Breast cancer
- davorkust
- May 17
- 4 min read
Updated: 3 days ago
Introduction and incidence
Breast cancer is the most common malignant tumor in women worldwide, although it can (rarely) also occur in men. According to the Croatian Cancer Registry, in 2017, breast cancer was the 1st most common malignant tumor in women (25% of all cancer cases).
Risk factors
Some of the risk factors for breast cancer are a positive family history (breast cancer in the family), a positive personal history (breast cancer, carcinoma in situ or some benign (non-cancerous) breast changes earlier in life), hereditary syndromes (BRCA1 and BRCA2 gene mutations), increased exposure to estrogen (early menarche, late menstruation, late age of first pregnancy or non-birth, some forms of hormone therapy for menopause), obesity, excessive alcohol consumption, and older age. Hereditary syndromes are the cause of 5-10% of breast cancer cases, and these patients may also have an increased risk of developing ovarian cancer and some other tumors. You can read more about hereditary breast cancer in the article on this very topic. You can read more about risk factors for developing cancer in a separate article.
Signs and symptoms
Early breast cancer often does not cause any symptoms. As the tumor grows, a lump or thickening in the breast and armpit area may appear, changes in the skin of the breast (puckering, redness, swelling, skin like an orange peel...) or nipples (twisting, unusual discharge, especially bloody), changes in the size or shape of the breast may appear (Figure 1).
Diagnosis
The basis is a detailed examination of the patient (especially both breasts and armpits) and taking a thorough medical history. Breast self-examination is also of great importance in early detection of the disease, which every woman can easily perform (instructions for self-examination). Basic imaging tests are mammography, or breast X-ray (Figure 2), and ultrasound of the breasts and armpits. In addition, in the case of clinical indication, an MRI of the breast is performed. CA15-3 and sometimes CEA are used as tumor markers. Other tests may be performed if necessary, and a definitive diagnosis is made by biopsy of the suspicious change. Additional tests of the biopsy tissue analyze the positivity of the tumor for estrogen and progesterone receptors and HER2 (human epidermal growth factor receptor 2), which provides additional information about the aggressiveness of the disease and directs subsequent treatment. The worst prognosis is for patients with negativity for all 3 groups of receptors (so-called triple-negative tumors). After the diagnosis is made, additional imaging tests may be ordered if there is suspicion of metastatic disease. You can read more about cancer diagnostics in a separate article.
Since 2006, the National Breast Cancer Screening Program has been launched in Croatia, which refers women aged 50 to 69 to mammography every two years, in order to detect breast cancer at the earliest possible stage.

Treatment
The treatment of breast cancer primarily depends on the stage of the disease. For early breast cancer, there are 2 main approaches. The first involves breast surgery, which can be either a breast-conserving operation (removal of the part of the breast where the tumor is located) or a mastectomy (removal of the entire breast). Depending on the findings after surgery, patients with mastectomy may need to undergo additional radiotherapy to the operated breast, while with breast-conserving surgery it is required in all patients. Additionally, depending on the characteristics of the tumor, chemotherapy, endocrine therapy and/or targeted therapy directed at the HER2 receptor may be necessary. The goal of treatment after surgery is to reduce the risk of the disease returning. Another option for patients with early breast cancer is to initially apply systemic treatment instead of surgery, which may include chemotherapy, hormonal therapy and/or targeted therapy directed at the HER2 receptor. The goal of this approach is to reduce the tumor mass, among other things, to enable a more sparing surgical procedure that follows the therapy.
Locally advanced breast cancer requires a combined treatment approach, which may include surgery, chemotherapy, radiotherapy, hormonal therapy and/or targeted therapy directed at the HER2 receptor.
Metastatic breast cancer is generally an incurable disease, but the use of adequate therapy allows most patients to significantly prolong their lives. The basis of therapy is systemic treatment, with the exception that the disease has spread throughout the body. The main treatment options are hormonal therapy, targeted therapy, chemotherapy (one or more cytostatics in combination) and/or immunotherapy, with combinations of several forms of treatment often being used. Surgery and radiotherapy are used for palliative purposes (e.g. to reduce pain). The radionuclide strontium-89, bisphosphonates and denosumab can also be used to treat bone pain caused by metastases. An important option for patients with breast cancer, especially in the metastatic phase, is participation in clinical trials.
Treatment at onkologija.net: We treat our patients according to American and Western European guidelines, and we provide genetic testing for personalized targeted therapy. Contact us for more details.
Additional interesting facts
Several studies have shown that breast cancer is more common in the left breast than in the right. Although this fact has been known for over 60 years, scientists still have not come to the conclusion why this is so. One hypothesis is body asymmetry: the left breast is, on average, larger than the right, and more breast tissue overall gives a higher risk. The same phenomenon is seen in breast cancer in men.

Did you know that men can get breast cancer? Breast cancer is the most common malignant disease in women, but it can also occur in men (although very rarely). Less than 1% of breast tumors occur in men. This is one of the reasons why the disease is most often detected in them at a more advanced stage (and the prognosis is generally worse), because this diagnosis is rarely thought about.
October is World Breast Cancer Awareness Month. National Breast Cancer Awareness Day is celebrated in Croatia every year on October 7. It is believed that over 90% of breast cancer patients can be cured if the disease is diagnosed at an early stage. How to detect the disease as early as possible? Through regular check-ups, which include self-examination, mammography and breast ultrasound.
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