Everything about breast cancer risk factors, symptoms, prevention, therapies and relapse
It is by far the most common cancer among women in Germany: every year around 70,000 people are diagnosed with breast cancer for the first time.
The average age at which women develop breast cancer is below that for cancer in general: three out of ten are younger than 55 years old when they are diagnosed with breast cancer. One in eight women will develop breast cancer at some point in their life. According to the RKI, about one percent of all new cases affect men.
- Breast Cancer in Germany
- How does breast cancer develop?
- What factors can increase the risk of developing breast cancer?
- How do I know if I have a genetically increased risk?
- Can I prevent the disease if I have a breast cancer gene?
- What screening tests are there at what age?
- What symptoms do I have to see a doctor for?
- What therapy options are there today for breast cancer?
- What is the chance of a cure for breast cancer?
- When should I do a genetic test for hereditary breast cancer?
- 50 important facts about breast cancer
Breast Cancer in Germany
With around 69,000 new cases annually, breast cancer is by far the most common cancer among women in Germany. Almost 30 percent of those affected are younger than 55 when the diagnosis is made. The death rate is 25 percent. The causes are hormones and genetic makeup, but also obesity, lack of exercise after menopause and alcohol.
How does breast cancer develop?
Breast cancer, as the medical term is used, is a malignant tumor in the mammary gland. It arises from changes in the genome of a cell that make it immortal, which means that it can multiply unhindered until many millions of cells form a tumor.
What factors can increase the risk of developing breast cancer?
► Hormones: An early first and late last menstrual period, childlessness or a higher age at the time of the birth of the first child are considered risk factors. Hormone replacement therapy for menopausal symptoms can also increase the risk of breast cancer.
► Obesity: People who are overweight produce large amounts of insulin. Many cancer cells use insulin as a growth factor. A permanently increased level of insulin therefore favors their growth and thus the development of breast cancer. In addition, fat cells produce the sex hormone estrogen, among other things. In the case of obesity, the hormonal balance is unbalanced, which promotes the growth of cancer cells.
► Alcohol: The more a woman consumes, the higher the chance of developing breast cancer.
► Family risk: Experts estimate that five to ten percent of all those affected have inherited the ability to develop breast cancer from their mother or father and can in turn pass this on to their children.
► Age: From the age of 50 one speaks of age risk. In old age, the body can repair cells with altered genetic material less quickly and reliably, ie the longer one lives, the more the genetic material changes.
How do I know if I have a genetically increased risk?
Anyone who belongs to a risk family because female or male family members have had breast cancer can seek advice from breast centers with specialized centers for familial breast and ovarian cancer (in Berlin: Charité, ☎ 450 527 237) and have a genetic test done to find out whether there is a mutation in the so-called BReast CAncer genes BRCA1 and BRCA2.
Can I prevent the disease if I have a breast cancer gene?
Yes, through risk-reducing operations: removal of ovaries and fallopian tubes and the breast. The overlying skin and nipple are preserved.
What screening tests are there at what age?
Women over 30 years of age have the option of an annual palpation examination by the gynecologist. Women between the ages of 50 and 69 are invited for a breast x-ray every two years as part of the mammography screening program.
What symptoms do I have to see a doctor for?
► Lumps in the chest or armpit
► Changes in the shape, position or size of the breast
► Retraction or bulging of the breast tissue
► Retracted nipple, which may discharge fluid
► Skin changes on the chest
► Unexplained weight loss
What therapy options are there today for breast cancer?
Surgery: Surgical removal of the tumor is necessary in most cases. On radical 0, the whole breast is removed. Today, breast-conserving operations are increasingly being performed (partial resection).
Radiation therapy : Ionizing radiation destroys any remaining tumor cells or metastases after the operation.
Chemotherapy: So-called cytostatics prevent cancer cells from dividing. The therapy is individually adapted to the patient and can be carried out on an inpatient or outpatient basis.
Anti-hormone therapy: In many women, breast cancer grows in a hormone-dependent manner , ie the tumors have docking points for the female hormones estrogen and progesterone. The hormones stimulate the growth of tumor cells via these receptors. There are two options for treatment: 1. The estrogen receptors are blocked. The body’s own hormones are still there, but their hormonal effect in the tissue is inhibited. 2. The body’s own production of sex hormones is prevented from the start.
Targeted therapy : The term summarizes active ingredients that counteract specific properties of the cancer cell. They occupy receptors on the outer wall of the cell (antibodies) or penetrate the cell and act there (signal inhibitors).
