All about breast cancer
Breast cancer (breast cancer) is the most common cancer in women. It rarely occurs in men. Genetic predisposition and a higher age of life favor the development of breast cancer as well as smoking, obesity and lack of exercise. All about the risk factors and precursors of breast cancer, as well as its diagnosis and prevention, read here!
Breast Cancer: Description
Breast cancer (synonyms: mammary carcinoma, carcinoma mammae, or short mammary carcinoma) is a malignant tumor of the breast. It can invade healthy tissue (invasive growth) and destroy it. Individual cancer cells can spread over the blood and lymphatic pathways in the body and form new growths (metastases) elsewhere.
Breast cancer: frequency
Breast cancer affects mainly women and rarely men. In 2012, 69,550 women and 620 men were newly diagnosed with breast cancer in Germany. In almost 17,750 female and 150 male patients, the tumor resulted in death. Breast cancer is the most common cancer in women.
Lesions and breast cancer precursors
Most knotted changes detected in the breast are benign. Other changes are considered to be “dangerous lesions”, that is, tissue damage that could result in breast cancer. Examples are the intraductal hyperplasia (UDH, too many normal cells in the milk ducts) and the intraductal atypical hyperplasia (ADH, modified cells in the milk ducts).
Lobular neoplasia (LN) is also associated with this. Cell changes in the glandular lobes are summarized as “atypical lobular hyperplasia” (ALH) and “lobular carcinoma in situ” (LCIS). Already as a cancer precursor (precancerous disease) is the ductal carcinoma in situ (DCIS).
Not all of these tissue changes have the same potential to develop into cancer. In addition, the degenerative risk is influenced by other factors such as age and breast cancer diseases among other family members. As a rule, therefore, it is decided in the individual case whether a detected change in the tissue is initially observed or a treatment is initiated at the same time. An exception is the DCIS: There are general recommendations on how to avoid this.
Breast cancer: Different forms
Breast cancer is not equal to breast cancer. Medical practitioners differ in their forms. With a proportion of approximately 75 percent, invasive ductal carcinoma (IDC) is the most common form of breast cancer. It is also referred to as an invasive non-specific type (NST = “no special type”). The tumor grows in the surrounding tissue, from the milk ducts.
The second most common form of breast cancer, accounting for about 15%, is the invasive-lobular mammary carcinoma (ILC). The cancer takes its origin from the glandular lobes.
In addition, some rare breast cancer forms are known, such as inflammatory breast carcinoma (“inflammatory” breast cancer). It is considered particularly aggressive breast cancer and is associated with an inflammatory reaction in the form of skin redness and swelling. Inflammatory breast cancer accounts for only about one percent of all breast cancer.
Where breast cancer arises
Medics divide the chest into four quadrants (15 minute steps, analogous to the dial of a clock). Thus, a statement can be made about exactly where the tumor is growing:
Approximately half of all breast cancers develop in the upper outer quadrant, approximately 15 percent in the upper inner quadrant. Approximately eleven percent of breast carcinomas grow in the lower outer quadrant and six percent in the lower inner quadrant. In approximately 17 per cent of the cases breast cancer develops under the nipple.
What is mammography?
What are the advantages and disadvantages of breast cancer care? How exactly does the investigation actually take place? And how are the results evaluated?
You can find out which physical changes and complaints can lead to a breast carcinoma, in the article Breast Cancer: Symptoms .
As with many other cancers, the actual cause is not known even in breast cancer. However, it is known that a number of risk factors favor breast cancer:
Speak risk factor speak
About 99 percent of all breast cancer patients are female. Males develop very rarely a breast cancer.
Risk Factor Life
According to statistics, the risk of breast cancer in different age groups is different:
- 35 years: One out of every 110 women are infected with breast cancer within the next ten years.
- 45 years: One out of 47 women become ill within the next ten years.
- 55 years: One out of every 31 women will be diagnosed within the next ten years.
- 65 years: Highest breast cancer risk. Within the next ten years, one out of 27 women.
- At an older age, the risk of breast cancer decreases slightly again.
Breast cancer shows hormone-dependent growth in most cases. The longer a woman is exposed each month to the cyclical fluctuations of estrogen and progesterone levels, the higher the risk of breast cancer. Women who have had their first menstrual bleeding (before the age of 11) and / or only very late in the menopause (after the age of 54) are particularly vulnerable.
Also childlessness increases the breast cancer risk. On the other hand, the more children a woman has carried out and the longer she is breastfeeding.
In women who are only given their first child after the age of 32, the risk of breast cancer is also moderately increased.
