Breast cancer: symptoms, therapy and chances of recovery of breast cancer

Breast cancer is the most common cancer in women. But even in men, breast cancer occurs. If the disease is recognized by its typical signs, an extensive network of therapy options is available. Most breast cancers are curable. If metastases have formed, the prognosis is much worse.

                                           Most breast tumors are discovered by those affected themselves.

The term breast cancer , referred to as breast cancer (from Latin mamma for breast and Greek carcinos for cancer ) refers to malignant tumors of the mammary gland. Almost all emanate from the milk ducts or glandular lobes of the breast tissue. They are called respectively ductal (from Latin ductus for aisle) or lobular(from Greek lobos for lobe) carcinomas.

Mutations turn normal body cells into tumor cells: they grow fast, change constantly, and divide uncontrollably. They penetrate into adjacent tissue and destroy it. Usually cell processes lead to apoptosis, cell death in such cases. A tumor cell - one also speaks of a dedifferentiated cell - loses this ability, but may gain other properties.

The risk of disease increases from the 40th year of life of a woman annually and decreases from about 70 years. The mean age of onset is 63 years. The diagnosis of breast cancer is by no means the death sentence of a patient, because more than 87 percent of affected women still live five years after the diagnosis. While the number of new cases in industrialized countries is rising, the number of deaths from breast cancer is falling. Most breast cancers can be cured with proper therapy and early diagnosis . However, if metastases have formed, a cure according to current knowledge is not possible. The course of the disease can be significantly delayed by therapies.

Breast cancer in men

Breast cancer rarely affects men. Although they have a mammary gland, only every 100th patient is male . But that's exactly where a danger lies: According to the German Cancer Aid, breast cancer is often recognized too late in men. One reason why the death rate of affected men, in contrast to that of women in the past 25 years has not fallen, although the chances of recovery for men are generally not worse.
Men should not ignore possible signs of shame. However, because breast cancer specialists are often gynecologists, men may also contact a breast cancer center or special breast cancer networks for men if they have doubts, advocates cancer aid.
The symptoms of male breast cancer are similar to those in women. Nevertheless, not every hardening equals cancer - in both sexes the cause is often harmless.

Symptoms: breast cancer and its typical signs
Breast lumps, skin and nipple changes, pain and thickened axillary lymph nodes may be the first signs of breast cancer.
Breast cancer arises in several steps. Therefore, it may take six or even ten years for the first symptoms to become noticeable. In women before menopause, however, a fast, aggressive tumor growth is certainly detectable.
In two-thirds of cases, sufferers are the first to discover the symptoms; only up to a third of breast cancers are diagnosed by the doctor, for example, by palpation, mammography or ultrasound . That is one reason why they are not undisputed.

Signs of breast cancer at a glance
  • Knot in the chest
They are often the first sign of disease. Depending on the size of the breast knots are palpable only from a diameter of about two centimeters. Cancer nodules do not hurt. They usually feel solid and irregularly limited. Some can not be moved. By pressing one can only draw suspicion on cancer. Further investigations often give the all-clear.
  • Change in the nipple
Inflammation, changes in the skin, or new nipple retractions, as well as bloody secretions, can be a sign of breast cancer.
  • Changes of skin and breast
Redness, retraction and protrusion of the skin or large-pored orange peel skin may indicate breast cancer. Sometimes the size and shape of the whole breast changes.
  • Pain
Pain is rarely an early symptom.
  • Swelling in the armpit
Infected axillary lymph nodes are rarely the first sign of disease. Smaller settlements of tumor cells in the lymph nodes can hardly palpate even an experienced examiner.