Immunotherapy: If certain proteins are detected on the tumor cells (e.g. the HER2 or PD-L1 receptor), appropriate antibodies can be administered in a targeted manner, which occupy the docking points and thus firstly prevent the growth of the tumor cell and secondly activate the body’s own immune system .
What is the chance of a cure for breast cancer?
Recognized in good time and treated in accordance with guidelines, most breast cancers are curable nowadays. The number of deaths is falling continuously: five years after diagnosis, according to the Robert Koch Institute, 87 percent of patients are still alive.
When should I do a genetic test for hereditary breast cancer?
About ten percent of all breast cancer and ovarian cancer cases are due to changes in certain genes and are therefore hereditary. The most common cause is changes in the BRCA1 and BRCA2 genes. But there are around 250 other risk genes that are currently being researched. This increases the cancer risk to 60 to 80 percent.
If there are at least two cases of breast and / or ovarian cancer in a family or if a woman under 36 has it, a “breast cancer gene test” can be useful. It provides information on whether a gene mutation increases the risk of breast cancer.
The current investigation procedures have a certainty of proof of more than 95 percent.
Those who test positive have the opportunity to take part in an intensified breast cancer screening program. This includes
▶ ︎ an ultrasound and palpation examination every six months
▶ ︎ magnetic resonance imaging once a year.
▶ ︎ Whether a mammography is also performed depends on the age and the nature of the mammary glands.
These close-knit examinations allow tumors to be discovered as early as possible.
The costs are often covered by the health insurances, although the preventive service is not automatically part of the scope of services.
Since the reimbursement practice is different, those affected should inquire in advance about the conditions for reimbursement.
Patients in whose families breast cancer occurs frequently can have their genes analyzed in one of the 18 German “Centers for Familial Breast and Ovarian Cancer” (to be found at www.konsortium-familiaerer-brustkrebs.de ).
Important: A positive test result does not mean that breast cancer is sure to occur. Those affected can, however, have more intensive early diagnosis examinations carried out.
50 important facts about breast cancer
1. Breast cancer is the most common form of cancer in women. Over 70,000 women develop breast cancer in Germany every year.
2. Men can also develop breast cancer. Every year 600 to 700 men in Germany are diagnosed with breast cancer.
3. Almost half of all breast cancer diagnoses (around 45%) are made in women between the ages of 50 and 69 years . That’s why women are invited to mammograms every two years during this period.
4. Age is a risk factor: just under every fifth breast cancer diagnosis is made in women who are younger than 50 years old.
5. From the age of 70, a woman’s risk of developing breast cancer decreases again.
6. The cure rate for breast cancer has improved significantly in the past few decades: from 50 to 60 percent in the 50s and 60s to 75 to 80 percent today.
7. Despite the good chances of recovery, over 17,000 women in Germany still die of breast cancer every year.
8. Around 30% of all women with breast cancer in Germany have a familial history of breast cancer and can have an examination for “breast cancer genes” carried out.
9. There are several genes that, if altered, can cause breast and ovarian cancer. The genes BRCA1 and BRCA2 are known and researched.
10. Changes in the breast cancer genes BRCA1 and BRCA2 can be detected in around 5 out of 100 women .
11. 60 out of 100 women with an altered BRCA1 gene will develop breast cancer by the age of 70.
12. 55 out of 100 women with an altered BRCA2 gene will develop breast cancer by the age of 70.
13. In women with an altered BRCA gene, the early detection is more closely meshed and intensified: For them, half-yearly ultrasound examinations of the breast are recommended, as well as an annual MRI examination.
14. A quarter of all women with an altered BRCA1 or BRCA2 gene will develop a tumor in the other breast within 15 years of surviving breast cancer .
15. Smoking is an influenceable risk factor for breast cancer. In a Canadian study, women who smoked for more than 40 years had a 57 percent increased risk of developing breast cancer .
Healthy lifestyle is important
16. A quarter of all breast cancer cases could be prevented by a healthy lifestyle . This includes little alcohol, regular exercise or sport and not smoking. Eating a healthy diet (little red meat, lots of fruit and vegetables) can also reduce the risk of breast cancer.
17. Women with dense breast tissue are at higher risk of breast cancer.
18. The intake of environmental toxins (eg bisphenols, polyfluoroalkyls, DES) in childhood and adolescence can increase the risk of breast cancer in adulthood.
19. Type II diabetes (“adult diabetes”) that is not well controlled can increase the risk of breast cancer . Active precaution is to avoid diabetes through a healthy lifestyle or, if one is present, to ensure good blood sugar control.