The hormonal effect on tumor formation is also evident in the intake of artificial hormones. For example, the “pill” can easily increase the risk of breast cancer. Women who take the pill for at least four years before they receive a child, as well as women who prevent the pill for several years before the age of 20, are particularly affected.
Hormone replacement drugs have a particularly negative effect on breast cancer risk against menopause symptoms – especially if they are taken for more than four years. Caution should also be exercised in herbal hormones (such as phytoestrogens) offered in the form of herbal supplements and dietary supplements for menopausal problems. Their application is also risk-averse.
Risk factors overweight and lack of exercise
Overweight is an important preventable risk factor for breast cancer: in adipose tissue, hormones are produced that increase estrogen levels. The female sex hormone stimulates the mammary glands to divide the cells. If mistakes occur, cancer can develop. Especially after the menopause, obesity appears to increase the risk of breast cancer – especially the risk for estrogen-dependent tumors.
Lack of exercise does not only have a negative impact on breast cancer risk, but also harms overall health.
Risk Factor Nutrition
Fat-rich diet affects the body’s hormone production (elevated estrogen levels) and can therefore promote breast cancer (among other diseases such as cardiovascular diseases and diabetes). This is especially true for animal fats such as fat sausage, meat, butter and other whole milk products.
Smoking and passive smoking are harmful to health in many ways. Among other things, they promote the development of malignant tumors such as lung cancer and breast cancer. Especially when girls start smoking as a teenager, the risk of a malignant tumor in the breast increases significantly.
Alcohol is also a risk factor: the higher the alcohol consumption, the greater the probability of breast cancer.
Risk factor genetic predisposition
Certain genetic changes increase breast cancer risk. Read more in the article Breast Cancer Genes BRCA 1 and BRCA 2 .
Risk factor tight breast tissue
In women with very dense breast tissue – ie less adipose tissue and more glandular and connective tissue – the risk of breast cancer is increased by a factor of five. The density of the breast tissue is determined in mammography, four levels of density being differentiated:
- Density grade I: fat-transparent, well-transparent breast tissue
- Density II: Moderately transparent breast tissue
- Density III: dense breast tissue
- Density IV: extremely dense breast tissue
The density of the breast tissue depends on various factors. It increases during hormone replacement therapy and decreases during pregnancy.
Risk factor Ionizing radiation
Anyone who has received irradiation in the breast area during childhood or adolescence (due to Hodgkin’s lymphoma, a form of lymphoma cancer, for example) has a slightly increased risk of breast cancer.
Other forms of ionizing radiation, such as radioactive rays and X-rays, can also trigger breast cancer and other forms of cancer. Mammary gland tissue is considered to be particularly sensitive to radiation, especially before and during puberty as well as before the first full-term pregnancy. With age, the breast tissue becomes less sensitive to radiation.
Breast cancer: examinations and diagnosis
If you have seen a nodule in the chest and / or notice other possible breast cancer symptoms (such as skin retractions or leakage of fluid from the nipple), you should immediately go to the gynecologist. He will first talk to you to obtain important background information (anamnesis). For example, the doctor inquires about when you have discovered the symptoms, whether you are taking hormones and whether there are cases of breast cancer or other cancer in your family.
Scattering of the chest
Then the doctor will scan your chest and surrounding areas (such as armpits, bones). To do this, you have to either stretch the arms upwards or press them into your hips. When scanning, the physician observes, for example, swelling, redness, loss, and changes in the shape of the breast and nipple. By pressing the nipple lightly, he can establish whether secretion escapes.
If changes or chest discomfort occur in women under 40 years of age, an ultrasound examination (sonography) is recommended as an imaging procedure. In addition, mammography can be performed.
For women over the age of 40, it is exactly the opposite: Mammography is the imaging method of choice. It can be supplemented by an ultrasound examination if the breast tissue is quite dense.
You can read more about the expiration, significance and risks of the Brustr X-ray in the article Mammography .
Magnetic resonance tomography (MRI)
In magnetic resonance tomography (MRI) the breast tissue is displayed layer by magnetic fields. However, this very precise imaging is not a routine examination in breast cancer diagnostics. It is carried out, for example, if there is a suspicion of the spread of the tumor in the surrounding tissue when there is more than one suspected site in the breast, or if mammography does not provide good images due to breast implants. A MRI can also be indicated in women with a strong family history (breast cancer in the family).
Not every tissue change in the breast is malignant. This can only be determined with a biopsy: the doctor removes a small tissue sample from the conspicuous area in order to have it examined histologically in the laboratory. If cancer is indeed the case, it is also determined how strongly degenerate the cells are compared to healthy tissue and whether they have many binding sites for hormones (ie grow hormone-dependent). This is important for therapy planning.
