Feminity in difficult times

Breast cancer is the most common female malignancy in the industrialized world. It is estimated that in Europe one out of eight women develops malignant breast disease during her life. 90 to 95% of breast cancer cases develop spontaneously, i.e. without evidence of an underlying cause. Only 5% can be explained by an inherited alteration in one of the two known breast cancer genes.


Even if the events leading to tumor development remain elusive, we still know a number of factors that can significantly influence disease risk. These include eating habits and environmental factors such as smoking or alcohol intake, but the use of hormones or the number of deliveries are equally important. Most likely it is not a single factor, but rather a combination of multiple modifications that are responsible for the development of a malignant breast tumor.


Since the risk of developing breast cancer increases with age, the participation in breast cancer early detection programmes is generally recommended in women aged 40 and older. For women with an increased familial background of breast or ovarian cancer an even more stringent programme is advised. In addition, every women should also perform a breast self exam at least once a month in order to detect suspicious lumps as soon as possible.


 


A malignant tumor is typically characterized palpated as painless, coarse, poorly circumscribed tumor that typically retracts the overlying skin or nipple. The development of ulcers or secretion from the nipple can also be a sign of breast cancer. Advanced cases can present with an infiltration and consecutive swelling of axillary lymph nodes - which thus become palpable – and with the development of liver, lung or bone metastases.


The complete resection of tumor tissue should always be attempted. In most cases, the breast can now be salvaged in the large majority of cases, and modern surgical techniques have made the previously much feared lymphedema of the arm a rare complication. After breast conserving surgery, local radiotherapy is usually administered to the breast. Further treatment strategies depend on the extent of disease and the recurrence risk. Dependent on the tumor constellation, both chemotherapy and endocrine therapy regimen can be administered. The development of modern antibody therapies has revolutionized breast cancer therapy over the last years and now allows us to offer a highly effective, yet well tolerated treatment option.

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