Introduction

Photo of a woman (PantherMedia / Frank Röder)

In breast cancer, new, malignant tissue starts growing in a mammary gland. Being diagnosed with breast cancer often makes people feel very frightened and anxious. Having cancer can really turn your life upside down for a while. It is helpful to know that if you get breast cancer for the first time and it has not spread far, there’s a good chance that treatment can lead to full recovery. There are also many support services that help people in everyday life, to return to work and cope emotionally with breast cancer.

Symptoms

Breast cancer is usually not painful in its early stages. But there are some things that could be signs of breast cancer. But they could be signs of a non-cancerous lump too. It is important to see your doctor immediately if you notice any of the following changes:

  • One breast changes size or shape
  • You can feel a lump in a breast or armpit
  • There is a sunken dip (dimple) on the nipple or elsewhere on the breast
  • Red or scaly skin on your breasts that does not heal
  • Clear or bloody fluid flowing from one nipple

Breast cancer screening may also detect abnormalities. If this is the case, further tests can be done to examine the area more closely.

Causes

Breast cancer can develop when the genetic material in cells changes and causes them to start multiplying in an uncontrolled way, forming lumps or nodules. How these changes come about, and how the cells then develop, depends on many factors that can also influence one another. These factors include age, height and weight, immune system, hormones, pregnancies and amount of breastfeeding. Breast cancer is not contagious.

Some women worry that they might be partly to blame for getting breast cancer because of their lifestyle. You may also often hear theories that certain character traits can increase a person’s risk of getting cancer. But these theories are unproven and now considered outdated. No one is to blame for a serious disease like breast cancer. Anybody can get cancer, regardless of their lifestyle and character traits.

Risk factors

Many of the risk factors for breast cancer cannot be modified, and there is nothing that can be done to influence them. These kinds of risk factors include genetic makeup and ethnicity. Women who have a sister or mother with breast cancer are at greater risk. Giving birth and breastfeeding, on the other hand, are thought to lower the risk.

Breast cancer is more common in some families. Genetics is estimated to be responsible for 5 to 10 out of 100 cases of breast cancer. It is known that women with mutations in the genes BRCA1 and BRCA2 have a considerably higher risk of getting breast cancer. The abbreviation “BRCA” stands for “breast cancer gene.” Between 50 and 80 out of 100 women with this kind of genetic mutation develop breast cancer at some point in their life. Women who have this mutation but have not yet had breast cancer are offered additional health care services such as regular screening tests.

Having children and breastfeeding are believed to lower the risk.

Prevalence

Breast cancer is the most common type of cancer in women. It is usually detected in older age: 60 out of 100 women with breast cancer are over 60 years old when the disease is first diagnosed. Men can also get breast cancer, although this is very rare.

Woman's age Number of women who will develop breast cancer in the next 10 years Number of women who will die of breast cancer in the next 10 years
45 years 21 out of 1,000 3 out of 1,000
55 years 32 out of 1,000 5 out of 1,000
65 years 37 out of 1,000 9 out of 1,000
75 years 31 out of 1,000 12 out of 1,000

Outlook

Successful treatment depends on a number of different factors, including the following:

  • Tumor size
  • Whether the tumor is confined to breast tissue and where exactly it is located,
  • Whether tumor growth is influenced by hormones
  • Whether the cancer cells have growth factor receptors (HER2 receptors)
  • Number of mutated cancer cells
  • Number of cancerous growths
  • Whether the cancer cells have spread through the lymph vessels in the skin (inflammatory breast cancer)
  • Whether all of the tumor tissue can be removed
  • Whether it has already spread to distant parts of the body
  • Past history of breast cancer

Sometimes breast cancer is first diagnosed after it has already reached an advanced stage. In this case the cancer may have spread and formed tumors in other parts of the body (metastatic tumors), for example in bones or lymph nodes. But even if this happens the disease can still be treated.

If a tumor can be completely removed and there are no distant metastases, full recovery is possible. This is also true for breast cancer that returns after going away, called recurrent breast cancer.

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Diagnosis

Your doctor is the first person to go to if you think you might have breast cancer. After discussing previous and/or current medical conditions (your medical history) with the doctor, he or she will perform a physical exam. This examination may include the following tests:

  • Feeling (palpating) the breast and armpits
  • Breast x-ray (mammography)
  • Ultrasound (sonography)
  • Magnetic resonance imaging (MRI)
  • Biopsy (taking a tissue sample for lab analysis)

If a breast tumor is detected, your doctor will also check whether the tumor has spread to the other breast or any other parts of the body. This can be done by doing an ultrasound test or x-ray of the other breast, an x-ray of the chest (thorax), a bone scan (bone scintigraphy), an ultrasound of the liver, or a computed tomography (CT) scan. Should one of these tests reveal abnormalities in any part of the body, it will be given closer examination.

You can talk to your doctor about which test is best for you and you have the right to refuse a test at any time.

After all the tests have been done, the breast cancer is then “classified.” A classification system is used to record the tumor size and information about whether the lymph nodes are also affected or whether there are any metastases. Your doctor will also try to find out how rapidly the tumor cells are growing and whether that growth can be influenced by hormones or growth factors. This is important when it comes to choosing your treatment.

