Breast cancer deserves special attention as it is the most widespread invasive cancer in women all over the world. During last 20 years progress in screening tests and significant advances in laboratory and instrumental exanimations have led to substantial increase in breast cancer diagnosis rates. This results in better treatment outcomes and improved survival rates – the most desirable aim of any oncological disease fighting.
Breast cancer is an acute social problem, as well. Feeling support of relatives, beloved people, friends and society is extremely important for women during the treatment and afterwards. Many well-known people (e.g. celebrities – Melanie Griffith, Jane Fonda, Larry King), who became familiar with breast cancer, tell their stories aloud and draw attention to the problem.
What is breast cancer and why should we pay attention to this disease?
According to current World Health Organization (WHO) definition breast cancer is a kind of malignant tumor that arises from the cells of the breasts.
Actually, female breast consists of few basically different cells, which may give origin to different types of breast cancer and require specific diagnostic methods:
- Lobules form the main volume of the breasts. These are milk-producing glands, which mainly work during breastfeeding. When a woman is not pregnant or lactating lobules are virtually inactive, so they go through oncological transformation rarely enough (about one of 10 breast cancer cases). The first stage of lobular carcinoma is carcinoma in situ – it is a small not-growing tumor, which is not considered to be a cancer, but provide high risk for cancer development. More serious condition is invasive lobular carcinoma.
- Ducts are the system of tiny tubes, which carry produced milk from lobules to the nipple. The most widespread type of breast cancer is ductal carcinoma. In much the same way, ductal carcinomas start from carcinoma in situ – this stage can already be revealed during screening examination. Not treated ductal carcinoma in situ progresses to invasive ductal carcinoma, which grows through the wall of duct and invades normal breast tissue.
- Adipose and connective tissue. These tissues complete the structure of the breasts, surrounding lobules, ducts and blood vessels; they are uncommon origin of oncological process.
It should be noted, that men can suffer from the breast cancer as well. According to statistical data breast cancer is about 100 times more common in women, but up to 1% of cancer deaths among men are due to breast cancer. Exact causes of breast cancer in men are unknown, as there are too few patients for creating comprehensive clinical trials. Treatment of breast cancer in men is also based on the treatment schemes for women, but the survival rates for men with this condition are a little bit better. The most tricky moment in this case is suspecting the disease and going through specific examination – general practitioner should be attentive enough in order to do it well.
To understand how common breast cancer among women is we may just say that this condition is the most significant cause of cancer deaths among women worldwide. The same time, breast cancer is the most common type of cancer in women. According to American Cancer Society data, general lifetime risk of having breast cancer among women comes up to 1 in 8. Incidence rate varies depending on ethnic origin, age and availability of medical services.
Timely examination and diagnosis increase chance of successful treatment result. For example, the rate of breast cancer revealing is higher in the USA and Europe than in developing countries. On the contrary, death rates are lower among Americans and Europeans.
In which cases additional attention to the examination should be paid?
Under certain circumstances risk of having breast cancer increases. Such conditions are called “risk factors”. Having a risk factor, or even few of them, doesn`t mean that you will develop breast cancer for sure. This is not an obligation or 100% probability, this is only a chance, which is higher than general among all women of your age and ethnicity. Being warned about these specific conditions gives you chance to avoid them or, in case you have non-modifiable risk factor, regularly go through specific examination. Precise screening tests were elaborated in clinical trials to reveal early stages of breast cancer more effectively.
So, who is at risk of breast cancer? You should pay particular attention to your health in the following cases:
- Female sex. As it was already mentioned, women are much more likely to be diagnosed with breast cancer than men are. This is mainly connected with hormones levels.
- Older age. Risk of breast cancer development increases with age. For example, between 20 and 29 years old this risk is about 1 in 2,000, and between 50 and 59 is comes up to 1 in 37.
- Exposure to radiation, as a treatment method (e.g. in certain diseases of chest organs), during the X-ray examination or by accident. Radiation changes normal process of cellular growth, dividing and death, creating favorable conditions for oncological states.