Causes of breast cancer: risk factors do not overstate
Hormones and genes, environment and lifestyle can affect breast cancer risk. By contrast, long periods of lactation and healthy eating, for example, reduce this risk. But those who carry a risk factor usually have no reason to be afraid. Because the risk of developing breast cancer generally remains low.
Scientists discuss a whole range of risk factors for breast cancer. However, nobody should overestimate the risk factors for breast cancer and give them the meaning of a prediction. Because the risk of getting cancer usually does not take on threatening proportions, even if someone carries one of the risk factors.
For example, a woman without any risk factor has a relative risk of 1. With a 1: 2,500 probability, she falls ill with breast cancer between the ages of 30 and 40 years. However, if her mother has breast cancer at a young age, her risk increases to 1: 1,000. The probability of experiencing the 40th birthday without breast cancer is therefore very high.

Family burden of breast cancer genes
Today, it is estimated that about five percent of all breast cancers are hereditary. This is mainly due to pathogenic changes (mutations) of the responsible. If such a mutation occurs, women have a risk of developing 56 to 84 percent of their breast cancer during their lifetime, and the risk of ovarian cancer also increases.
Breast cancer is also more common in men with BRCA-1 or BRCA-2 gene. These mutations can be passed on to offspring with a probability of 50 percent. 

In addition to the two aforementioned "breast cancer genes", there are also changes in other genes, for example p53, which are associated with an increased probability of breast cancer but appear to play a minor role.

Risk factors at a glance:
  • Hereditary factors : If breast cancer has occurred in the family and / or there is a mutation in the BRCA1 or BRCA2 gene, the risk of breast cancer is increased.
  • Hormonal factors : The female sex hormones estrogen and progesterone have an influence on the development of breast cancer. What that means for hormone replacement therapy during and after menopause is discussed controversially. Recent studies do not seem to increase the risk for a duration of up to five years. With prolonged use, it rises slightly. Women who have a history of breast cancer in their family seem to be more vulnerable to hormone replacement than others. Before deciding on hormone replacement therapy, one should carefully weigh the benefits and risks.
  • Benign breast disease: Proliferative mastopathy, which results in an initially benign proliferation of breast tissue with incipient cell changes, may increase the risk of breast cancer.
  • Pre-existing disease: If you have ever had breast cancer, the risk of recurrence is increased.
  • Alcohol : Alcohol stimulates the growth of breast cells and increases the concentration of estrogen in the blood. In addition, regular consumption of alcohol puts a strain on the liver. Thus, carcinogenic substances can not be degraded sufficiently.
  • Smoking: The breast cancer risk of smokers and ex-smokers is 40 percent higher than that of non-smokers. However, it also depends on the duration of smoking and the amount of cigarettes consumed. Heavy smokers who have been addicted for more than 15 years have up to 60 percent higher breast cancer risk, according to a study by the Fred Hutchinson Cancer Research Center. Even for female ex-smokers there is no all-clear in the first years after smoking cessation. Only ten years after stopping her breast cancer risk drops back to normal levels.
  • Obesity : Overweight women are more likely to develop breast cancer than lean ones. It is not only the weight gain is a risk, but also the estrogen levels in the blood, which increases as a result of the increase in fat.
  • Number of menstrual cycles and childlessness : Many menstrual cycles in a woman's life increase the likelihood of developing breast cancer. The reason is unclear. Also, childlessness, early first or late last menstruation are considered risk factors. Conversely, births and long periods of lactation provide some protection (see also "Prevent Breast Cancer"). This is especially true when the women give birth to their first child at a younger age. If they become mothers for the first time beyond the age of 30, investigations lead to different results.
  • Birth control pills : In adult women, the pill has little influence on the risk of breast cancer. However, very young women who use contraceptive pills in the first few years after the first menstrual bleeding are more likely to become ill at a younger age. It is possible that glandular cells are particularly sensitive during and shortly after puberty, and that their genetic material is more likely to be damaged during this time than later. However, birth control pills reduce the risk of ovarian cancer.


Diagnosis: detect breast cancer
After breast cancer, you can search with your bare hands, but also with great technical effort. Whether you want to investigate a suspected healthy woman or to secure a suspected diagnosis, is crucial for the choice of the method. By combining tactile findings, imaging techniques and biopsy , the diagnosis can be made in most cases with certainty.