20. For a more precise determination of the breast cancer, a tissue sample is always taken and the tissue is examined. Then it can be determined whether the breast cancer is hormone-dependent and whether the tumor has “docking points” for the so-called epidermal growth factor 2 (HER2-positive tumor). Both pieces of information are important in order to be able to initiate the correct treatment after the operation.
21. Tumors that are neither HER2-positive nor have “docking points” for the sex hormones estrogen and progesterone are called “triple negative” (ie triple negative). They are considered to be more aggressive and difficult to treat.
22. In principle, an operation is always performed first (if possible). The aim is to remove the tumor completely, ie without any residues remaining. This is often possible as part of breast-conserving therapy, and in some cases the affected breast has to be completely removed.
23. A complete surgical removal of the affected breast should be carried out if the tumor cannot be completely removed in the context of breast-conserving surgery or if it is an inflammatory breast cancer or if the patient is not allowed to be irradiated due to a skin disease, for example, after breast-conserving surgery OP but radiation would be required.
24. Breast reconstruction does not jeopardize the chance of healing and does not interfere with follow-up care
25. The tumor is HER2 positive in 15 out of 100 patients.
Anti-hormone therapy makes sense
26. In the case of HER2-positivity, drug therapy with an appropriate antibody (eg trastuzumab) should be carried out for more than one year after the operation. It is often given together with chemotherapy.
27. In HER2-positive tumors, treatment with trastuzumab plus chemotherapy can almost halve the relapse rate .
28. Three quarters of all breast cancer tumors have docking points for the female sex hormone estrogen receptor, ie cancer growth is hormone-dependent.
29. Anti-hormone therapy increases the cure rate in patients with hormone-dependent breast cancer by 30%.
30. Anti-hormone therapy halves the risk of a tumor developing in the other breast in patients with hormone-dependent breast cancer.
31. Anti-hormone therapy must last for at least 5-10 years . Their protective effect lasts for up to ten years after they are stopped.
32. The standard drug for anti-hormone therapy in premenopause is tamoxifen (20 mg per day).
33. In the case of “triple negative” tumors, chemotherapy is usually carried out after the operation.
34. Chemotherapy may also be necessary for other tumors, especially when there is a high risk of relapse (eg the patient is young at the onset of disease, aggressive tumor or lymph node involvement).
35. The duration of so-called adjuvant chemotherapy (chemotherapy after breast surgery) is usually 18-24 weeks.
36. The benefit of chemotherapy after surgery in terms of the risk of relapse and death is particularly high in women under 50 years of age.
37. Women with lymph node involvement particularly benefit from chemotherapy with so-called taxanes after the operation.
Breast cancer and pregnancy
38. You can also get pregnant after chemotherapy . Patients who want to have children should seek advice on ways to protect their fertility.
39. There are women who develop breast cancer during pregnancy . Termination of pregnancy does not improve the prognosis, but cancer treatment must begin immediately in this situation as well. OPs and some chemotherapy treatments that do not harm the child are possible.
40. For women with a large tumor that cannot be operated on or that requires the complete removal of the breast in any case, chemotherapy may be advisable before the operation
41. After a breast-conserving operation, radiation therapy is always given if the tumor has been classified as aggressive.
42. Supportive radiation therapy following a complete breast removal is always necessary if the tumor was already extensive (tumor stage T3 or T4), the tumor could not be completely removed during the operation or the neighboring lymph nodes were affected.
Checkpoint inhibitors as bearers of hope
43. The standard treatment after breast-conserving surgery is so-called hypofractionation. The entire breast is irradiated several days a week over a period of three weeks.
44. According to a Heidelberg study from 2016, 83 out of 100 women lived disease-free 5 years after being diagnosed with breast cancer, so they had not suffered a relapse.
45. The same study showed: After 5 years, 85 out of 100 women had no metastases.
46. In 10 out of 100 women who underwent breast-conserving surgery, the cancer recurs in the same place within 10 years.
47. In 4 out of 100 women, a new tumor forms in the chest wall even after the breast is completely removed.
48. The most common metastases are in the bones, lungs and liver.
49. Where metastases develop, however, often depends on the type of breast cancer: With hormone-dependent HER2-negative breast cancer, metastases usually form in the bones, with HER2-positive tumors brain metastases are more common and “triple negative” tumors more often metastases in the liver and lungs.
50. Metastases are usually treated with chemotherapy if they do not occur in isolation and can be operated on or irradiated. Often, depending on the type of tumor, new targeted substances (antibodies, small molecules) are given for chemotherapy . The so-called checkpoint inhibitors are particularly hopeful.