Breast Cancer: The Most Common Cancer in Women

No cancer affects women as often as breast cancer. The diagnosis is frightening. But thanks to modern therapies, breasts can often be preserved today.

Breast cancer – what is that actually?

Breast cancer is a malignant tumour in the mammary gland. Breast cancer is by far the most common cancer in women: According to the Robert Koch Institute, more than 55,000 women in Germany are diagnosed with it every year, almost one in two of them is younger than 60. Five years after treatment, four out of five patients are still alive.

Who gets breast cancer?

Doctors assume that breast cancer is caused by a combination of genetic predisposition, lifestyle and environmental influences. Four to nine percent of all breast cancer cases are hereditary: physicians now know of six breast cancer genes. However, their presence does not always lead to breast cancer. If, however, close relatives suffer from breast cancer, an increased risk can be assumed.

The female sex hormones oestrogen and progestin play an important role in the development of breast cancer. Hormone replacement therapy, which is sometimes prescribed for menopausal symptoms, therefore increases the risk of getting breast cancer: It can stimulate undetected breast cancer cells to grow.

If women drink too much alcohol or are overweight, the oestrogen level in the blood increases and so does the risk of breast cancer. Smokers are more likely to develop breast cancer than non-smokers. Women who had their first period early and entered menopause late are more likely to get breast cancer. Childless women also have a slightly higher risk than women who have already had several children. Women with nodular changes in the breast (mastopathy) are also at risk.

Which complaints should make me sit up and take notice?

Breast cancer is not noticeable for a long time. A woman usually only notices it when a lump has already formed in the breast. In addition, changes in the breast can also occur. When the breast becomes hard, tight, itchy or tight, the skin becomes inflamed, the nipple changes shape or fluid leaks, these are all signs that indicate breast cancer.

How does the doctor determine whether I am affected?

The doctor often detects breast cancer during the palpation examination, during which the breast, the lymph nodes in the armpits and above the collarbone are palpated. If there is a suspicion of breast cancer, a mammography follows, in which the breast is x-rayed with low-dose X-rays. Ultrasound can be used to determine whether the node consists of tissue or whether it is a cyst filled with fluid.

In order to clarify whether a lump is benign or malignant, the doctor uses a punch needle to take a tissue sample which is then examined under a microscope. In addition, various statements about the tumour can be made in this way: If its cells have receptors for estrogen and progesterone, hormone therapy is a possibility. If the tumour contains the body’s own protein HER2, its growth can be inhibited with the cancer drug Herceptin.

How can breast cancer be treated?

Surgery is usually required to remove breast cancer. Today, breast-conserving surgery is possible in 70 percent of cases. Usually the lymph nodes under the armpit are also removed. If the tumours are already larger than three centimetres, the patient receives chemotherapy before the operation to reduce the size of the tumours. After breast-conserving surgery, radiotherapy is absolutely necessary: this kills all cancer cells that may not have been removed. Sometimes, however, a better aesthetic result is achieved if the breast is first amputated and later reconstructed.

There are also various cases in which a mastectomy, also called ablation or mastectomy, is unavoidable, for example in the case of larger tumours, when the cancer has already spread far into the milk ducts or has a connection to the nipple. Amputation is followed by breast reconstruction, either with the body’s own tissue or an implant.

Radiotherapy is only used as the only treatment in exceptional cases, for example when a woman does not want an operation. Radiation is mandatory after breast-conserving surgery, but not in all cases after amputation. It usually begins six to eight weeks after the operation, unless chemotherapy is first followed by radiotherapy.

The operation can also be followed by outpatient chemotherapy, which lasts about six months. The patient receives a series of drugs, so-called cytostatic drugs, by infusion. There is a break of several weeks between the individual treatment cycles so that the body can recover from the therapy. Chemotherapy is much better tolerated today than in the past, but there are still side effects such as nausea, diarrhoea and vomiting. In addition, hair falls out in most women. Chemotherapy also helps to relieve symptoms when the cancer is already well advanced and therefore incurable.

