma do not settle (metastasise) in other organs. About 20% of such surface carcinomas of the mammary ducts occur on both sides and in several places (multiple). If such a surface carcinoma grows (proliferates) faster than vessels can form that can supply the surface carcinoma with nutrients, some parts of the tumour may die (necrosis).
These dead parts can calcify in the further course. These calcifications in the breast cancer tissue can be detected by mammography. These surface carcinomas of the milk ducts, i.e. the preliminary stage of breast cancer of the milk ducts, can develop into destructive (destructive, invasive) breast cancer that penetrates (infiltrates) the surrounding tissue.
This usually occurs in less than 10 years. The preliminary stage of breast cancer of the lobules (invasive lobular mamma carcinoma) is also a surface carcinoma (lobular carcinoma in situ = LCIS). This carcinoma does not grow in the ducts but in the tissue of the lobules.
Dead tissue is less frequent than in the case of surface carcinoma of the mammary ducts and therefore calcification is less frequent. About 30% of the cases are bilateral and about 60% of the cases are located in several places (multicentre). After about 25 years, this preliminary stage develops into breast cancer of the lobules.
and breast cancers. Breast cancer of the milk ducts is the most common form of breast cancer followed by breast cancer of the lobules. Another rare form of breast cancer is the mucinous carcinoma, also called gall bladder carcinoma, which can produce viscous mucus.
The medullary carcinoma and the papillary carcinoma are also other rare forms of breast cancer. Other rare forms are tubular carcinoma, adenoid-cystic carcinoma and comedo carcinoma. The latter is a malignant tumour with centrally located (central) dead cells (necroses).
A special form is the so-called inflammatory breast cancer (inflammatory mamma carcinoma). It accounts for 1-4% of all breast cancers. The name comes from the fact that the breast looks as if there is an inflammation.
As the cancer cells settle in the lymph channels (lymphangiosis carcinomatosa) of the skin, the breast becomes overheated and reddened (erythema). The breast is also swollen. The skin has retractions (orange peel skin).
In the case of a breast with such an appearance it must always be clarified whether it is an inflammation or breast cancer. Paget’s carcinoma (Paget’s disease of the breast) is also a special type of breast cancer. In this type of breast cancer, the tumour is connected to the nipple (nipple).
The nipple is red, scaly and itchy. Paget’s disease is also a special type of breast cancer. In this type of breast cancer, the tumour attaches to the nipple (nipple). The nipple is red, scaly and itchy