- Obesity. Adipose tissue produces estrogens – female hormones. Thus, overweight people often have hormonal disturbances, which may finally influence breasts state.
- Alcohol consumption. Precise mechanisms of alcohol influence are currently unknown, but this factor is connected with postmenopausal breast cancer development.
- Beginning of the period at a younger age, start of menopause at an older age. During normal menstrual cycle breasts are exposed to constant hormonal changes. More menstrual cycles you have, higher the chance of the breast cancer development is.
- Having first full-term pregnancy after 30 years old or never having full-term pregnancy. Pregnancy and period of breastfeeding “switch off” menstrual cycle, so breasts have chance to rest from regular hormonal changes.
- Going through postmenopausal hormone therapy. Some women may take supplemental hormones during the menopause, as this period causes unpleasant symptoms. Taking estrogen and progestin for 5 years and more significantly increases risk of breast cancer development.
- Situation with birth control pills is somewhat similar. Certain forms of complex synthetic hormones are associated with increased oncological risk.
- Being diagnosed with precancerous breasts conditions (like carcinoma in situ of atypical hyperplasia of the tissue) or having personal history of breast cancer.
- Having family history of breast cancer or gene mutations associated with significant breast cancer risk. Genetic disorders can`t be fixed, but timely examination gives chance to fight the disease immediately after the onset.
Don`t waste time, start diagnostics by yourself
When we talk about “breast self-awareness” we imply that each and every woman should be familiar with the normal state of her breasts. Monitoring changes of the breasts in different phases of menstrual cycle will be helpful in distinguishing normal physiological and pathological changes. You should take into consideration both appearance and feel of your breasts, as some signs of oncologic process are invisible. Actually, you shouldn`t panic once you reveal any newly onset lump in your breast, as most new formations in the breasts are benign. Benign lumps usually change in size during different stages of menstrual cycle. In case you have any suspicions regarding the nature of the lump, you should consult the doctor without any delay.
So, how to check for breast cancer? Five necessary for self-examination steps include the following:
- You are standing in front of the mirror with straight shoulders; your arms are placed on the hips. Now you may estimate shape and size of your breasts, color of the skin or its changes.
- Continue standing in front of the mirror and raise your arms. Now estimate visual state of the breasts in this position.
- Pay particular attention for your nipples. You should notice not only color and position of the nipple, but also signs of fluid possibly coming out of it. This fluid may look like milk, water, pus or blood.
- Now proceed to feeling your breasts. First lie down in a comfortable position without clothes. Then use first two finger pads of your right hand to examine your left breast. Keep your fingers together and don`t bend them. Your touch should be firm, but smooth. Make a plan of movements and examine (palpate) all the tissue of the breast. You may move in a circular motion, up and down, in rows – any effective personally for you variant. Change pressure of your hand in order to feel tissues in the middle and back of your breast. If you are doing everything correctly, you will feel ribs behind deep tissues of your breast.
- Now proceed to feeling your breasts while standing or sitting. Going through this step in the shower may be a really comfortable option, as the skin is wet and slippery. Use the technique you`ve elaborated for yourself in the previous step.</p>
Don`t forget to examine both of your breasts. Sometimes comparing breasts is helpful in assessing normal and pathological signs. Examination should be regular, no less than once a month.
So, how do you know that you have breast cancer? What do breasts with cancer look like? We are not talking about exact diagnosis on the basis of sole self-examination. Breast self-examination allows only revealing suspicious changes and proceeding to consultation with doctor and medical check-up.
Following signs should draw your attention:
- Pain or unpleasant feelings in your breasts or armpits that are not connected with the phase of menstrual cycle
- Changes in size or shape of the breast, especially when comparing two breasts
- Changes of the skin over the breast – dimpling, “orange skin”, pitting or redness
- Changes of the nipple – inverted nipple, sunken nipple
- Discharge from the nipple – blood, abnormal fluid
- Revealing newly onset thickening in the breast tissue
- Revealing newly onset and constant lump in the breast tissue
When noticing one or few signs you should tell your doctor about them. Of course, you may wonder who to consult in such case. You should start from attending your general practitioner, who will provide basic examination and refer you to the necessary specialist – this may be mammologist, surgeon, and oncologist.
