Given the risk, diabetes or a heart attack, therefore falls by 93 or 81 percent – in each case compared with people who have a completely unhealthy way of life. The risk of stroke was smaller by half, there were at least in cancer even 36 percent. Who has a body mass index (BMI) below 30, but this diminishes the risk of developing chronic, more than half. 70 percent had it, if someone then even his life is non-smoking.

Long-term study by the Institute of Nutrition gave the results showed how important it is to have a healthy lifestyle as part of a more effective prevention of chronic diseases in the population and to assist with health policy measures.

Basis of the study results were declared as data are analyzed by 23,153 participants of the Potsdam begun in 1992, called EPIC study, the relationships between diet, cancer and other chronic diseases such as type 2 diabetes.

However, this could also take patients. Thus, the head of the doctors’ association of North Rhine, Leonhard Hansen wanted to make a precise assessment of costs and benefits of very expensive specialty drugs, the additional cancer patients, for example, only a few days of life. A discussion of treatment goals was an urgent need, “said Hansen.

He also gave out a line for his own medical colleagues to prescribe a patient, preferably not more than five different preparations. Experience shows that otherwise the “therapy compliance” vanish – the individual patient can be arbitrarily pills away. In part they were discharged from hospitals with up to 14 different drugs for specific diseases, told Hansen.

29.2 billion Euro cost

The cost of drugs to run away all the other health care costs for years. With the increase of 5.3 percent last year, a total of 29.2 billion euros has been achieved – the second largest item of expenditure according to the hospital costs, which rose 3.5 percent to 52.6 billion euros.

Cost according to an analysis of the reports Arzneiverordnung expensive mass-market products such as blood pressure lowering agents and antidiabetic drugs as well as special as immunotherapeutics and tumor drugs. These few groups alone accounted for 65 percent of the cost increase to 1.4 billion euros, “said Report Editor Ulrich Schwabe.

Vaccination costs in the U.S., only half

He also criticized the high prices in Some parts of the world, especially for novel drugs that are still patent, and often have no competition. As an example he cited the vaccine against cervical cancer: In Some parts of the world, a primary immunization would cost 477 euro, in the U.S. for instance, with 247 euros, only about half.

A thorn in the eye are the experts still also called Analogpräparate – funds with no or little added value compared with conventional proven drugs. Here there is a potential savings of 1.7 billion euros.

Savings successes than there are for generic drugs, according to Schwabe – these are cheap imitation after a drug patent. Here are the prices had fallen by four percent. In addition, generic drugs were prescribed more frequently: the number of daily doses increased by eleven percent. Here Schwabe, “criticized the high” distribution costs: While the funds would get themselves often cost only cents amounts to a flat rate regardless of price pharmacist of 8.24 euros.

No “astronomical prices more»

The publishers of reports, and drug doctors and health insurance funds were largely in agreement that further legal costs brakes were required. To prevent “astronomical prices” too had a “legal framework” to be found, “said chief executive Herbert AOK Reichelt. Main thrust: The manufacturers will be forced into price negotiations with the treasury or a “central institution”.

A recent study shows that mothers whose mother or sister had breast cancer, through her own breast cancer risk by more than half can reduce. “Background of the study was to determine more precise relationships between breast feeding and the incidence of breast cancer in women before the menopause occurs.

For their study, the researchers analyzed the data from 60,075 women who gave birth in her life drops at least a child. These were a group of mothers who had participated in the large-scale Nurses’ Health Study II, “from 1997 to 2005. In the follow-up period were 608 cases of breast cancer among the surveyed women. It was found that mothers who breast-fed previously were compared with women who had not given the breast, a reduced risk of disease was 25 percent. Even more benefit breast feeding women who was at risk of familial breast cancer, from Milchgabe the chest. They reduced by suckling her child’s risk for one Erkankung by 59 percent. The positive aspect of breast-feeding was in each case regardless of the duration of breast feeding and the intensity of breast feeding.

The current study confirms a risk-reducing effect of breast feeding on breast cancer and also shows that this appears in diseases involving the formation of genetic factors is particularly strong, “said Dr. King, the study results. One possible explanation for the beneficial effect of Breast-feeding is that the surface cells of the mammary glands caused there to the birth of a first child relatively vague. Only after the first childbirth a hormonal impulse that the milk gland cells resume their function of milk production. The milk supply is determined by the suckling of the child will continue to stimulate and sustain . If this development of the mammary gland cells due to infertility or not breast-off, increasing the risk that these cells at a later time out of control and degenerate into vicious.