Screening

From the age of 30, all women who have statutory health insurance in Germany are eligible for an annual breast exam (palpation) at no additional cost. These examinations are not able to stop breast cancer from developing, though. The aim is to detect breast cancer as soon as possible in order to provide better treatment and increase the chances of recovery. Only mammography has been shown to lower the risk of dying of breast cancer. In Germany, women between the ages of 50 and 69 can also have a mammogram every two years.

In order to ensure a high level of quality, screening is only done at specialized facilities that are part of the national mammogram screening program. Participation is voluntary, but the costs are covered by statutory health insurers. As with all screening programs, there are advantages and disadvantages to breast cancer screening: For example, it may lead to unnecessary treatment. Your doctor can help give you advice and support if you have questions about breast cancer screening.

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Treatment

Breast cancer treatments will vary quite a bit based on your individual circumstances. The type of treatment always depends on tumor type and size, where it has spread to, your general condition, and general preferences. Surgery, radiation and medication can be used to treat breast cancer, and different treatment approaches are often combined.

The standard treatment is to try to surgically remove as much of the tumor as possible. Neighboring lymph nodes are sometimes also removed. If the tumor is small, women are often faced with a decision: Should they keep the breast or have it completely removed? Nowadays many women can have surgery that allows them to keep the breast (breast-conserving surgery). But sometimes the entire breast needs to be removed (mastectomy) to make sure that all of the tumor tissue has been eliminated.

Chemotherapy (treatment with medication) is sometimes used to shrink larger tumors before surgery and make it easier to operate on them. This treatment is called “neoadjuvant chemotherapy.”

Chemotherapy is sometimes used after surgery too. Anti-hormonal therapy is an option for women who have a hormone-sensitive tumor. This therapy aims to slow down tumor growth.

After breast-conserving surgery the surrounding tissue is exposed to radiation, if possible, so that any remaining tumor cells can be destroyed. This is sometimes necessary after a mastectomy as well. Radiotherapy is also commonly used if the tumor cannot be surgically removed.

The different types of treatment can be very difficult to go through and sometimes have very severe side effects or cause other medical problems. The side effects vary depending on the kind of therapy, but it is often possible to get effective treatment for them. Treatment for side effects is called supportive therapy.

Before deciding on whether to have a particular treatment, there is usually enough time to get information from your doctor about the possible benefits and the expected side effects, and to talk with your family or other people who are close to you. You have the right to get a second opinion from another doctor or to decide not to have a treatment.

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Rehabilitation

People can have rehabilitation treatment directly after leaving the hospital or at a later time. Rehabilitation is offered in both inpatient and outpatient settings and aims to ensure the success of the treatment, improve your physical and mental wellbeing, and to help you cope with the disease. Rehabilitation programs usually last three weeks in Germany. A doctor has to prescribe them, and approval from your health insurer is also required. The hospital’s support services department can help you apply for rehabilitation treatment.

In Germany there are rehabilitation service centers that provide information about the rehabilitation treatments offered by different institutions. Addresses are available from health insurers and pension funds.

In Germany, a program called the "Hamburg Model” helps people gradually return to work after being off work for a long time due to illness. This model allows working hours to be adjusted in a flexible way. To do this kind of reintegration you need to get the approval of your employer and your health insurer first. You can find out more about different ways of returning to work on the German Federal Ministry of Labour and Social Affairs’ website under “Hamburger Modell” (in German).

Everyday life

Any life-threatening disease that requires subsequent courses of physically draining treatment will inevitably end up affecting mental health as well. Most people in this situation may feel quite depressed from time to time.

Many women say that it comes as a relief to admit that they are feeling scared, anxious or desperate, and to talk things over with people close to them. In addition to talking with friends and relatives, psychosocial counseling or joining a self-help group can also help.

Self-help groups offer women the opportunity to meet others who have first-hand experience with the feelings and practical problems associated with recurrent breast cancer. There they can discuss topics that are often difficult to speak about with people who do not have cancer. Talking with others can take some of the weight off of your shoulders. Many women say that the solidarity they find in the group and the willingness of others to help gives them strength. Self-help groups often provide even more, like organizing sports groups or offering help with social law issues.

Nowadays good oncological therapy also includes psycho-oncological treatment. Psycho-oncologists are specialists with a background in psychology, medicine and/or social work. They offer support to patients and their families coping with the emotional and social aspects of the disease.

It is important for women with breast cancer to make sure they take good care of themselves. Here are some ways for women to actively support their treatment and to do themselves some good:

  • Exercise regularly, if possible
  • Eat what you enjoy and feel like
  • Find the right balance of activity and rest
  • Get a good night’s sleep
  • Do things that make you feel good during this difficult time

Further information

In Germany, breast cancer treatment plans are usually put together, and treatment is usually carried out, in certified breast cancer or tumor centers, or in doctor’s practices specializing in oncology. There, specialists from different disciplines work together to treat the various effects that both the disease and the treatment have on your body and mind. Treatment may also be carried out in a non-certified hospital or in a gynecologist’s practice. Gynecologists or family doctors might carry out some of the treatment and check-ups too.

In Germany, you are entitled to a variety of support services, including sickness benefit, home help and nursing care. There are numerous places you can go to for advice and help if you need to apply for support.

Professional help is available when making personal decisions, as well as getting advice about financial and legal matters. You can find out where to get help by contacting self-help groups and information centers.

In Germany, individual advice is available – either over the telephone or in person – from

The addresses of self-help groups in Germany are available from the Cancer Information Service (Krebsinformationsdienst) or local health authorities.

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Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?”

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