Self-examination of the breast
Although nodules are clearly palpable only from a size of one and a half to two centimeters, self-examination is the most important method of detecting breast cancer . In 60 to 70 percent of all cases, the patient first notices the first symptoms. Many women then hesitate to visit a doctor for weeks to months. As a result, they lose valuable time. The sooner the breast cancer is discovered, the better the prospects for a successful, healing treatment. If you notice anything suspicious during the self-examination , you should consult your doctor. He will give the all-clear after further investigations.

Tasting by the doctor
Every year, from the age of 30, a person with statutory health insurance is entitled to a clinical examination for the early detection of breast cancer. The doctor scans the breasts and armpits and looks for knots. He also takes care of the size and shape of the breasts as well as changes to the skin and nipple. However, the chance of early detection of breast cancer is small. If the palpation findings appear conspicuous to the physician, he will arrange further investigations.

Mammography (x-ray)
Mammography and mammography are the most important diagnostic tools for the diagnosis of breast cancer. They are used as a first step in the further investigation of tactile knots. In addition, they serve for early detection because they also show non-palpable changes in the breast tissue. However, they only indicate with more or less certainty whether the changes are benign or malignant. The final proof must always be a tissue sample (biopsy).

         Mammography is used either for early breast cancer detection or in the suspected diagnosis of breast cancer.

In mammography, an X-ray of the breast, two images are taken - from above and from the side obliquely above. Two plexiglass discs press the chest together, which many women find uncomfortable.
Mammography is especially suitable for older women from about 50 years. In younger women, the likelihood of detecting a malignant tumor with mammography is limited. Your breast tissue is usually too dense and more sensitive to radiation. 

Mammographic findings are relatively often mistakenly considered malignant. And the quality of the examination is heavily dependent on the X-ray institute.

Mammasonography (ultrasound)
The ultrasound examination provides a cross-sectional view through the breast. In the case of specific questions due to a conspicuous palpation or suspicious mammography, the significance of this method is high. Depending on the examiner, however, the quality varies greatly. Because of the high time required, the method is also not suitable as a search method in probably healthy women. 

Mammasonography is considered a supplement to mammography. In young women with dense breast tissue, it is usually more meaningful than mammography and then comes before this used. In addition, it brings no radiation exposure with it.

Magnetic Resonance Imaging (MRI)
The MRI , also called magnetic resonance imaging, is particularly suited to soft tissue - show with great clarity - fat, connective and glandular tissue of the breast. It produces images that resemble x-rays. For breast cancer detection, this study has the disadvantage that benign and malignant changes can not always be distinguished. Therefore, the MRI is mainly used as an adjunct method when
  • Patients with implants should be examined.
  • the breast cancer course during a therapy (for example chemo ) is to be controlled.
  • in known breast cancer is to be ruled out that more foci are present.
  • on the scar of a pre-operated breast between harmless scar tissue and a recurrence of carcinoma tissue is to be distinguished.


Biopsy
According to the Cancer Information Service, images alone are not enough to safely diagnose breast cancer. Therefore, it is necessary to use a hollow needle to take a tissue sample from the affected area of the breast and examine it. The procedure is carried out under local anesthesia. If a malignant condition is present, the pathologist determines the exact characteristics of breast cancer.

Forms and stages of breast cancer
Before the breast cancer therapy is initiated, first the tissue changes and the tumor stage must be determined.
Tumors are classified according to where they occur and whether they have already grown into surrounding tissue:
  • lobular neoplasia (new formation): altered tissue in the glandular lobules, still no carcinoma
  • ductal in situ carcinoma: tumor in the ducts, which has not broken through
  • invasive ductal carcinoma: most common form of breast cancer; Tumor in the milk ducts, which already outgrows it
  • lobular carcinoma: rarer; invasive tumor starting from the glandular lobes
  • tubular, medullary and other carcinomas: very rare; invasively
Based on the biopsy, the pathologist can also determine the degree of maturation of the tumor cells ( grading ). The higher the degree of maturation, the less quickly the tumors grow as a rule:
  • G1: well matured
  • G2: moderately mature
  • G3: poorly matured
In order to further determine the disease stage, staging serves The examination results of mammography, ultrasound, MRI and biopsy are combined and evaluated. The extent of the tumor and possibly the involvement of lymph nodes and the presence of secondary tumors (metastases) are recorded.
Staging results are summarized using the TNM classification . T stands for tumor, N for lymph nodes (from the English term "nodes" for nodes) and M for metastases.