The reason for the significant increase of the female victim, according to the statisticians that the women in the context of emancipation in the past decades, have more access to cigarettes. This was always more socially accepted. The number of smoking women has increased, so also increase the diseases.

In 2007 total of 43 005 people Died with cancer of the respiratory tract, which is 657 more than the year before. Based on per 100 000 inhabitants died in 2007, 52 people in the lungs, bronchial, larynx or trachea cancer. In regional comparison, the mortality rates in Saarland and Saxony-Anhalt, at 76 and 66 deaths per 100 000 inhabitants at its highest. In Baden-Wuerttemberg and Bavaria died with both 39 per 100 000 inhabitants on the other hand, the lowest number of nationwide people.

While the average age of death for women due to smoking in 2007 was around 80 years,. Even when men age mortality declined from 73 to 70 years.

According to statistics, the English in 2008 smoked 240 million cigarettes a day, or 141 million less than it did in 2000.

On the other hand, the consumption of cigars and cigarillos in the same period has doubled to 14 million units per day. Moreover, the daily consumption of fine cut tobacco from 35 tonnes to 60 tonnes and the consumption of pipe tobacco increased from two tonnes to five tonnes per day.

In animals, one speaks of Gesäugekarzinom.

Of the malignancies of women accounts for about 25% to breast cancer, it is the most common cancer in women. It affects every 8th to 10 Woman during her life. The likelihood of developing breast cancer increases with age, but increasingly also young women. Per year, approximately 110 new cases per 100,000 women, which are in Some parts of the world, about 47,000 cases.
In women between 30 and 60 Year of life, breast cancer is the commonest cause of death in the western world. Specifically, in 2004 more infected women than 55,000 new breast cancer disease and the consequences are in the same year a total of 17,592 women died.

Even men can get breast cancer, here is the occurrence is very rare. On average they fall ill 10 years later than women do.

Causes and Risk Factors

The etiology (cause) of breast cancer is not known.
Genetic factors also appear to play a source such as external influences (habits, nutrition, etc.). The mutation of the BRCA-1 tumor on chromosome 17q and BRCA-2 on chromosome 13q increased the risk by a factor of 10-20 At 80% of familial diseases are inherited mutations of BRCA-1. Mutations of this gene are also associated with an increased risk of ovarian hand. A lesser role seem even more recent data suggests that mutations of the ATM gene (responsible for the ataxia teleangiectatica) and a newly discovered mutation of the gene BRIP-1 to play.

Since the 1930s, was even after a breast cancer virus sought, which in women may cause this disease, analogous to the mouse mammary tumor virus, a benign breast tumors in mice. The search and the characterization of such a virus are not completed and a development of breast cancer in the context of a particular viral infection also has not been proven safe.

The risk of taking the contraceptive pill is not entirely clear, however, show the Nurses’ Health Study and other large-scale prospective and retrospective studies, a moderate increase in risk in revenue of more than five years (relative risk 1.2 to 1.4).
Geographical differences are possibly due to lifestyle habits (diet, etc.) conditional, since the risk of migrants after a few generations the population of the homeland has aligned.
Mammography examinations lead to no significant risk increase.

A current metastudies on the connection between motherhood, breast feeding and breast cancer risk was found that with increasing number of children and increasing the cumulative risk of breast-feeding, a breast cancer to develop, and significantly decreases.
Some recent studies also write the permanent wearing of bras to increase the disease risk.

Diagnosis

If changes in your breast noticed, the doctor (depending on age) i.e. Mamma sonography an ultrasound examination of the breast or a mammogram before. The ultrasound is used primarily in younger women, because in them the proportion of glandular tissue is higher. In older women increases the growth of fat tissue and the ultrasound display will be inaccurate. Therefore, a mammogram made. This is a special x-ray examination of the breast, which can also detect tumors, too small to be feeling. If you have a knot in your chest, your doctor when you may receive a small tissue sample is taken and examined under a microscope for cancer cells investigated. This procedure is called biopsy. Sometimes biopsy will be carried out also by a needle in the corresponding breast tissue, and some tissue is cut. If the biopsy shows that cancer is present, must be absolutely certain tests (they are called estrogen and progesterone receptor tests) to the cancer cells are carried out.

Early detection and Screening

The screening of the breast by a doctor is part of the statutory early cancer study program from 30 Year of life. By contrast, the self-examination of the breast is not suitable in early stage breast cancer to identify missing Tastbefund closes a tumor is not enough. The breast self-examination of the bear as opposed to screening mammography does not reduce mortality from breast cancer when.