Some tumour cells have receptors for the female sex hormones oestrogen and progestin. In this case hormone therapy is possible. There are several possibilities here: Anti-oestrogens, for example, occupy the receptors on the tumour cells so that the oestrogen cannot dock. Bleeding can occur during treatment, and the risk of thrombosis increases. Aromatase inhibitors prevent the release of oestrogen; as a side effect they can cause muscle and joint problems.

Other forms of treatment target the ovaries directly: For example, the ovaries can be removed by surgery or switched off by radiation treatment. If a woman wants to have children later, the ovaries can be temporarily prevented from producing oestrogen with the help of GnRH analogues. All these measures put the woman in a state similar to the menopause.

If the tumour contains the protein HER2, its growth can be slowed down with antibody therapy. This involves the use of the cancer drug Herceptin, which has been approved for therapy since summer 2006.

Are there also gentle healing methods?

Breast cancer is a dangerous disease that must be treated by conventional medicine. Alternative healing methods can help to improve the woman’s condition during therapy. Relaxation exercises such as autogenic training or yoga can help with exhaustion, acupuncture can relieve nausea and pain. Patients should always talk to their doctor before using alternative healing methods to supplement their therapy.

The Cancer Information Service of the German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) warns that for many alternative healing methods it has not been scientifically proven that they really work. There is also often a lack of information about possible side effects and interactions with conventional medicine. It is a misconception that supposedly “gentle” remedies with natural active ingredients are generally harmless.

Moreover, cancer attracts many profiteers who use the patients’ desperation to take money out of their pockets. The cancer information service advises caution above all:

• if the provider forbids the patient to consult his orthodox medical doctor about the alternative therapy.
• if the provider advises the patient to discontinue the conventional medical therapy.
• if the provider promises that his treatment method will help against all types of cancer and cancer at all stages.
• if the provider demands advance payment.
• if the provider is located abroad and/or the remedy can only be ordered via the internet.

Cancer cannot be influenced by diet. Cancer diets and fasting cures designed to starve the tumour can even be dangerous: they often prohibit energy and vitamin suppliers that would be important for patients in the exhausting cancer therapy.

Probably the best-known alternative treatment for cancer is mistletoe therapy, which has its origins in anthroposophical teaching. Although it is largely unknown outside the German-speaking world, it is widely used in Germany. In many cases health insurance companies cover the costs of treatment. Mistletoe extract available without a prescription is injected under the skin. The manufacturers of mistletoe preparations promise various effects: The preparations are said to increase appetite, relieve pain, make people more resistant to infections, and improve mood and well-being.

Many women are convinced that mistletoe helps them to feel better. To this day, however, experts still disagree on whether mistletoe preparations can actually improve the state of health or even slow down or cure tumours, as has been claimed by some. The available scientific studies on mistletoe therapy are not very conclusive, even though there are indications that it improves the well-being of breast cancer patients during chemotherapy. However, there is a lack of reliable studies on the side effects of mistletoe – the manufacturers of the preparations provide a wide variety of information on this subject, such as fever, chills or allergic reactions.

Unfortunately, conventional cancer therapy cannot prevent some drastic side effects: chemotherapy causes hair to fall out, radiation irritates the skin and hormone therapy triggers hot flushes. The Cancer Information Service has compiled extensive information on how side effects like these can be treated in a gentle and conventional way.

How can I protect myself?

A healthy lifestyle significantly reduces the risk of breast cancer, so women should drink little alcohol, watch their weight and exercise regularly. Under certain circumstances, hormone replacement therapy for menopausal symptoms can increase the risk of breast cancer. Women with a higher risk in their family should therefore avoid this treatment.

Although early detection cannot prevent breast cancer, it does help to detect and treat it in time. Every woman should palpate her breast regularly. The best time for this is between the seventh and twelfth day after the start of menstruation. At this time you should also check in the mirror to see if the appearance of the breast has changed. For women over 30, health insurance companies pay for a palpation examination by a gynaecologist once a year.

Since 2007, there has been a nationwide mammography screening for women between 50 and 69 in Germany: Every two years, women of this age are invited for an X-ray examination of the breast; the costs for the mammography are covered by the health insurance companies. In the USA, there is a debate about whether healthy women with a family history of increased breast cancer risk should have their breasts amputated as a precautionary measure. This is a drastic step that should only be considered at all after consultation with the doctor.