Breast cancer, also known as mammary carcinoma, is the most common cancer among women in Germany, with around 70,000 new cases annually. Among all new diagnoses, about 1% also affect men.

Factors contributing to the development of breast cancer can include age, lifestyle (e.g., alcohol consumption and smoking), obesity, and lack of physical activity. Additionally, the risk is increased in childless women, women giving birth for the first time over the age of 30, and women who take combination preparations of estrogens and progesterone after menopause.

Approximately a quarter of all women with breast cancer also have increased family incidence, which can indicate a genetic cause. However, a disease-causing gene, such as BRCA1 or BRCA2, which is referred to as hereditary breast cancer, can only be detected in 5-10% of cases. Women with these high-risk genes for breast cancer have a 50-80% lifetime risk and the risk of developing the disease 20 years earlier than women without these genetic changes. They also have a 60% chance of developing cancer in the other breast and a 10-40% risk of developing ovarian cancer.

Changes within the breast are often difficult or impossible to palpate in an early stage. Therefore, it is all the more important to pay attention to other signs of changes. These include, in addition to lumps or hardenings in the breast, for example: skin dimpling when raising the arms, changes in nipple shape, color or texture changes of the skin on the breast or nipple, discharge of bloody, purulent, or clear fluid from a nipple, or pain/pulling sensation in the breast without a known cause, independent of the menstrual cycle and hormone intake.

If breast cancer is suspected, for example after a self-examination or a doctor’s palpation, important imaging examinations of the breast are carried out for further diagnosis, such as a mammography and, depending on the situation, also ultrasound or magnetic resonance imaging. If the suspicion of breast cancer is strengthened, a tissue biopsy may also be performed for further clarification.

Don’t rush anything; immediate tumor surgery is only necessary in a few cases. However, a quick clarification and a rapid start of drug treatment are very important to halt the progression of the disease. If surgery is performed, the goal is to remove all tumor cells from the breast, which also involves removing some healthy tissue. The margins are then examined for tumor cells. In most cases, the breast can be preserved, and radical removal can be avoided. Discuss the treatment and any open questions thoroughly with your doctor or even seek a second opinion (e.g., Charité Berlin or KEM Essen).

Information on tumor size and spread alone is often not sufficient to assess the risk of a tumor. Molecular biological examinations can help characterize the tumor and better assess its aggressiveness. They are also important for choosing the therapy and can support the creation of a personalized treatment concept. The most important characteristics include the following:

• Hormone Receptor Status: The hormones estrogen and progesterone can influence the growth of breast cancer cells. To determine if a tumor grows hormone-dependently, the proportion of cells with hormone receptors is examined. If the tumor is considered hormone-sensitive, it is referred to as HR+. Approximately 75% of breast cancer patients are positive for the estrogen receptor. Hormone-dependent growth can be slowed or stopped by hormone deprivation and/or blockade of hormone receptors; in this case, it is called endocrine therapy.
• HER2 Receptor Status: HER2 receptors are binding sites for growth factors on the surface of cancer cells. A high number of HER2 receptors is often associated with a more aggressive course of the disease. Approximately 15% of newly diagnosed breast cancer patients have HER2-positive tumors. Targeted therapies block these receptors, thereby inhibiting cell growth. Tumors without hormone and HER2 receptors are referred to as triple-negative.
• Ki-67: Ki-67 is a marker that indicates how quickly a tumor grows and is important for assessing the risk of the disease. A risk is classified as low if 10% or less of the tumor is Ki-67-positive, and as high if more than 25% is Ki-67-positive.

The treatment of breast cancer is structured into various therapeutic pillars, depending on the molecular characteristics of the tumor. Treatment can take the form of: surgery, endocrine therapy, radiation, chemotherapy, targeted therapy, e.g., with immunotherapy. Surgery often takes place directly after diagnosis. However, increasingly, it is preceded by chemo-, anti-hormone, or antibody therapy to shrink the tumor or even destroy it completely. This therapy is referred to as “neoadjuvant” (preoperative) therapy. The tumor’s response to this drug therapy before surgery determines further treatment after surgery (post-neoadjuvant therapy).

The patient-doctor discussion is the cornerstone of treatment. Only through trust, openness, and transparency in the joint conversation is it possible for the doctor to adequately address your concerns, wishes, and complaints.