Breast cancer: ‘The earlier we detect a tumour, the better we can treat it’

What changes in the breast should women take seriously and have checked by a doctor?

Any new change in the breast that does not go away on its own or whose cause is unclear should be investigated by a doctor.

This could be a new lump or area of hardening, but also a dimpling of the skin or nipple, a change in the shape of the breast, redness or swelling, or discharge from the nipple – particularly if it is bloody.

I therefore think it is important for women to know their breasts: what do they normally look like, and how do they feel? This often means that changes are noticed at an early stage.

At the same time, I’d like to reassure you: the vast majority of changes in the breast are benign. Nevertheless, it’s better to have something new checked once too often than once too little.

Many women are unsure when they should start with early detection. What do you recommend?

For women with an average risk of breast cancer, mammography is the most important screening test from the age of 50.

Before that age, there is no general mammography screening for women without any particular risk. However, if symptoms arise or there is an increased risk, we carry out examinations regardless of age.

Depending on the situation, a mammogram, an ultrasound scan and, for women at very high risk with very dense breast tissue, a magnetic resonance imaging (MRI) scan may also be advisable.

It is important to note that the examination is determined by age, breast tissue, symptoms and individual risk.

Which women are at increased risk of breast cancer – and what role does family history play?

The most important risk factor is, first and foremost, age. Other factors that play a role include a family history of the disease, certain genetic mutations, high breast density and some pre-existing breast conditions.

We consider a hereditary predisposition, for example, if several close relatives have had breast or ovarian cancer, if the condition occurred at a very young age – for instance, before the age of 40 – if there has been bilateral breast cancer, or if a man has been diagnosed with breast cancer.

In such cases, genetic counselling may be advisable. These days, we look not only at BRCA1 and BRCA2, but also at a whole range of other genes. For women with a significantly increased risk, we draw up a personalised early detection plan. Screening often begins earlier and is carried out more frequently.

The issue is particularly prominent in October, which is Breast Cancer Awareness Month. This can give the impression that breast cancer often has a genetic cause. In fact, however, around 70 per cent of all cases have no hereditary basis.

What can women do themselves to reduce their risk of breast cancer?

Unfortunately, breast cancer cannot be reliably prevented. However, by leading a healthy lifestyle, we can certainly have a positive influence on the risk.

There is very strong evidence in favour of regular physical activity – you don’t need to take part in competitive sport – and maintaining a healthy body weight, particularly after the menopause. When it comes to alcohol, the rule is: the less, the better. Not smoking, along with a varied, plant-based diet with as few processed foods as possible, complements a healthy lifestyle.

This is not about perfection, nor is it about individual so-called ‘anti-cancer foods’ – such things do not exist. What matters most is maintaining as healthy a lifestyle as possible over many years.

What would you like to say to women who keep putting off a screening out of fear of a possible positive result?

I see this time and time again and can understand this fear very well.

But the screening does not cause the disease – it can only detect it. And when it comes to breast cancer in particular, the earlier we detect a tumour, the more effectively – and often more gently – we can treat it.

That’s why you shouldn’t keep your fears to yourself. It’s better to talk about them and get clarity than to live with stressful uncertainty for months on end. I hear patients say time and again: ‘If only I’d done this sooner.’ The uncertainty leading up to the screening is often found to be particularly stressful.

Not all breast cancers are the same. What does that mean for treatment today?

That’s a very important question. Breast cancer isn’t the same in every woman. There are tumours that are biologically very different.

That is why, if breast cancer is suspected, it is extremely important to take a tissue sample. It not only confirms the diagnosis but also reveals important characteristics of the tumour. This allows us to tailor the treatment to the specific tumour biology right from the start and provide personalised care. The concern that a tissue sample might ‘set the tumour off’ and cause it to spread is unfounded.

For example, we investigate whether a tumour is hormone-dependent or HER2-positive and what other biological characteristics it possesses. Treatment is then tailored accordingly. Some women require surgery, radiotherapy and anti-hormonal therapy. For others, chemotherapy, antibody and/or immunotherapy, or other targeted drugs are also used.

So we do not simply treat ‘breast cancer’; instead, we take into account the individual biology of the tumour and the situation of the woman concerned.

Does breast cancer always require the removal of the entire breast these days?

No. For most patients – around 70 per cent – we can now perform breast-conserving surgery.

Surgery on the armpit has also become significantly less invasive. In the past, many lymph nodes were often removed. Today, in many situations, we can take a much more targeted approach or, in some cases, avoid removal altogether without compromising safety.

The principle of modern breast cancer treatment is: as much treatment as necessary, but as little burden as possible. Nevertheless, treatment remains a major challenge for some women. It is therefore particularly important to me that patients receive good support before, during and after treatment.

Does every woman with breast cancer need chemotherapy?

No. Whether chemotherapy is appropriate depends very much on the biology of the tumour, the woman’s age and the risk of recurrence.

For many hormone-dependent tumours, we can now avoid chemotherapy. In certain situations, molecular tests also help us with this. For other types of tumour – for example, HER2-positive or triple-negative tumours – chemotherapy is, by contrast, very important and is often administered before surgery.

The decision is now much more individualised than it used to be.

What in particular has changed in breast cancer treatment in recent years?

A great deal. We now have far more targeted treatment options. These include modern HER2-targeted therapies, new drugs for hormone-dependent breast cancer, immunotherapies for certain triple-negative tumours, and PARP inhibitors for specific hereditary mutations.

Furthermore, we now sometimes treat patients even before surgery. This allows us to see how the tumour responds to the treatment and to tailor further treatment even more precisely to that response. In some cases, this makes it possible to perform breast-conserving surgery instead of a mastectomy.

Breast cancer treatment is thus becoming increasingly precise and personalised.

Many patients are interested in complementary medicine. What role can it play in the treatment of breast cancer?

For me, it is an important component of integrative therapy.

It is important to distinguish between complementary and alternative medicine. Complementary medicine means that we use sensible and, as far as possible, scientifically validated methods to support effective oncological treatment – not as a substitute for it.

These may include, for example, exercise, acupuncture, yoga, relaxation and mindfulness techniques, anthroposophic and herbal therapies, orthomolecular substances, nutritional advice or – depending on the individual’s situation – other integrative medical methods. There is now scientific evidence supporting certain complementary approaches for various symptoms such as fatigue, sleep disturbances, hot flushes or joint pain.

Other methods are also frequently requested by patients. Here, it is particularly important to me to take a close look: What is sensible and scientifically proven? What can alleviate side effects? And where might there be interactions with cancer treatment that could impair its effectiveness? For this reason, dietary supplements or herbal preparations, in particular, should not be taken without medical advice.

For many years, my aim has been to practise integrative medicine: to deliver the best possible oncological treatment whilst, at the same time, supporting the patient holistically through the possibilities offered by complementary medicine. The aim is to maintain and strengthen quality of life, inner strength and self-efficacy as much as possible. For me, it is not a case of ‘either/or’, but rather a meaningful combination of both worlds.