Information regarding breast cancer

Definition: What is breast cancer?

Breast cancer in the female breastBreast cancer is the most common cancer in women and also the most common cause of death among cancers. Around 75,000 new cases of breast cancer were predicted for 2014. The number of breast cancer cases has risen continuously since 2005, but the number of deaths has fallen. This is thanks to more intensive cancer prevention through the introduction of breast X-rays (mammography) in 2005.

One in eight women is diagnosed with breast cancer during their lifetime. This malignant tumor originates from the glandular tissue or milk ducts in the breast. The risk of developing breast cancer increases with age.

Causes: What are the causes of breast cancer?

As with most cancers, the primary trigger for breast cancer is unknown.

However, there are certain risk factors that are associated with a small to significantly increased risk of breast cancer. These include hereditary genetic changes (particularly genes BRCA1 and BRCA-2) which are also associated with ovarian cancer. Depending on who in the family has the disease, your own risk increases many times over (men can also get the disease, although much less frequently).

Long-term hormonal influence from estrogens is also one of the risk factors. It is caused by an early first period (menarche) and a late last period (menopause) as well as by missing or late pregnancies.

X-rays (mammography is harmless due to the low radiation dose), inflammation of the breast, smoking, alcohol and obesity also have a negative influence.

Symptoms: What are the symptoms of breast cancer?

In 80% of cases, breast cancer is discovered by the woman herself. A hard lump is usually felt during a breast examination (most often in the outer upper quadrant of the breast). There is also a bulging or retraction of the skin, and in later stages, orange peel skin (due to lymph fluid that cannot drain away), bloody secretion from the nipple and chronic rashes (eczema) in the breast area.

Metastasis (spread of tumor cells in the body - formation of secondary tumors) occurs relatively early. The lymph nodes in the armpit, the skeletal system, lungs, liver and brain are affected. There is a clear positive correlation between tumor size and the speed of metastasis. However, tiny tumor cell clusters can remain silent in the body for up to 15 years before they grow into a recognizable secondary tumor.

Diagnosis: How is breast cancer diagnosed?

From the age of 30 (often much earlier), the gynecology specialist performs an annual breast examination. If the specialist detects changes that suggest cancer (palpable lump, breast pain, bloody discharge from the nipple or retracted nipple), the suspicion can be confirmed using mammography (X-ray) or breast sonography (ultrasound).

Ultrasound is the method of choice for palpable lumps, mammography for non-palpable changes in the breast. Mammography is performed every two years in women between the ages of 50 and 59.

The specialist then takes a tissue sample (biopsy) to confirm the diagnosis. A contrast medium examination of the milk ducts (galactography) can also be carried out if there is bloody secretion, and in certain cases an MRI.

Therapy: How is breast cancer treated?

After the diagnosis, the spread of the disease is diagnosed (staging). These include chest X-rays, liver ultrasounds, and bone scintigraphy.

What is important for the prognosis is the spread in the body (metastasis) and not the radical nature of the breast cancer operation. In the past, the entire breast was always removed (mastectomy), but today the treating specialists operate in a breast-preserving manner where possible. Only the tumor is removed and the healthy breast tissue is preserved. The most important prognostic factor is lymph node involvement. Therefore, these must also be examined and removed if necessary.

The breast can be reconstructed after mastectomy in the same session or after 6 months at the earliest.

After the operation, the preserved breast is also irradiated. This reduces the risk of local recurrence from 30 to 5 percent. In addition, depending on the nature of the tumor, chemotherapy and/or certain antibody therapies are carried out. The aim is to eliminate possible metastases.

Radiation therapy alone is only used in cases of inoperable breast cancer (palliative treatment).

Chances of recovery: What is the prognosis for breast cancer?

The 5-year survival rate is between 80 and 85%. The 10-year rate is slightly lower.

The definitive cure can only be determined 20-40 years after treatment, as small tumor cell clusters can remain hidden in the body until then.

Follow-up examinations are therefore important. The treating specialist inspects and palpates both breasts. The drainage area of the lymph fluid (especially in the armpit area) is also examined. In the first three years, follow-up care takes place quarterly, then half-yearly and from the fifth year onwards annually. Mammography is carried out annually.

Newly occurring symptoms such as bone pain, breathing or upper abdominal complaints must always be examined carefully, as they can be signs of metastases.

If you have any further questions about the treatment and prognosis of breast cancer, please contact a gynecologist at the University Hospital of Bonn .