The pathological finding
In the pathological findings, the characteristics of the breast carcinoma are recorded as precisely as possible, usually in the form of abbreviations.
For example, the TNM designation indicates the size of the tumor (T1 to T4), whether adjacent (regional) lymph nodes are infected (N0 to N3) and whether the breast cancer has already formed (remote) metastases in other body regions ( Yes = M1, no = M0).
For example, T4N3M0 denotes a large tumor that has penetrated into the surrounding tissue (T4), but has not yet formed any distant metastases (M0) in many lymph node cancer cells (N3).
Additional abbreviations before the TNM designation provide additional information. For example, an initial “c” means that the TNM classification is based on the results of the imaging investigation. In the case of a prefixed “p”, however, the classification is based on the findings of the fine-web examination of the tissue sample.
The “grading” – degeneration of the tumor is also important for the classification of breast cancer stages. It consists of four stages: from G1 (tumor still well differentiated, slow growing, less aggressive) to G4 (undifferentiated tumor, fast growing, tends to grow aggressively into surrounding tissue).
In the pathological findings, the hormone receptor status of the tumor is also indicated, ie whether breast cancer has many docking sites for estrogen (ER + or ER-positive) and / or progesterone (PgR + or PgR-positive). If so, a corresponding hormone withdrawal can slow down tumor growth.
The HER2 receptor status, ie the tumor cells on their surface have many docking sites for growth factors, is also recorded. If yes (HER2-positive), the disease usually takes a more aggressive course. With special therapies that block the HER2 receptors, attempts can be made to prevent breast cancer from growing.
Unsuitable for diagnosis: Tumormarker
Breast cancer can not be diagnosed, as hitherto hoped, by means of tumor markers in the blood. Tumormarkers are proteins whose concentration in the blood or tissue can be increased in cancer. They are either produced by the tumor itself or by healthy cells in response to the tumor. However, other diseases can often also increase the amount of such tumor markers, which is why they are usually not suitable for cancer diagnosis. The most important tumor marker in breast carcinoma is the CA 15-3; CEA also plays a role. However, the repeated determination of these tumor markers can help to assess the course of the disease and the success of the therapy.
Breast cancer: treatment
On the basis of the results of the examination and individual factors (such as age and general health) the doctor will draw up an individual therapy plan. This usually comprises different therapeutic approaches. Thus, after the surgical removal of the tumor, the affected area is often still irradiated in order to kill cancer cells left behind.
Breast cancer: chemotherapy, radiation, hormones
Obtain a second opinion
If you are unsure about the suggested therapy plan, you can ask for a doctor’s second opinion. Health insurance companies and cancer counseling centers help you find the right specialist. You must provide all documentation that led to the initial diagnosis (laboratory findings, radiographs, etc.) as well as a summary of the diagnosis and the planned measures (the first-time physician is obliged to provide these documents or copies thereof).
The second specialist can confirm the suggested therapy or recommend it in modified form. If the first and second opinions differ strongly, the two doctors should consult with each other and formulate a joint therapy recommendation in order not to discourage you as a patient.
After a breast amputation, a breast reconstruction can significantly improve the cosmetic result. For more information, see Breast Building .
The partial or complete removal of one or both breasts can be masked optically with a prosthesis. Read more about breast prostheses .
Aftercare and rehabilitation after breast cancer
If aftercare and rehabilitation measures are appropriate after the treatment of a breast carcinoma, read the section ” Follow-up and rehabilitation after breast cancer” .
Breast cancer: disease history and prognosis
The course of the disease in breast cancer depends on various factors. Especially the type of breast cancer and the stage of the tumor in its discovery play a role. Other factors also have an influence. For example, fewer relapses occur in patients under 35 years of age, and the prognosis is generally less favorable for them than in older age groups.
Breast cancer: metastases
For more information on the development, diagnosis, symptoms and therapy of breast cancer, see Breast Cancer: Metastases .
Breast cancer: healing chances
As the prognosis in a breast cancer looks like, read the article Breast Cancer: Healing Chances .
Some risk factors for breast cancer can be avoided or at least reduced. For example, you should pay attention to regular physical activity: anyone who is physically active 30 to 60 minutes at least five times a week reduces his breast cancer risk by 20 to 30 percent.
Strengthened exercise also helps to avoid or reduce excess weight – excess fat pads also favor breast cancer. The same applies to high-fat diet: therefore do not eat too many animal fats (such as fat sausage, meat, butter and other dairy products).
If possible, do not smoke or drink alcohol (or only in moderation).
Also, consult with your doctor to see if hormone replacement therapy (HET) is appropriate for you during the menopause. Because hormone drugs can increase the risk of breast cancer .