Investigating your breasts in a greater detail
As you have already understood, the next step in clarifying results of self-examination is arranging the appointment with your general practitioner. During the visit doctor will ask you questions about complaints, symptoms, history of previous diseases and family history of oncological disorders. After this the doctor will proceed to clinical breast examination. Clinical breast examination (CBE) is somewhat similar to self-examination, although this procedure is performed by trained healthcare professional. Experience and medical knowledge allow doctor to notice more details and come to certain conclusions. Based on the results of clinical history taking and CBE performing you will be referred to further laboratory and instrumental examination.
The most widespread, easy and informative examination, which is also used for breast cancer screening, is mammography. Mammography is a type of X-ray examination with low dose of obtained radiation. The procedure allows detailed visualization of the internal structure of the breast, revealing all abnormalities and alarming signs.
Currently three types of mammography are available depending on the technical level of the healthcare institution:
- Screen-film mammography. This is classical type of procedure that uses ordinary X-ray equipment to record images directly on the film.
- Digital mammography. In this case more specialized computerized equipment is used to obtain a digital image of the breasts. Digital mammography requires lower doses of radiation and appears to be safer for patients. In addition, digital mammograms are easier to store and compare with future results.
- Digital breast tomosynthesis or 3D mammography. This technique uses multiple high-resolution X-rays to create a 3D image of the breast. Actually, FDA recommends using combination of 3D images and 2D digital mammography images – such comprehensive approach gives the most informative result.
Mammography is the first choice procedure when we are talking about breast cancer screening tests. The examination is easy to perform, well tolerated, noninvasive and financially affordable. For example, FDA recommends women with average breast cancer risk to undergo annual mammography starting from age of 40 years old. After 55 years of age or older women may be examined more rarely, once in two years, or continue with annual screening mammography. Mammography is the most effective technique of early breast cancer revealing.
Under the certain circumstances (for example, in women with mammographically dense breast tissue) mammography may be substituted with breast ultrasound; it is administered for evaluation of abnormal findings on a mammogram or during CBE, as well. This technique uses sound waves for creating pictures of the internal breast structures. Similar to mammography, ultrasound is a comfortable for patients, painless and noninvasive procedure, but it doesn`t imply influence of ionizing radiation. In addition, breast ultrasound doesn`t require any special preparation and takes no more than 30 minutes. Ultrasound technique is also informative for evaluation of the regional lymphatic nodes state – as we know, oncological process may affect lymphatic system. So-called “guardian lymphatic nodes” assessment (this is the lymphatic node where breast cancer starts spreading) is another advantage of going through breast ultrasound.
For women with high risk of breast cancer development (this is why evaluation of risk is of great importance) another additional noninvasive examination is recommended – breast MRI. MRI uses not X-rays, but magnetic fields, so it produces very detailed and precise cross-sectional images of breast and surrounding organs. Contrast material, which is injected into a vein, improves the quality of images even more. MRI is also used for revealing of metastases – locations, where breast cancer spreads. Usually MRI is less favorable financially than mammography, but most major insurance companies will partially cover its costs in woman from high risk groups.
Up to this moment we discussed imaging methods, now we are proceeding to basically different and more invasive methods.
When more invasive diagnostic procedures should be performed?
Finding the tumor and exploring its features with the help of imaging techniques implies just looking on the tumor. To receive necessary information about the nature of lump or its specific features we should examine tumor tissue in the laboratory, out of the human body. Invasive diagnostic procedures include taking part of tumor or certain amount of blood for further examination.
The most simple invasive method is blood test. The doctor will assess complete blood count and biochemical blood test in order to receive information about level of hemoglobin (presence or absence of anemia), inflammation markers, function of liver and kidneys. Blood test doesn`t provide direct information about oncological process, but is important in estimating general state of health.