TNM classification for breast cancer
  • T0: no tumor detectable in the breast
  • Tis: Carcinoma in situ, ie non-invasive tumor
  • T1: The tumor measures less than two inches.
  • T2: The largest tumor is larger than two centimeters, but smaller than five centimeters.
  • T3 : The largest extent of the tumor is more than five inches, but less than ten inches.
  • T4: Irrespective of its size, the tumor has already grown beyond the breast tissue into the chest wall or skin.
  • N0: no palpable lymph nodes in the armpit on the side of the tumor
  • N1: palpable, that is probably afflicted, but still movable lymph nodes in the armpit
  • N2: axillary lymph nodes that have grown together and are therefore no longer displaceable among themselves or other structures
  • N3: The lymph nodes along the internal mammary artery are affected or swelling of the arm indicates a drainage failure in the lymphatic system.
  • M0: No distant metastases detectable. In contrast to regional metastases, distant metastases are no longer located near the primary tumor or the adjacent lymph node, but have spread to other organs through bloodstreams or the lymphatic system.
  • M1: distant metastases present (this includes skin involvement outside of the mammary glands)
  • Abbreviations before T indicate further details about the tumor:
    • c (English "clinical"): The classification of the tumor is based on the tactile findings.
    • p (from "postoperative"): The finding is based on the result of the microscopic examination of the tumor tissue (pathohistological findings).
    • m (from English "multiple"): Several, mutually independent tumors were found simultaneously.
    • r (from "relapse"): It is a recurrence, a tumor relapse.
  • An x after an N or M indicates an unclear classification of lymph node involvement or metastasis.


TNM classes are occasionally grouped into stages
In addition to the TNM classification, the staging of the International Union against Cancer (Union Internationale contre le Cancer, UICC) is sometimes used to group together several TNM classes.
Simplified, these can be defined as follows:
  • Stage 0: TisN0M0; ductal in situ carcinoma without lymph node involvement and without distant metastases
  • Stage I: T1N0M0; small tumor without involvement of the lymph nodes, without distant metastases
  • Stage IIA: T2N0M0 or T0-1, N1M0; larger tumors without lymph node involvement and without distant metastases or smaller tumors with few affected lymph nodes or affected lymph nodes without detectable tumor in the chest
  • Stage IIB: T2N1M0 or T3N0M0; larger tumors with or without lymph node involvement
  • Stage IIIA: T0-2, N2M0, T3N1M0, T4 tumors, M0; larger tumors with affected lymph nodes not only in the immediate vicinity of the mammary gland
  • Stage IIIB: T4N0-2, M0; large tumor with possible lymph node involvement without distant metastases
  • Stage IIIC: each T, N3M0; extensive lymph node involvement regardless of tumor size, no distant metastases
  • Stage IV: every T, every N, M1; Distant metastases are present.


Receptor status
  • Hormone receptors : In most breast cancer patients, the tumor cells have receptors, binding sites, for the hormones estrogen and progesterone. The growth of the tumor is promoted by these hormones, it is then said to be hormone receptor positive and sometimes respond to (anti) hormone therapy.
  • HER-2 receptors : HER-2 proteins are factors that promote the growth of tumor cells. The more of these receptors are present, the more aggressive is usually the course of the disease and the less favorable the prognosis.  


Therapy: How is breast cancer treated?
The surgery is usually the first treatment for breast cancer. Depending on the spread of the tumor, breast cancer, hormone receptors on the tumor tissue and age of the patient, other procedures follow: radiation, chemo, hormone and / or targeted therapies.

surgery
In a fifth of cases, surgery alone or in combination with radiation is considered sufficient to treat breast cancer. If the tumor tissue has safely or even presumably sent daughter cells, the operation will be followed by systemic drug treatment.

