Breast cancer

Overview: What is breast cancer

The female breast consists of glandular, fatty, and connective tissue. The glandular tissue consists of various glandular lobules, where breast milk is produced and then travels through the milk ducts to the nipple. In addition, blood and lymph vessels run through the breast tissue. Hormonal changes caused by the menstrual cycle, pregnancy, breastfeeding, and menopause repeatedly alter the breast tissue. Breast cancer develops when cells begin to multiply uncontrollably. Malignant tumors usually develop in the glandular tissue of the breast. Lobular breast cancer originates in the lobules of the breast, while ductal breast cancer originates in the milk ducts. Experts also differentiate between invasive and non-invasive breast cancer:

• Invasive breast cancer: The cancer cells have already spread to the surrounding tissue.
• Non-invasive breast cancer: The tumor is still localized; a precursor or early stage of breast cancer (ductal carcinoma in situ)

If you divide the female breast into quarters, most malignant changes occur in the upper outer quadrant—that is, the area between the armpit and the collarbone. Regular self-exams are the best way to get to know your breasts and learn to feel for changes. This way, you can notice even small changes early on and contact us for further evaluation.

Malignant tumors rarely develop in the connective tissue of the breast; when they do, they are not breast cancer, but rather skin or connective tissue tumors.

Breast cancer: causes and risk factors

There are risk factors for breast cancer that you can influence to some extent through your lifestyle, and others that are beyond your control. Risk factors for breast cancer can include

• Early onset of menstruation, late menopause
• prolonged use of female sex hormones, hormone replacement therapy during menopause
• Excess Weight and Lack of Physical Activity After Menopause
• regular, heavy alcohol consumption
• Childlessness or a late first pregnancy
• benign proliferation of glandular tissue

Age is also one of the risk factors for breast cancer. The risk increases with age; most women are over 65 at the time of their diagnosis.

Hormone replacement therapies during menopause are now viewed very critically. The risk of breast cancer increases with the duration of treatment. Doctors therefore only recommend short-term therapies with the lowest possible doses to treat menopausal symptoms.

Breast Cancer and the BRCA-1 and BRCA-2 Genes

There are two tumor genes, BRCA-1 and BRCA-2, which have been proven to be associated with a high risk of developing breast cancer. Women with this genetic mutation have a 50 to 80 percent chance of developing breast cancer, usually around the age of 40. The BRCA genes also increase the risk of other types of cancer, and even men are affected, though not to the same extent.

If you would like to undergo genetic testing as a preventive measure because you have a family history that puts you at increased risk, please contact our accredited breast center. If a BRCA mutation has already been detected in your family, family members should seek counseling and get tested. Genetic testing makes sense because, on the one hand, preventive and prophylactic measures can be derived from it and, on the other hand, you can be relieved if the results are negative. In Switzerland, genetic diagnosis is recommended from a mutation probability of ten percent.

Symptoms: Breast cancer

Breast cancer does not cause any symptoms at first. The safest way to detect possible malignant changes is to perform regular breast self-exams. If you check your breasts yourself every month—preferably after your period—you’ll notice even small changes right away. If you are taking hormonal birth control, you should examine your breasts at the beginning of each monthly pack. Women who have gone through menopause should set a regular appointment for themselves every four weeks. Possible signs of a malignant tumor in the breast area can be

• Sudden lumps and hardened areas
• Changes in the skin or nipple, redness
• sudden differences in breast size or appearance
• Palpable lymph nodes in the armpit
• Discharge from a nipple
• Weight loss
• chronic fatigue

If you notice any of these symptoms, it is advisable to have the exact diagnosis clarified by a specialist or in hospital. Lumps are usually palpable when they reach a size of one centimeter or larger; they do not cause chest pain, feel hard to the touch, and cannot be moved within the tissue. Not all of the changes listed necessarily indicate breast cancer; there may be another underlying condition. However, the earlier a malignant tumor is detected, the better the prognosis is, as a rule. However, experts agree that self-examination alone is not sufficient for early detection. Therefore, take advantage of the opportunities for preventive screenings.

