Breast cancer – turning point in life
Diagnosis: breast cancer. Those who gradually try to bring order to their thoughts after this shocking communication often find themselves faced with a hard piece of work: mobilizing their own forces, taking their lives into their own hands, gaining confidence. To deal with the therapy proposals, to make important decisions. But also accept help: All this is enormously important to survive the coming hardships without too much damage.
The future? Later please. First, it’s about the here and now. The goal: to win valuable years of life. In fact, breast cancer today is often and for a long time realistic. Despite all the stress that the therapy often brings, many people confirm that they can be helped. And the cancer? First defeated and over.
This article gives an up-to-date overview of breast cancer. It provides information on risk factors such as hormones and genes, benign findings in the chest that bring an increased breast cancer risk, via non-invasive (non-destructive growing) cancer precursors such as ductal carcinoma in situ (DCIS), through early detection, diagnosis, prognosis, and Therapy.
With the chapter list in the box at the top or the bar at the bottom you can quickly navigate, as well as the capital links in the text.
About half of those affected are under 65 at the time of diagnosis and about one in ten women are even under the age of 45.
Incidentally, even men can get breast cancer, but very rarely. Only about every hundredth breast cancer patient is a man.
Early detection shows successes
The undoubtedly frightening numbers, however, can be contrasted with a positive development: breast cancer is no longer the most threatening tumor in women. Meanwhile, it has overtaken lung cancer among women in developed countries (in men, lung cancer tops the list of the highest-mortality forms of cancer, both in developed and developing countries). The main cause is smoking .
Diagnosis and therapy have improved steadily, especially in breast cancer. According to current estimates, this includes mammography screening, which was introduced in Germany in 2005, ie the chest X-ray examination as part of the free early detection program for women between the ages of 50 and 69 years. The chapter “Early detection, diagnosis, prognosis ” informs you about this in detail.
The relative 5-year survival rates of breast cancer patients, considered across all disease stages, are now over 83 percent. The term “relative 5-year survival” is a statistic commonly used in cancer.
It states how many patients of one hundred affected persons live five years after the diagnosis has been established, referring to the general population of the same age and sex surviving in the same period.
The vast majority of people affected by breast cancer are still alive five years after the diagnosis, many even ten or fifteen years later. Nevertheless, the disease develops differently in every woman.
What does the prognosis depend on?
First of all, the earlier breast cancer is detected, the better the overall treatment prospects.
Crucial for the prognosis, in addition to tumor size and possible lymph node involvement of the armpit, is the biological character of the cancer. From this it is possible to draw conclusions about its growth behavior. This becomes more and more important for therapy.
But the type of treatment, the age of the patient, possible personal risk factors for breast cancer and comorbidities play a role in the prognosis.
Therefore, statistical figures are ultimately relative and always to be viewed with caution in view of the individual disease process.
What are the risk factors for breast cancer?
Breast cancer is very diverse – there are over thirty known forms alone. In the meantime, it is even thought that every patient has “her” breast cancer. The decisive cause is not there.
Significant risk factors include influences of female sex hormones and lifestyle, then age and genetic factors.
In some families breast cancer is more common. But only a part of them have a clearly hereditary predisposition. : Thus, for example, certain changes (mutations) of the two genes BRCA1 and BRCA2 (BRCA is derived from the English term for breast cancer Br east Ca responsible for about five percent of all breast cancers ncer). Another five percent are changes in other genes, including influential ones like the BRCA genes. For some, researchers have also identified increased cancer potential in conjunction with environmental factors such as alcohol.
What symptoms indicate breast cancer?
Breast cancer often develops over years. Possible signs include lumps in the breast tissue, dimples or redness of the skin , a one-sided enlargement of the breast, and more rarely also chest pain . The nipple may contract or secrete fluid (more on this in the chapter “Symptoms “)
to a swelling or hardening of the chest with redness and painIt can also come, for example, with a congestion or a resulting breast inflammation. These changes typically occur at the beginning of lactation. With a chest inflammation the pains are even more pronounced, the affected ones also feel unwell and have a fever. Local measures, such as regular emptying of the breast as well as local warmth before and cooling after breastfeeding , usually help against a stagnation . If there is evidence of infection , the doctor will also treat the woman with antibiotics. Then the inflammation usually stops.
Otherwise – and outside of pregnancy and lactation in principle – an inflammation with redness and swelling or hardening of the breast is always suspicious and in need of clarification. Rarely, in about one to four percent of cases, a so-called inflammatory (inflammatory) breast cancer may be present. The average age of the disease is 57 years, and fever is not a typical symptom. Breast cancer should always be recognized and treated quickly. This is especially true for inflammatory breast cancer as it tends to progress rapidly.
Breast cancer: early detection – diagnosis
Breast cancer is still predominantly incidental. Often, women discover the changes in the breast itself – accidentally or consciously (self-examination).
The self-exam guidance is part of the breast cancer screening by the gynecologist.
It is recommended for every woman to use the regular basic cancer screening offers.
The reimbursement by the statutory health insurance companies for women without increased risk provides for the following:
Women over the age of 20 receive an annual free screening test for cervical cancer .
For women over the age of 30, a free screening test for breast cancer is planned once a year.
The doctor carefully examines the breasts and also scans the lymphatic drainage pathways of the breast. With special features he will promptly take further steps.
Mammography Screening: Detecting Breast Cancer Earlier
The greatest importance for the diagnosis of breast cancer in addition to the palpation mammography, so the chest X-ray examination.
There are two main ways to do this: Voluntary chest X-ray examinations should contribute to earlier detection and better prognosis of breast cancer.
To this mammography s screening”healthy women” are invited between the ages of 50 and 69 – ie until the end of their 70th year – every two years. Further information can be found in the chapter “Early detection, diagnosis, prognosis”. If there is an unclear change in the breast between the screening appointments or at any time, the doctor will initiate a so-called clarification or curative mammography if necessary .
Other imaging techniques such as ultrasound examination (mamma ultrasonography ), in certain cases, magnetic resonance imaging ( MRI) of the breast may be necessary in addition – both to clarify a suspected findings in the screening as well as a curative mammogram. Modern imaging is constantly evolving, which is particularly useful in the diagnosis of breast cancer.
Ultimately, however, only the histological analysis of a tissue sample (biopsy) can ensure the diagnosis. If necessary, the doctor takes samples from a suspicious area of the breast. The tissue is then examined in detail.
First of all, there is the fundamental question of whether a destructive, invasive cancer or a non-invasive, non-invasive tissue tissue such as ductal carcinoma in situ (DCIS, see chapter “Breast cancer (breast cancer) suspicion: yet benign or already cancer? “) is present.
In both cases, the determination of specific proteins on the cell surface follows. These include those that form docking sites for sex hormones, such as estrogen or progesterone , and the molecule HER2. Physicians also speak in this context of hormone receptors and HER2 receptors, Through such receptors, both normal body cells and cancer cells receive signals to divide. Cancer cells can have a lot of them. Then they grow faster. At the same time, there are starting points for the therapy (see below).
Which diagnostic methods are suitable in detail, also in the chapter “Early detection, diagnosis, prognosis”.
Breast cancer therapy: according to guidelines
Basically, the spread of the tumor – the stage in which the breast cancer is at the time of diagnosis – influences treatment planning. Often the first treatment step is the surgical removal of the tumor, possibly also of the axillary lymph nodes (more on this in the chapter “Therapy “). During surgery, the breast can often be preserved. If it needs to be removed, the surgeon can rebuild it using an implant, body tissue, or both (breast reconstruction).
Which treatment sequence is ultimately chosen depends on various factors. So breast cancer can be different aggressive. Certain variants such as HER2-positive tumors usually treat doctors in advance with antibody therapy and / or chemotherapy. But in other cases, in which chemotherapy is indicated, this is now increasingly preceded by surgery.
And: Hormone-sensitive tumor cells react to female sex hormones, thus also to a hormone withdrawal. This is what doctors use for therapy (anti-hormone treatment). Among other things, the decisive factor here is whether the tumor occurred in a woman before or after menopause. If a hormone-sensitive breast cancer has a favorable overall prognosis, after its complete removal and subsequent irradiation usually a sole anti-hormone treatment is sufficient. Important: The treatment of breast cancer today follows scientific guidelines and is at the same time tailored to the individual patient.
Medical guidelines are recommendations for physicians based on confirmed clinical trial results. The aim is to achieve as high a degree of agreement as possible on the widest possible expert level.
The guidelines serve to achieve adequate health care. This should reduce mortality and improve the quality of life in breast cancer in the medium and long term. The recommendations contained are regularly adapted to current developments.