Breast conserving surgery
Primary therapy of a breast cancer is, if possible, the removal of the tumor by surgery. This operation has changed a lot in the last two decades: If you used to remove most of the breast tissue in breast cancer, today it has come to the realization that radical breast surgery does not improve the treatment outcome in all cases by far. Today, about two out of three operations can be performed in a breast conserving manner. Removal of the breast ( mastectomy ) is only necessary if the tumor is already at an advanced stage and has affected large parts of the breast.
During breast cancer surgery, the surgeon must be careful to remove the tumor with so much surrounding tissue that no tumor cells can be found in the histological examination of the cut margins. This means that healthy tissue is always removed with every tumor removal. If it is a large tumor, which requires a lot of tissue removal, a size difference between the two breasts can occur despite the gentle surgical technique. However, this can be well compensated by plastic surgery: You can either glandular tissue from the chest itself or larger defective parts of muscle in the resulting cavity.
In most cases, in breast cancer - especially after breast-conserving surgery - there is an irradiation of the affected breast, including the wall of the chest. This will destroy any remaining tumor cells in this area and reduce the risk of disease recurrence to about one-quarter to one-sixth.
More and more frequently, doctors today also use chemo or hormone therapy before breast cancer surgery. If the tumor responds and shrinks, the operation may be smaller; In some cases, a breast-conserving operation becomes possible as a result.

Breast removal (mastectomy)
In some cases, doctors recommend mastectomy . Mammary gland tissue, dermal nostrils and the pectoral fascia are removed, while the pectoral muscle itself is preserved, unlike the earlier radical mastectomy.
If the healthy tissue space becomes too small, the tumor grows in different places at the same time or adheres to skin or muscle, this procedure appears to be the safer procedure. Sometimes the size ratio between breast and tumor is disadvantageous. The result of a breast conserving surgery would then be cosmetically less favorable than after a plastic reconstruction at a later date.

Removal of axillary lymph nodes
During surgery, the surgeon also extracts some lymph nodes from the adjacent axillary region via a separate incision. Their investigation provides further information about the tumor stage and the spread of the tumor. If tumor cells are contained in the lymph nodes, the risk that the disease has spread to other parts of the body increases (metastasis). In such cases adjuvant (concomitant) chemo- or hormone therapy can be performed after the operation, which can kill already migrated tumor cells.

Chemotherapy
In chemotherapy, cytotoxic drugs that act as cell toxins are used. They disturb the cells especially during their most sensitive phase: cell division. As tumors grow rapidly, many cells are in the division stage. Therefore, the effect of chemotherapy on cancer cells is stronger than on healthy tissue. Against dormant cancer cells, however, the strong drugs can do nothing.
Chemotherapy is used today at three different times.
  • The adjuvant chemotherapy is the most common form of chemotherapy. It is used when the tumor infiltrates already surrounding tissue (invasive), but still no daughter tumors are detectable. Adjuvant chemotherapy begins in the first few weeks after surgery and is designed to prevent tumor spread and improve the chances of survival. On average, it reduces mortality by 25 to 35 percent.
  • The neoadjuvant chemotherapy takes place before the operation, such as when the tumor is relatively large. It creates favorable conditions for the procedure by reducing the cancerous tissue.
  • The palliative chemotherapy relieves the advanced stage of the disease, for example, pain caused by metastases.
Even at a very early stage, cancer cells can spread in the organism and form tiny settlements (micrometastases) that can not be detected even with modern imaging techniques. Therefore, the use may be worthwhile in women with breast-limited carcinomas. Although it is assumed that the operation did not remove all cancer cells from the body, chemotherapy is recommended.
There are several cytostatics that are used in different combinations. Which are used in individual cases, decides the doctor, for example, based on the individual characteristics of the tumor and also taking into account previous therapies.

