Breast Cancer


Breast cancer is the most frequently diagnosed malignancy in women, accounting for over a million cases every year.  The chances of healing of this type of cancer are very high, 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 the fact that screening has become wide-spread, and to improved treatment possibilities.

Should I carry out breast self-examination?
It’s not scientifically proven that breast self-examination would improve the diagnostic rate of breast cancer. However, a big part of the tumours is discovered by the patients themselves. If you can feel
a lump in the breast, you should consult a specialist.
I have pain in my breast…
Usually, pain is not a symptom of breast malignancy, but you need to be examined by a specialist in this case.

I have found a node in my breast…
A suspicious node should never be ignored, even if you have recently had been examined. In this case, we always recommend you to consult your specialist urgently. Breast cancer is often discovered by the palpation of a node, an induration or any other irregularities of the breast.

Other warning signs may include the dimpling of the skin, the change in the size or shape of the breast, the recent retraction (withdrawal) of the nipple or the 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. It is proposed upon the palpation of a node, or if the mammography or the 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 needs to be used.

What is mammography?
Mammography is a low-dose X-ray examination. During the examination, the breast tissue is compressed, which decreases the thickness of the tissue on the one hand, and holds the breast in position on the other hand. Each breast is X-rayed from two planes to make sure that the examination is as complete as possible. In an image, a tumour can be indicated either by a mass or by small white dots
(microcalcifications), the number, the form and the distribution of which allows for suspecting the existence or non-existence of cancer.

When should I have a mammography?
In Luxembourg, there is a screening program organised by the state, in the frame of which women between the age of 50 and 70 receive an invitation for a mammography every second year. You will automatically be 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 higher than 20%
4. Patients who had thoracic irradiation between the age of 10 and 30
5. Patients who are carriers of the Li-Fraumeni syndrome
6. Patients with Li-Fraumeni, Cowden or Bannayan-Riley-Ruvalcabaeni syndromes.

Is an ultrasound always necessary?
The ultrasound is an examination that allows for the visualisation of breast tissue density. This examination can thus reveal if a nodule is of solid or fluid nature. However, an ultrasound is only used to examine a limited area of the breast and is not yet used for the screening of an entire breast. On the other hand, it is an excellent exam to complement mammography.
Should I have a breast MRI?
Magnetic Resonance Imaging uses a magnetic field to create a detailed picture of a part of the body. This technique does not employ X-ray or any other types of radiation, but it requires the
intravenous injection of a contrast medium. It is only used by high-risk patients, not as a general screening method. Sometimes, we turn to this technique 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.
They have found something…
If the different exams return a suspicious image, normally we recommend a biopsy that is performed by a trained radiologist.
The area biopsied is usually marked by a clip or another method to facilitate any future monitoring or perhaps surgical removal in case the biopsy shows cancer.
Breast cancer – not one but many…
Breast cancer is a malignancy that develops from 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 canals or the lobules, it is called in situ carcinoma.
2. On the other hand, if the malignant cells have passed through the so-called ‘basal’ membrane of the canals or the 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 of the development of metastases. Recent progress in genetic research which makes it possible to study cancer at the level of the genome allows us to distinguish four main types of tumours:

1. Luminal A and B type cancer: these are the most frequent types. They develop from the epithelial cells of the canals or the lobe (the cells of the thin tissue lining the canals or the lobe). Luminal type A cells have more oestrogen receptors, while luminal B cells have a little less.
2. HER2+ 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 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 cancers: if the cancer cells do not have oestrogen(, progesterone) or HER2 receptors, we call the cancer triple-negative.

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

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