Breast Cancer:
Screening, Treatment & Living with Endocrine Therapy

1. What is breast cancer?

Breast cancer (breast carcinoma) is a malignant tumour of the breast. It usually develops in the cells of the milk ducts or the lobules, when those cells start dividing without control. Breast cancer is the most common cancer in women in Germany — and at the same time one of the best researched and most treatable.^¹,² If the tumour is found early, the chances of cure are good according to current evidence; that is exactly why screening matters so much.

One important point for perspective: not every change in the breast is cancer. Cysts, benign lumps (fibroadenomas) and hormone-related areas of thickening are far more common than malignant tumours. A lump you can feel is therefore a reason to get it checked, but not a reason to panic.

Known risk factors include older age, a family history (among other things changes in the BRCA1 and BRCA2 genes), dense breast tissue, hormonal factors such as many years of hormone replacement therapy during the menopause, as well as obesity, lack of exercise and alcohol. Many of those who fall ill, however, have none of these risk factors — breast cancer can affect anyone, without anyone having “done something wrong”.

2. Screening: self-examination and mammography

The mammography screening programme in Germany

In Germany, women between 50 and 75 are entitled to a mammogram (an X-ray examination of the breast) every two years within the quality-assured screening programme — the invitation arrives by post, participation is voluntary and free of charge for people with statutory health insurance.^³ Age limits and the invitation process differ from country to country; what is described here applies to Germany. Screening can find tumours before they can be felt and, according to current study data, reduces the risk of dying from breast cancer.

An honest account includes the other side as well: screening occasionally finds changes that turn out to be harmless (a false alarm, with a stressful work-up), and it can detect tumours that would never have caused symptoms in a person’s lifetime (overdiagnosis). Expert bodies judge that the benefit outweighs the harms for the age group that is invited — but the decision remains yours, and the invitation material explains both sides.^²,³

Self-examination: useful, but not a substitute

Examining your own breasts regularly — ideally once a month, and for women before the menopause in the first half of the cycle — is no substitute for screening: as a stand-alone method of early detection, self-examination has not been shown in studies to reduce mortality. It is still worthwhile, because it makes you familiar with your own body. Many tumours are noticed first by women themselves — and if you know how your breast normally feels, you notice changes sooner.

• Look: In front of the mirror, with your arms down and raised — compare shape, size, skin and nipples.
• Feel: With flat fingers, in circular movements, over the whole breast and the armpit, both standing and lying down.
• Make a note: Write down anything unusual with the date — that makes the medical assessment considerably easier.

3. Warning signs: what you should get checked

The following changes do not automatically mean cancer — but they do belong in a gynaecology practice promptly:

• A new lump or area of thickening in the breast or armpit that does not resolve with your cycle.
• Retraction of the skin or the nipple, or newly appearing differences in the size or shape of the breasts.
• Discharge from the nipple, especially if it is bloody or comes from one side only.
• Skin changes such as redness, scaling or “orange-peel” skin (coarsened pores).
• New, persistent pain in one spot of the breast — pain is rarely the first sign, but it should still be checked.

4. Subtypes: why breast cancer is not one single disease

After the diagnosis, the tumour tissue is examined closely in the laboratory. Among other things this determines which “docking sites” (receptors) the tumour cells carry — and that decides which medicines can work. The three most important classifications, greatly simplified:^¹,⁴

This classification is the reason why treatment plans differ so much from one patient to the next — and why comparing yourself with other people affected is often misleading. Which path is right for you is decided by your treatment team together with you, on the basis of your findings.

5. Diagnosis: from suspicion to certainty

• Clinical examination and ultrasound: The first assessment of an abnormal finding at the practice.
• Mammography: An X-ray of the breast; with dense glandular tissue it is supplemented by ultrasound, and in individual cases by MRI.
• Biopsy (tissue sample): Only the examination of the tissue itself confirms the diagnosis — and determines the subtype, the grading and the receptor status.
• Staging investigations: Depending on the findings, further imaging to rule out spread to the lymph nodes or other organs.
• Tumour board: Certified breast centres discuss every case across specialties and draw up a treatment recommendation in line with the guideline.^¹

Between an “abnormal finding” and the final diagnosis there are often agonising days. It can help to collect findings, questions and phone notes in one place during this time — and to take someone with you to every appointment who listens in.

6. Treatment: the building blocks

Treating breast cancer today means assembling a set of local and drug-based measures according to the subtype, the tumour stage and your life situation. No single building block is “standard for everyone” — and no reputable source promises a cure. The decision is always made in conversation between you and your treatment team, ideally at a certified breast centre.^¹

7. Endocrine therapy: the years after the acute treatment

For most women with hormone-sensitive breast cancer, the longest part of the treatment begins after surgery, radiotherapy and, where needed, chemotherapy: endocrine therapy (anti-hormone therapy). It takes away the growth signal oestrogen from the tumour cells — and with it reduces the risk of the cancer coming back. The guideline usually recommends it for at least five years, and for longer where the risk is higher.^¹,²

The two drug classes

Which agent is used when — and whether there is a switch after a few years — depends on menopausal status, risk profile and how well the treatment is tolerated. That decision always lies with the treating practice or the oncology team.

Adherence: the underrated survival question

Unspectacular as a daily tablet may seem, endocrine therapy only delivers its protection if it is taken for the whole recommended period. Studies and routine care data have shown the same pattern for years — a relevant proportion of patients take the tablets irregularly or stop the treatment early, often because of side effects, and this goes hand in hand with a higher risk of recurrence.^²,⁴ Put differently: the tablet that stays in the cupboard does not protect you.

8. Managing side effects instead of stopping

The most common reasons for stopping treatment are well known — and for most of them there are counter-strategies. What matters is raising and recording symptoms early, instead of putting up with them for months.

For more depth, our symptom articles on joint pain and hot flushes are worth reading — both also cover medicines as a trigger. If your bone density falls, you will find the background in the article on osteoporosis. And because further medicines are often added during long-term treatment: an overview of drug interactions helps you keep track of combinations — with tamoxifen it is relevant, among other things, that certain antidepressants can weaken its effect. So do not start any new preparation without having the combination checked.

9. Follow-up care and everyday life

Once the acute treatment is complete, structured follow-up care begins: close check-ups in the first years with a consultation, a clinical breast examination and an annual mammogram, then at longer intervals.^¹,⁵ Follow-up care is not only about detecting a recurrence — it is also the place where side effects, emotional strain and open questions get discussed.

• Keep your appointments, even when you feel well — follow-up care is designed to run for years and only works with continuity.
• Plan exercise in firmly — regular physical activity demonstrably improves exhaustion, joint symptoms and quality of life, and is explicitly recommended by the guideline.
• Speak up about persistent exhaustion — cancer-related fatigue is common and treatable; our article on fatigue helps you put it in context.
• Don’t push the emotional load away — fear of recurrence is normal; persistent low mood can develop into depression. Psycho-oncological counselling is part of standard care in Germany.
• Build a routine for taking your tablet — a fixed time, tied to a daily ritual, with a reminder on your phone. Practical tricks are in How to take medications; and if a tablet does slip through, Missed a medication will help.

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