Hormone therapy
A large proportion of breast tumors are promoted by estrogens and progesterone. So - called hormone receptor - positive tumors have binding sites (receptors) on their surface. When hormones are docked there, growth and proliferation of the tumor cells are stimulated. As the production of female sex hormones declines during menopause, hormone-sensitive breast tumors in women before the menopause - stimulated by the hormone effect - usually take a more rapid course than in postmenopausal women.
In hormone receptor-positive tumors, hormone therapy is the standard therapy - especially since it is better tolerated than chemotherapy. It inhibits the hormones that promote tumor growth and is therefore also called antihormonal therapy . The risk of relapse can thus be significantly reduced.
Prior to menopause, anti-estrogens, such as tamoxifen , and GnRH analogues, anti-estrogens and aromatase inhibitors after menopause are used primarily Side effects are similar to typical menopausal symptoms such as no menstrual bleeding, sweating, hot flashes , dehydration and inflammation of the vaginal mucosa, headache , sleep disorders and depressive moods. 

There are three ways to interfere with hormonal balance during breast cancer therapy:
  • Removal of hormone-producing organs
  • Inhibition of hormone action with drugs
  • additional administration of hormones
Although all three paths are being followed to this day, the medical procedures are still in the foreground. However, it can not be predicted how well the tumor cells respond to the respective therapy.

Radiotherapy
By the irradiation , the risk of recurrence of the tumor (relapse) can be greatly reduced after breast-conserving surgery. In addition, radiotherapy is used inter alia in the treatment of secondary tumors or possibly after a breast removal.
Irradiation begins after complete healing of the surgical wounds , usually about four to eight weeks after the procedure, and lasts for six weeks. If chemotherapy is given, the radiation will follow. An antihormonal therapy may take place in addition to radiation.
Irradiation equipment and techniques are today well developed and overall radiotherapy is very gentle: only the area that is affected is irradiated. As a result, side effects are less common. These can basically occur during, but also after irradiation. Many disappear, but some are permanent. Often, skin reactions such as redness, superficial layers of the skin (epitheliolysis), scaling. Occasionally damage to the sweat glands may result, resulting in permanently dry skin. Also possible are persistent hyperpigmentation of the skin or dilated or ruptured vessels. Other side effects like nauseaThese days are rare. Possible permanent damage is scarring (fibrosis) of the lungs and chest. Rarely lymphatics can occur in the arms or chest when lymphatic vessels are irradiated.

Targeted cancer therapies
Tumor cells react differently than normal body cells. Exactly these characteristics target targeted therapies . There are several medications with different functions. For example tyrosine kinase inhibitors and monoclonal antibodies inhibit signal transduction and thus "growth orders" to the cancer cells. Angiogenesis inhibitors provide insufficient supply of oxygen and nutrients to the tumor tissue.

Alternative therapies for cancer
Alternative treatments and preparations are usually offered to strengthen the immune system. However, their effectiveness is usually not scientifically-clinically tested. The cancer information service therefore advises caution, because even unwanted effects can not be ruled out. Patients should consult their treating physician prior to alternative treatment. Alternative therapies should at the most additional, that is complementary, to the conventional-medical done and not instead of this.

Prognosis: Metastases enormously worsen the chances of breast cancer being cured
Even though breast cancer appears to have been defeated after surgery and other therapies, relapse rates remain high. Distant metastases are particularly feared: tumor cells that scatter into other, sometimes distant organs and tissues and lead to a daughter tumor here.
The prognosis for breast cancer depends - as with many other cancers - on various factors:
  • Size of the tumor at initial diagnosis
  • Spread of the tumor (lymph node involvement, metastases)
  • Degree of differentiation of tumor cells: how strongly do tumor cells deviate from normal breast cells?
  • Hormone receptor status
  • HER-2 status
  • Presence of circulating tumor cells in blood and bone marrow
  • Age of the patient
In individual cases, there are usually different influencing factors that influence each other in their impact on the prognosis. Statistical values ​​for the forecast are therefore always to be understood as a rough guide.
For all breast cancer patients and stages together, the relative five-year survival rate is about 81 percent . This means that five years after diagnosis, more than four-fifths of ill women still live. Thus, the prognosis for breast cancer has improved significantly in recent decades, which is attributed, among other things, to the introduction of new therapies.
If distant metastases occur, chances of survival decline drastically. In such cases, according to Krebsgesellschaft, "with today's treatment methods, there is no chance of complete cure , that is, permanent removal of all tumor cells from the body."
Therefore, in addition to the complete removal of the breast tumor, the primary goal is to counteract the spread of cancer cells as early as possible. If metastases are already present, the progression of the disease is delayed as long as possible and the symptoms are alleviated.
According to Krebsgesellschaft, the further prognosis depends heavily on where the metastases occur: they can be kept relatively well in the bones and the skin, while they cause a rapid deterioration of the condition in the lungs, brain and liver. In patients with advanced breast cancer, the life expectancy according to the Cancer Society is an average of two years after the onset of the first metastases. One quarter of those affected still live five years. These forecasts also include cases from past decades and should continue to improve with the ongoing development of modern therapies.

Sports and nutrition support healing in breast cancer
Obesity is a risk factor for breast and other cancers. However, reducing excess weight can not only prevent breast cancer. Even if the cancer has already broken out, the reduction of obesity and other lifestyle factors, especially sports, can accelerate the healing process.

Nutrition
An (anti) cancer diet does not exist. Nevertheless, you can pay a lot of attention to improve the diet during and after a breast cancer. The main rules according to the Cancer Information Service: eat a lot of fruits and vegetables and avoid being overweight . A study by the American Thomas Jefferson University showed that if cancer was already reduced, it reduced the daily amount of calories by 30 percent. "The diet activated an epigenetic program that slowed metastasis," says study director Nicole Simone in a press release from the university. "Epigenetic" describes the influence of environmental factors on heredity, turning certain genes on or off, in this case by light fasting .

Vitamins
Animal studies and test tube studies indicate that vitamins play an important role in the prevention of breast cancer. This is especially true vitamin A , its precursor beta-carotene , vitamin C and vitamin E to. The prophylactic effect of beta-carotene appears to be confirmed in several independent studies. Beta-carotene is found mainly in carrots , spinach and broccoli, as well as in melons and apricots in relatively high concentrations.
The clinical effect of vitamins on existing breast cancer in humans, however, is unsecured and controversial. The previous opinion is that the vitamin content, which is fed by a varied and high-fiber diet including vegetables, is sufficient. In the treatment of breast cancer and also in the prevention of recurrence additional vitamins are not required in normal nourishing persons .

Acetylsalicylic acid
One can stop breast cancer. That works, at least in the lab. The aspirin drug ASS slows down the growth of isolated breast cancer cells and tumors in mice. That's what scientists from the US University in Kansas City found out. The widely used headache medication prevents them from spreading the cancer. According to the study, the analgesic prevents or at least reduces the formation of cancer stem cells, whereas chemotherapy does not attack them. Cancer stem cells are responsible for the current state of knowledge that a tumor grows and scatters. How this protection mechanism of ASS works exactly, but is still largely in the dark. In addition, aspirin has side effects . Whether the benefits of regular intake will make up for this damage still needs to be explored.

Sports
In women who have breast cancer, the course of the cancer can be favorably influenced by physical activity. Study results show that breast cancer patients who were physically active several times a week before their illness, less frequently relapse and the cancer progresses less frequently. In addition, the breast cancer-related risk of death is lower than in athletically inactive breast cancer patients. The cause is thought to be changes in the hormone balance caused by physical activity. Thus, in sports women after menopause, a permanent reduction in estrogen levels in the blood was detected.
After a breast operation, especially endurance sports are recommended, for example swimming . Preventive postures due to pain should be avoided because they promote muscle tension and edema . On the other hand, one should refrain from exaggerated physical stress or competitive sports. Anyone who used to have little or no exercise in the past can start out with ergometer training and walking after the breast surgery. Sport is useful not only during and after a cancer, but also preventive, as several studies have shown.