Blind people in general have a distinct touch above average. This special ability could be used in future for the (early) detection of breast cancer will be harnessed. As part of North Rhine-Westphalia held model project “Discovering hands’ (Discover hands) are already the first attempts. If successful, the development of a new profession for blind women conceivable for 2008 is the start of a regular training course is planned.

The mammography is the essential part of the basis of early detection and population-based breast cancer screening. There is currently a high-quality mammography screening program set up, on the basis of the ‘European guidelines for quality assurance of mammography screening. ” In some regions, a mammography screening in the target group (women 50 to 69 years) is offered.

In addition to the examination of the breast and mammography is especially for young women an ultrasound examination of the chest, because there are tumors that mammography is not in the notice. Approximately 10-15% of cancers are not visible at mammography, but may be in the ultrasound examination may be discovered.

Symptoms

A doctor visit is strongly recommended if you noticed the following symptoms:

* Re-occurred, fuzzy finite node
* Derbe body or hardening of the breast
* Emerging size and shape changes of the breasts (side comparison!)
* A different behavior of the breasts while lifting of the arms, which is new for you
* Vorwölbung or thickening of breast
* A sudden, no longer a decaying redness breasts
* Recovers skin or orange skin (thickened skin with recovered bodies)
* Collect or lesions of the nipple
* Discharge from the nipple
* Nodes in the armpit
* Eczema-like change in the nipple with bloody secretion
* Power Knick
* Bone pain

Stages of division

The stages of breast cancer division are the same as for other tumors according to the TNM classification. This is done on the basis of imaging techniques and the samples collected / lymph node / of surgical preparation. For breast cancer, the classification as follows:

* T (tumor size)
* T0: no detectable tumor
* Tis: carcinoma in situ, non-invasive
* T1: The tumor is no larger than 2 cm
+ T1a: 0.1 to 0.5 cm
+ T1B: > 0.5 to 1 cm
+ T1c: > 1 o’clock-2 o’clock cm
* T2: Tumor with a diameter of> 2-5 cm
* T3: The tumor is larger than 5 cm
* T4: tumor of any size with extension to chest wall or skin

* N (= Affected lymph nodes)
* N0: no lymph nodes infected
* N1: metastasis in 1-3 axially lymph nodes
* N2: metastasis in 4-9 axially lymph nodes
* N3: metastasis in 10 or more lymph nodes of the armpit or under / over the clavicle

* M (remote metastases)
* M0: no metastasis to other organs
* M1: Remote metastases exist, mostly in bones, lungs, liver or brain

Sometimes grouped the TNM findings:

Stage I

T1, N0, M0

Stage II

IIA: T0-1, N1, M0 or T2, N0, M0

IIb: T2, N1, M0 or T3, N0, M0

Stage III

IIIA: T3, N1, M0 or T0-3, N2, M0

IIIB: T4, any N stage, M0

IIIc: each T-stage, N3, M0

Stage IV

Each T-stage, each stage-N, M1

Certified Breast Centers

The Cancer Society wants the award of the label “certified breast center” to ensure that patients can be in the center certified under the current state of science treated werden. Mit the certification process, the Cancer Society to ensure that the supply situation for patients with breast cancer have improved significantly. The term “Breast Center” is not protected and each hospital can use it without having to provide information on the quality of the offer there.

The Cancer Society has taken in cooperation with the Society for Senology (Senology: Teaching from breast disease), a requirement catalog developed for breast centers, which includes European Directives (“EUSOMA” criteria for breast centers) and also the documentation of treatment outcomes requires. These substantive requirements have been in a catalog “Technical standards for breast centers”, and in test and pilot certifications in four breast centers reviewed.

In addition, the Cancer Society asks that the breast center should have a recognized quality management system. The breast center has adapted perfectly to the basis of internationally accepted guidelines (e.g. ISO 9001), organized, constantly working on improvements and the organizational structure is reviewed annually by an outside state-approved company (e.g. TÜV, DEKRA, NIS Zert etc.) checked.

The quality labels “certified breast center” award is given Only when the breast center has an externally certified quality system and has introduced the “technical requirements for breast centers”.

A rough guide to whether a center meets quality standards, you can use the following questions below. They provide an excerpt from the “technical requirements for breast centers dar.