Mögliche Brustkrebs-Symptome

Breast cancer - diagnosis by us

If there is a suspicion of a malignant lesion in the breast, we will first perform a mammogram. In some cases, an ultrasound exam may also be appropriate. The goal is to distinguish between benign and malignant growths and to identify so-called microcalcifications, which can accumulate in breast tissue and indicate the presence of a tumor that is still small. If we suspect a tumor, we take a tissue sample—a biopsy—and have it examined in a laboratory for tumor markers. The biopsy procedures commonly used today are:

• Core biopsy – Under local anesthesia, a hollow needle is inserted into the affected area and a tissue sample is removed. After the procedure, bruising may occur, but it will disappear after a short time.
• Vacuum biopsy – this method allows for the removal of larger tissue samples. The procedure is performed with a thicker needle and takes longer than a punch biopsy. The procedure may leave a small scar. Depending on the findings, surgery may be necessary afterward. To be able to locate the spot exactly, a small marker wire is inserted there.

If the removed tissue contains tumor cells, further examinations are carried out to determine how aggressive the tumor is, what type it is and how far it has spread. In addition, there are various tests available to help determine the most appropriate treatment. For example, it matters whether the tumor’s growth is stimulated by hormones or not—in other words, whether it is hormone receptor-positive. Or whether there are specific receptors that stimulate the proliferation of cancer cells. It is also important to determine whether tumor cells are already present in the lymph nodes; these are examined through physical examination and ultrasound, and a biopsy is performed if a tumor is suspected. If women already have

• if there is a larger tumor,
• Lymph nodes are affected,
• the tumor is growing aggressively,
• if there are symptoms typical of cancer,

then further examinations such as a breast MRI, a computer tomography and/or a PET-CT are appropriate in order to find metastases and to be able to plan the therapy in a targeted manner.

Breast Cancer – Staging

If the examinations have confirmed the suspicion of breast cancer, it is important to determine the exact stage in order to tailor the therapy accordingly. The spread of the tumor is described by experts using the TNM classification.

• T for Tumor: T describes the size of the tumor, ranging from T1 to T4. “Tis” stands for “tumor in situ,” which means the tumor has not yet spread to the surrounding tissue.
• N stands for the Latin word Nodus (node): Es bedeutet Lymphknoten. The number of affected lymph nodes is described as N0 (none) through N3.
• M for Metastases: M describes the status of metastases, ranging from M0 (none) to MX (unknown) to M1 (metastases present in other organs).

Self-Help Groups

Talking with others who are going through the same thing can be a great source of support when coping with an illness. If you are looking for a suitable self-help group , you can get advice from Selbsthilfe Zürich. Selbsthilfe Zürich and the University Hospital of Zurich are partners in the national project “Health Literacy Through Self-Help-Friendly Hospitals.”

Breast cancer - prevention, early detection, prognosis

It is still not entirely clear what the causes of breast cancer might be. Many factors remain unclear. However, based on recent research, it is possible to draw some conclusions about potential risk factors. Thus, there appears to be a link between a lack of physical activity, being overweight, and the risk of breast cancer. Being overweight both before and after menopause appears to increase the risk. Alcohol also affects the likelihood of developing breast cancer. A high-fat diet rich in animal fats leads to higher levels of estrogen in the blood, which is another risk factor for breast cancer.

By eating a healthy, balanced diet, avoiding excessive alcohol consumption, and following a regular exercise routine, you can help keep your risk lower. If you also get into the habit of examining your breasts regularly and taking advantage of the preventive check-ups on offer, you will have made an important contribution to your health.

Course and Prognosis of Breast Cancer

In addition to early detection, conscientious aftercare is also part of the treatment. Although breast cancer is one of the most common types of cancer among women, it also has a good cure rate today. Five years after diagnosis, 80 percent of women with the disease are still alive. Experts recommend at least ten years of follow-up. The point is,

• to detect new tumors at an early stage,
• To address the consequences of treatment and
• To support anti-hormone therapies.

If the breast had to be completely removed, there are options for reconstruction. Reconstruction can take place shortly thereafter or even several years later. The methods of breast reconstruction are

• Reconstruction using the body’s own tissue,
• Reconstruction with silicone implants,
• Breast prostheses that are inserted into a bra.

In a final step, nipple reconstruction may also be performed.

Breast cancer: treatment

Breast cancer treatment involves the complete removal of tumor tissue. For most women today, this can be done in a breast-conserving procedure. Following this, radiation therapy is given. Radiation is intended to destroy any tumor cells or minute metastases that may still be present. Since research has now found out a lot about the malignant tumors of the female (and male) breast, the therapy can also be very individually tailored to you.