Much more informative procedure is the biopsy. During the biopsy a sample of tumor tissue or tissue from the suspicious area is surgically removed to be tested in the laboratory. This is the only 100% exact way of determining benign or malignant origin of the tumor.
Depending on the size and location of the tumor few types of breast biopsy may be performed:
- Fine-needle aspiration biopsy. A sample of suspicious cells is taken with the help of small needle.
- Core biopsy requires larger needle, as it removes bigger volumes of suspicious tissues for the examination. Core biopsy is performed under ultrasound or stereotactic control.
- Open excisional biopsy removes the whole neoplasm during more invasive surgical procedure. Performed correctly, it can serve as the first stage of treatment, as well.
- In addition, sentinel node biopsy may be performed the same time, if indicated clinically. This technique investigates lymphatic nodes to detect cancer spreading.
In case the biopsy confirms the diagnosis of breast cancer, removed tissue undergoes additional investigation in order to elaborate individual and effective treatment plan.
These diagnostic steps include:
- Investigation of the receptor status, namely, presence of the receptors to estrogen and progesterone. Tumors with the first type of receptors are called “ER-positive”, with the second one – “PR-positive”. Oncologic cells can carry both types of receptors, as well.
- Another important for treatment planning receptor is HER2 (human epidermal growth factor receptor 2). Medication types for HER2-positive and HER2-negative breast cancers have significant differences.
The most complex tests are genomic ones – Oncotype DX Test and MammaPrint Test. Genomic tests analyze activity of certain genes in the tumor cells. This information is extremely helpful in treatment plan choosing, as it predicts speed of the tumor growth, probability of metastasizing and risk of recurrence after the completion of treatment.
Availability of more complex types of diagnostic procedures to a large degree depends on the level of healthcare institution and general state of medicine in the country.
Where is it better to have a mammalogical examination?
As it was mentioned above, precise diagnosis requires few important conditions:
- Decent state of medical system in general, following approved diagnostic and treatment protocols, and meeting modern diagnostic requirements.
- Decent state of laboratory system (e.g. possibility to perform Oncotype DX Test and MammaPrint Test) and medical equipment.
- Wide clinical experience of healthcare professionals, ability to understand and analyze all the received data.
- Availability of diverse treatment options for further therapy and follow-up period.
Taking into consideration available options in native countries, many women seek for the medical help abroad. In the modern world all medical information is open – you can easily choose desirable specialist online and check all the data about doctor`s education, practical experience and success rates in diagnosis and treatment.
In this scope, patients often take a decision on going through the specialized examination in Germany, as hospitals of Berlin, Cologne and Munich are famous worldwide in this connection. Germany is in the TOP-10 of countries worldwide when we talk about breast cancer prevention and surviving of patients after treatment.
In case you are not a citizen of Germany you can still apply for the treatment as an international patient. What may somewhat confuse you – applying directly to the hospital will put you in the end of long queue of international patients. This is natural, as German citizens have higher priority in waiting lists. In addition, administrative workers, who receive number of applications every day, may have difficulties with medical documents, as some information is clear only for doctors.
Most appropriate option of arranging treatment abroad is using help of company Booking Health. Booking Health is the medical tourism company, which annually helps thousands of patients with diagnosis and treatment abroad. The company has international quality control ISO certificate in this field of work, which ensures reliability and correspondence to the highest international demands.
Booking Health offers help in such significant aspects, as:
- Recommending the best doctor and clinic for your case
- Booking an appointment on the convenient date
- Organizing comprehensive examination
- Providing you with transfer, interpreter and medical coordinator, if necessary
- Preparing for you all the medical reports and further recommendations
- Providing help in further treatment, if necessary
- Providing help in further communication with your treating physician, if necessary
To start planning your medical trip you should leave the request on the web-site of Booking Health. Our patient case manager or medical advisor will contact you the same day to discuss all the details. Aim of our work is to help you in being confident about your health.
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova