Breast Cancer

Cancer féminin le plus fréquent, il touche une femme sur huit.
Une prise en charge globale et pluridisciplinaire est la clé
de son traitement.

- The Different Treatments -

- Risk Factors -

Diagnosis

  • Introduction

 

Breast cancer is the most frequently diagnosed form of cancer in women, accounting for over a million cases every year.

 

 There is a good chance of recovery from this type of cancer, especially when it is diagnosed at an early stage.

 

 The number of deaths caused by breast cancer has decreased by more than one third over the past three decades, which is mostly due to widespread screening and improved treatment possibilities.

 

 

  • Diagnosis

 

Should I carry out breast self-examination?

It’s not scientifically proven that breast self-examination improves the rate of breast cancer diagnosis.

However, many tumours are discovered by patients themselves. If you can feel a lump in your breast, you should consult a specialist.

 

I am experiencing breast pain...

Pain isn’t usually a symptom of breast cancer, but you need to be examined by a specialist in this case.

 

I have found a lump in my breast...

A suspicious lump should never be ignored, even if you have recently been examined.

In this case, we always recommend that you consult your specialist as soon as possible.

Breast cancer is often discovered during a physical examination, where a lump, induration or other irregularity is felt.

Other warning signs may include dimpling on the skin of the breast, change in the size or shape of the breast, recent retraction of the nipple (sunken into your breast) or discoloration of the skin of the breast.

 

 

How to diagnose breast cancer?

The only way to diagnose breast cancer is to carry out a biopsy.

A biopsy is recommended when a lump is found, or if the mammography or ultrasound shows a suspicious lesion.

Breast tissue biopsy is either ultrasound- or mammography-guided, which means that a special device called a prone-table or mammotome is used.

 

What is mammography?

Mammography is a low-dose X-ray examination.

During the examination, the breast tissue is compressed, which both decreases the thickness of the tissue and holds the breast in position.

Each breast is X-rayed in two planes to ensure that the examination is as complete as possible.

In an image, a tumour can be identified either by a mass or by small white dots (microcalcifications), which according to their number, form and distribution could be signs of cancer.

 

 

When should I have a mammogram?

In Luxembourg, there is a screening program organised by the state, which ensures that women between the age of 50 and 70 receive an invitation for a mammography every second year. You will be automatically invited to this examination.

However, it is necessary and important for you to do a risk factor evaluation with your specialist and establish the optimal schedule for these examinations.

Patients with a high risk of breast cancer are recommended to undergo an annual mammography and an annual breast MRI examination from the age of 25.

 

 

Who are the high-risk patients?

  1. Patients with BRCA mutation
  2. Patients with a close relative who has BRCA mutation
  3. Patients with a familial risk above 20%
  4. Patients who had thoracic radiation therapy between the age of 10 and 30
  5. Patients who are carriers of the Li-Fraumeni syndrome
  6. Patients who are carriers of Cowden or Bannayan-Riley-Ruvalcabaeni syndromes.

 

Is an ultrasound always necessary?

The ultrasound is an examination that allows breast tissue density to be visualised.

This examination can thus reveal if a nodule is solid or contains fluid. An ultrasound is only used to examine a limited area of the breast and is not yet used for screening an entire breast. However, it is an excellent examination in conjunction with mammography.

 

Should I have a breast MRI?

Magnetic Resonance Imaging (MRI) uses a magnetic field to create a detailed picture of part of the body.

This technique does not use X-rays or any other type of radiation, but it requires the intravenous injection of a contrast solution (dye).

It is only used for high-risk patients, not as a general screening method.

Sometimes this technique is used to clarify the nature of certain lesions discovered by other types of exams.

It might also be used for examining breasts that are otherwise very difficult to examine.

 

If something is found...

If the different exams return a suspicious image, normally we recommend that a trained radiologist perform a biopsy.

The site of the biopsy is usually marked with a clip to facilitate any future monitoring or eventual surgical removal should the biopsy indicate cancer.

 

Breast cancer - not one but many…

Breast cancer is a cancer that develops in the glandular tissue of the breast. The malignant cells multiply in an uncontrolled way, forming a mass. But this general description covers several different situations. In fact, breast cancer is known as a heterogeneous disease because it may manifest itself as different types of tumours that all need to be treated differently.

 

First of all, everything depends on the stage at which the cancer is detected.

 

  1. If the malignant cells do not spread beyond the ducts or lobules, it is called an in situ carcinoma.
  2. On the other hand, if the malignant cells have passed through the basal membrane of the ducts or lobules and have invaded the surrounding tissue, it is called an infiltrating carcinoma. The malignant cells can propagate either in the lymph nodes located under the armpit or through blood. There is a risk that metastases may develop.

 

Recent progress in genetic research which makes it possible to study cancer at genome level allows us to distinguish four main types of tumours:

  1. Luminal A and B type breast cancer: these are the most frequent types. They develop from the epithelial cells of the ducts or the lobules. Luminal type A cells have more oestrogen receptors, while luminal B cells have slightly fewer receptors.
  2. HER2+ type breast cancer: HER2 receptors can be found on the surface of the cancer cells. When the receptors are activated, they induce cell proliferation.
  3. Basal-like breast cancer: this type is named after the shape of the cells. They look like the basal cells of the canals, unlike the luminal cells.
  4. Triple-negative type breast cancer: if the cancer cells do not have oestrogen, progesterone or HER2 receptors, we call the cancer triple-negative.

 

Upon identifying the exact type of tumour, we can choose the most appropriate treatment.

L'Institut de Gynécologie et d'Obstétrique

121 A route d'Arlon / L-1150 LUXEMBOURG