The current situation
Due to great progress regarding early cancer diagnosis, diagnostics, therapy and care in the last decades, the survival rate and quality of life of patients suffering from breast cancer increased significantly in Germany. Despite that, breast cancer remains a big challenge in medicine: In 2012, breast cancer was the second most common cancer in the world with an amount of 12 % of all cancer cases. [1]
Breast cancer represents more than 30 % of all cancer cases in women, followed by colon cancer (12 %) and lung cancer (9 %). By contrast, the incidence of breast cancer in men is nearly 1 %. More than 70.000 women and 600 men develop breast cancer every year in Germany, causing every eighth woman to receive a cancer diagnosis in her lifetime. [2,3,4] But with modern diagnostics and therapeutic approaches the current chance for recovery is up to 80 %.
However, which are the factors influencing the risk of developing cancer? The exact reasons still remain unclear, whereas the age, hormonal balance, lifestyle (e.g. diet, sports, smoking,…) and genetic predisposition of the patient act as influencing factors for cancer development. [1,2,5,6]
Breast cancer counts as a geriatric disease like the most cancer types, developing at a mean age of 63 years, (see Fig. 1). When receiving the diagnosis, 25 % of the patients are younger than 55 years and 10 % are younger than 45 years. [2,3,4,6]
Genetic risks
Cancer is not a hereditary disease in general, but some types of cancer are based on a inherited genetic mutation. Genes showing a higher cancer risk and being present in every human are BRCA1 and BRCA2. A mutation in one of these genes increases the risk of cancer development up to 80 %. Anyway, just 5-10 % of the breast cancer patients are affected by a BRCA mutation. [2,3,5,7,8]
In addition to these genes, about 60 other genes can also increase the risk of breast cancer development. These mutations are extremely rare and just have a low effect on the cancer risk, except several mutations accumulate in the patient’s genome. [7]
Preventive and therapeutic options
Possible treatment options of breast cancer are surgery, antihormone (endocrine) therapy, chemotherapy, radiotherapy und novel treatments with targeted drugs. The individual choice of the therapy depends on breast cancer type, stage of disease, health status and possible comorbidities. Additional cancer influencing factors like sensivity to hormones or aggressiveness are considered when choosing the most promising treatment. [2,3]
Nowadays, targeted drugs are used for breast cancer treatment increasingly. Artificial antibodies don’t harm the whole body, but just interact with certain cell attributes promoting cancer growth. Thus, cancer therapy becomes more bearable for patients while becoming more effective against cancer cells. Targeted treatment also works in advanced and metastatic breast cancer. But patients lacking the required cell attributes won’t derive any benefit of this treatment option. [2,3,4]
For example, 15-30 % of all breast cancer patients show an increased appearance of HER2 receptors on cancer cells, causing excessive proliferation and tumor growth and making this form of cancer more aggressive. In this case, the high-performance drug Trastuzumab can be applied for therapy, being a potent antibody against HER2. [4,9,10] The chance for complete recovery is low in severe cancer cases, but this drug allows a long life as possible and good quality of life after all.
With many different and complex types of breast cancer, special genetic analyses came to the market for the purpose of prevention and early detection. The molecular analysis of certain gene combinations showing potential mutations are intended to support the choice of promising therapy options. For example, the OncotypeDX test analyzes a panel of 21 genes being associated with breast cancer development, resulting in a prediction whether a patient with certain types of breast cancer will benefit from chemotherapy. [1,7,10] However, gene analyses are not yet completely recognized as an additional value in healthcare.
Initiatives for fighting cancer
In 2008, the Federal Ministry of Health initiated the „National Cancer Plan“ in collaboration with the German Cancer Society, the German Cancer Aid and the Association of German Tumor Centers. This project comprises several multidisciplinary members und focuses on current problems in early detection and prevention of cancer. Coordinated by the Federal Ministry of Health, it is supported by VDI/VDE Innovation + Technique. Involved health insurances, pension insurances, providers as well as research and patients’ organizations collaborate closely and cross-sectoral, working on the following focal points: [11]
- Advancement of the early cancer detection: Compliance with existing quality regulations, improvement of information services and participation rates of patients
- Advancement of the healthcare infrastructure regarding oncology and quality assurance: Ensured access to oncological care, distribution and application of existing guidelines, qualitative reporting to providers and payers
- Efficient and individual oncological treatment: ensured and fast access to effective and innovative cancer therapies
- Stronger orientation to patients: Consulting and supportive services, involvement of patients into medical decisions
Additionally to the „National Cancer Plan“, the Federal Ministry of Health, the German Cancer Society and the German Cancer Aid just initiated another cancer initiative called “National Decade against Cancer”. Aim of this project is to improve the early detection and prevention of cancer and to provide new oncological insights in a faster and more efficient way to patients within the next 10 years. Further, the initiative intends to build a National Center for Cancer Prevention as well as 8 National Centers for Tumor Diseases. Main objects are the research on the influence of chronic inflammation on cancer progression, the development of molecular testing methods for early cancer detection and the production of vaccines against cancer. The Federal Ministry invested 60 Mio. € in this project. [12]
Future perspective
New insights in the fields of breast cancer and the increasing focus on Personalized Medicine require a stronger structuring and a closer cross-linking between research and care. A more efficient and faster transfer of knowledge from basic research to clinics and back to research is a big challenge, but can be coped with the introduction of appropriate statutory conditions and consistent cancer registries. An additional expansion of the services in the ambulant cancer care and a stronger orientation towards patients will enable a high-quality, innovative and cross-sectoral cancer care and will promote the fight against breast cancer.
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