Prevent the breast cancer
According to experts, about 30 percent of all breast cancer cases can be avoided by a healthy lifestyle and a well-considered, economical use of hormone replacement products during menopause and afterwards.
Women can significantly influence their breast cancer risk by eliminating the biggest preventable risk factors in their lives. According to study results, this mainly includes lack of exercise, obesity, alcohol consumption and smoking. Other factors such as breastfeeding play a positive role in the prevention of breast cancer.

Sports
Several studies have already suggested that regular physical activity may reduce breast cancer risk. An international research team evaluated the results of 62 investigations on this topic.
Overall, the incidence of morbidity in women who moved regularly was 25 to 30 percent lower than their less active counterparts . Recreational sports had a more positive effect than physical exertion at work or in the home. Mediocre and heavy stress had the same effect on breast cancer risk.
According to the study, the lowest risk of breast cancer was found in women who had been active all their lives. In addition, sports after menopause caused a greater risk reduction than sports at a young age. Thin women and mothers benefited more from exercise than fat or childless women.
The World Health Organization (WHO) recommends at least 150 minutes of moderate physical activity or 75 minutes of strenuous exercise per week.

Healthy eating
In addition to sufficient exercise, women should drink little alcohol and not overweight to reduce their risk of cancer. Nutrition should focus on nutritious foods and healthy fats (especially omega-3 fatty acids in fish, walnuts or flaxseed) and on not eating too many calories. Alcohol should be consumed in moderation and several abstinent days a week.

Do not smoke
Scientists at the University of Granada in Spain analyzed data from more than 500 patients aged 19 to 91 years. Each of them had been diagnosed with breast cancer between 2004 and 2009. It turned out that smokers who tended to have familial cancer fell ill some ten years earlier than non-smokers with inherited risk factors.

Breast-feeding
The Spanish study also looked at the effects of breastfeeding on breast cancer risk: If there is no family risk, women who breastfeed for at least six months suffer significantly less from breast cancer. In women who had breastfed longer, the preventive effect increased. In smokers, however, a protective effect was missing. The researchers predict that breastfeeding for months would encourage the release of certain hormones that could fight cancer cells directly.

Early detection of breast cancer
Although preventive care is not a way to prevent breast cancer. However, they can sometimes detect tumors early. From the age of 30, every legally insured woman is entitled to a clinical examination for the early detection of breast cancer (examination and palpation of the breasts and armpits) by the gynecologist. The cashier will pay the costs.
                                           Self-examination of the breast is recommended once a month.
Once a year is not too often. Therefore, every woman should conduct a self-examination once a month . Women between the ages of 50 and 69 also have the option of mammography screening. However, experts still disagree whether the benefits of this early detection method outweigh the risks, for example due to radiation exposure.

Breast cancer and the desire to have children
Breast cancer occurs not only in old age, but also in younger women who still want to have children. Pregnancy is by no means excluded following cancer treatment. Often, however, chemo and hormone therapy override the function of the ovaries.
In principle, there is nothing wrong with pregnancy for some time after a breast cancer disease. However, many patients have difficulty getting pregnant after cancer therapy. By chemotherapy it can lead to permanent cessation of ovarian function occur. The menstrual period is over, the menopause set prematurely. For women over 40, this is almost the norm.  
Also, the hormone therapy suspends the function of the ovaries, but only temporarily. GnRH analogues, which are used exclusively in breast cancer patients before the menopause, block the menstrual cycle completely. During treatment with the anti-estrogen tamoxifen or the antibody trastuzumab pregnancy is possible in principle. Nevertheless, experts currently advise against the fear of damage to the embryo.
Patients with breast cancer who wish to become pregnant but have difficulty getting pregnant can get help from the specialist. First contact person is the gynecologist. He can already carry out various tests and treatments and if necessary transfer them to a specialized center. There, the affected women also find trained contact persons who assist them in coping with the psychological stress associated with fertility treatment and unfulfilled desire for children.


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