* Checklist for Patients
* Has the breast center a quality certificate (eg quality management system according to DIN ISO 9001) acquired?
* Find a regular interdisciplinary tumor conferences at which representatives of the participating disciplines together to determine treatment strategy? Participants: breast surgeons (gynecologist, surgeon), X-ray diagnosticians, internal oncologist (cancer specialist), oncological gynecologist versed, radiation therapist, pathologist
* Are the treatment guidelines of professional societies to apply?
* If an appointment in the chest within hours of max. Awarded two weeks, the waiting time in the chest under Sprechstunde max. 60 minute and are the final result of a tissue sample within max. One week by the physician in person?
* Are the operations of breast operators, which at least 50 breast operations per year?
* Be at least 50 percent of the operations and consists brusterhaltend access to building chest surgery procedures?
* Be a year at least 150 new cases of breast cancer treated in the center?
* Works in the disciplines involved at least one specialist with sufficient experience in the Breast Center?
* Pathologist: may be at least 300 breast cancer histological findings presented,
* Radiation therapist: Proof of regular certified training, internal and gynecological oncologist
* Oncologist: Internist with sub-area designation “Hematology / Oncology, gynecologist, with proof of at least 400 by chemotherapy, radiologist: Notes on breast cancer screening, and befundet mammography at least 3000 per year.
* Are the treatment results (event-free survival, number of relapses, durability, quality of life, etc.) will be fully documented?
* Is access to psychological care, a social worker and self-help, where? After the diagnosis the treatment plans together with the patient and will provide the opportunity to obtain a second opinion.

Therapy

Approximately 70-80% of patients, a breast-conserving therapy, whereby the tumor with a safety margin below, leave the rest of the mammary gland body is removed. Subsequently, radiotherapy to the whole breast performed. If a breast-conserving therapy is not possible (tumor in the breast relative to very large, multiple nodes, patients’ request), the entire mammary gland body removed (mastectomy, ie, mastectomy). Then on a subsequent irradiation may be omitted.

For the follow-up and assessment of prognosis on the affected side, usually the axillary lymph nodes removed and examined. To this unnecessary lymph node distance to avoid, you can – if a certain tumor size does not exceed – even at first only a single (so-called guard or sentinel lymph nodes) removed and investigated. This is around the tumor around radionuclides or dyes injected and then the Lymphabfluss and thus also the first station lymph nodes displayed. Thus, targeting this first station of the Lymphabflusses away from the tumor werden. Sollte these cancer cells to attack, only then will the remaining lymph nodes removed.

Currently, over 90% of patients required chemotherapy. These are often to be treated with FEC or TEC. The treatment is carried out in several cycles.

In hormone-positive tumors is in addition an anti-hormone treatment with selective estrogen antagonists such as tamoxifen or aromatase like Arimidex, but only after the chemotherapy should begin. Because of the high cost of Arimidex (30-times more expensive) and the significantly shorter clinical experience with this drug is currently the gold standard tamoxifen. Recent studies on Arimidex seems to follow something to show better results in terms of disease-free survival, however, slightly increased side effects (osteoporosis, with the result of fractures). A simultaneous treatment with both agents does not make sense.

Unfortunately, relapses are common (same breast) or metastases too. While relapses are treated well, it comes with metastases usually do not cure. However, lung and liver metastases a significantly worse prognosis than bone and skin metastases.

For a uniform quality in the (post-) therapy, the statutory health insurance since 2003, disease management programs (DMP) to. The participating doctors are based in the therapy to the current guidelines for treatment and aftercare of breast cancer. Participation is possible for all doctors who are these quality assurance programs have. Information on participating physicians and / or hospitals is affiliated with any statutory health insurance to obtain. For the patients is to participate in this program has a restriction of free choice of doctor.

In 1998, the drug trastuzumab (trade name Herceptin ®) in the U.S. and 2000 in the European Union for patients with metastatic breast cancer admitted. He is a therapeutic monoclonal antibody against the HER2/neu growth receptor on the cell surface of cancer cells and is indicated for the treatment of patients with breast cancer admitted. If the tumor cells increased HER2/neu on their cell surface train (express), which is about every fourth case of breast cancer patient is. Studies showed that this soganannten Targeted Therapy-substance the risk of relapse by about 50% could be reduced. Since 2005, indicates that in clinical studies indicate that even women with no metastases benefit if they are HER2-positive breast cancers.

Forecast

Established prognostic factors are the so-called St. Gallen criteria to assess a tumor. Here, the lymph node invasion, tumor size, degree of differentiation, the hormone receptor status and age of the patient into account.

In nodal negative breast cancer (not breast cancer cells infected lymph nodes), the long-term cure about 85%.