Breast cancer

The most serious risk factor, however, is age. While these tumours occur only rarely at the age of over 25, their incidence begins to rise markedly around the age of 30, and tumours appearing at the age of over 45 make up the vast majority. In 75% of women, no known risk factor other than age is identified. For this reason, attention is paid to women over 45, whom their doctor sends for a mammography examination every two years. This is a great success among the preventive measures paid for by the insurer, because most other tumours have no similar prevention. Of course, the high frequency of breast tumours plays a role, but so does their good treatability if they are found in time.

Middle-aged women should therefore not underestimate the possibility of this tumour growth and should attend mammography check-ups. It is really just an X-ray examination, which does not hurt and is not demanding in any way.

Younger women who have a suspicion (for example, they feel a lump in the breast themselves or there is a high occurrence of tumours in the family) can also ask their doctor to send them for an examination, and that is only a good thing. In this case, however, ultrasound is rather recommended, because it cannot be ruled out that a woman of that age might be pregnant, and X-rays could then harm her.

Women after the menopause use hormone replacement also for a better mood and mental well-being. On the other hand, hormone replacement therapy is disadvantageous in terms of the risk of breast carcinoma and thrombosis. Oestrogens alone could also cause carcinoma of the womb, which is why progestins are also included in hormone replacement; they reduce this risk and have a favourable effect on the womb. Unfortunately, a similar effect has not been clearly proven in the case of breast carcinoma.

It is generally recommended not to use hormone replacement therapy in women at risk who also have some of the factors listed below.

The risk is increased mainly in direct female relatives (mother, sister, daughter) or in families where various kinds of tumours accumulate as part of so-called syndromes (Li-Fraumeni syndrome, Cowden syndrome, etc.). In these cases human DNA is damaged precisely in the key regions where important genes for DNA repair or for triggering cell death are located.

Risk factors also include obesity and an excess of fat in the diet (mainly saturated fatty acids, which are contained, for example, in butter, animal fats, fatty cheeses, mayonnaise and so on). Other classic factors are smoking and lack of exercise.

It follows from the above that we cannot influence many predispositions, as is the case above all with age, with hereditary tumours, or with tumours that occur without prior exposure to any of the other risk factors.

If you want to do the maximum for your prevention, keep to regular mammography check-ups, or come to the doctor even earlier if you are not yet 45 and suspect that you might be ill. Check your breasts yourself at least once a month for any lump (breast self-examination). Discuss the question of hormone replacement therapy with your gynaecologist.

The other factors are a matter of your lifestyle, so if you eat healthily, play some sport recreationally and do not smoke, it will certainly benefit you in a number of other respects of your health too.

Enlarged lymph nodes in the armpit or above the collarbone are already a sign of spread of the tumour. Fewer than 10% of cases present with symptoms of distant metastases, that is, symptoms in other organs (for example back pain from metastases to the bones).

It is also decisive for treatment whether or not the patient has a metastasis in the lymph nodes or even in distant organs. Further examinations of the organs concerned serve this purpose - for example ultrasound (sonography) of the liver, a chest X-ray and scintigraphy of the bones (an examination at the nuclear medicine department).

Ultrasound is also used to examine the lymph nodes to which the tumour spreads first (in the armpit and above the collarbone).

A biochemical examination (from a blood sample) is also carried out to determine tumour markers, which are, one could say, molecules specific to the given tumour that it releases into the blood (in breast carcinoma it is mainly CEA). Another thing determined from the biochemistry is the presence of certain receptors that are important for hormonal treatment, so that the substance we give in tablet form binds to the given receptor at all. Some breast tumours do not have these receptors, so they cannot be treated with hormonal therapy and a different approach must be chosen.

The choice of treatment strategy therefore depends on age, hormonal status (presence/absence of receptors), general condition, and the presence and number of metastases. The basic method of treating early carcinomas is a surgical procedure in which either the whole breast or part of it is removed (in the latter case radiotherapy usually follows). To get rid of the tumour it is also better to remove the lymph nodes in the armpit, because in many cases the tumour has already spread there and may not yet be demonstrable in any way. At present, however, there is already the option of performing a scintigraphic examination (application of a radioisotope) of the so-called sentinel node during the operation. This is in fact the first node that could be affected, and if this examination were negative, the nodes would not have to be removed at all, because the tumour has fortunately not yet reached them.

After the operation, chemotherapy is given to patients whose nodes were also affected by the tumour. This is because micrometastases may have occurred during the operation, that is, the spread of even just a few tumour cells into the blood, so that these cells are destroyed and the tumour is thus completely eliminated.

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