Breast diseases
How we diagnose and treat changes in the breast.
Most changes in the female (or male) breast are not cancerous. However, several important examinations are necessary to determine whether breast cancer or other breast diseases are present. Often, several different examinations must be combined to arrive at the correct diagnosis and subsequent treatment.
What causes breast pain and stinging or lumps in the breast, and what we recommend.
These are usually not a sign of a malignant breast disease. They often have hormonal causes and can be treated, for example, with herbal remedies. Hormonally related (cyclic) breast pain can often occur before menstruation and is usually not a sign of breast cancer.
In this breast condition, various changes in the milk ducts lead to the discharge of fluid (secretion) – for example, this often occurs in the first 1–2 years after giving birth, as well as a side effect of various medications.
Skin problems can also occur on the breast and can cause itching, inflammation, swelling, redness, or discoloration. Clarification of the cause and correct therapy are very important, as breast cancer diseases are also associated with skin changes in some cases.
A physical examination alone cannot usually exclude a diagnosis of breast cancer with sufficient certainty. Although most breast lumps are benign (e.g., fibroadenoma, cyst, etc.), breast cancer may also be the cause.
This malignant tumor of the breast occurs in approximately 6,000 women annually in Switzerland. The process of determining whether breast cancer is present is described below and usually involves several examinations. Breast cancer is almost always curable in its early stages and very treatable even in advanced stages. The close collaboration of various specialists (radiologists, gynecologists/surgeons, medical oncologists, nurses, plastic surgeons, and radiation therapists) in the certified breast center of the Klinik Stephanshorn enables the rapid, competent, and empathetic treatment of this most common tumor disease in women.
In adolescents, this breast condition is quite common due to hormonal changes and usually disappears on its own. The causes are varied (medications, anabolic steroids, hormonal disorders). Sometimes surgery is helpful.
What causes breast pain and stinging or lumps in the breast, and what we recommend.
These are usually not a sign of a malignant breast disease. They often have hormonal causes and can be treated, for example, with herbal remedies. Hormonally related (cyclic) breast pain can often occur before menstruation and is usually not a sign of breast cancer.
In this breast condition, various changes in the milk ducts lead to the discharge of fluid (secretion) – for example, this often occurs in the first 1–2 years after giving birth, as well as a side effect of various medications.
Skin problems can also occur on the breast and can cause itching, inflammation, swelling, redness, or discoloration. Clarification of the cause and correct therapy are very important, as breast cancer diseases are also associated with skin changes in some cases.
A physical examination alone cannot usually exclude a diagnosis of breast cancer with sufficient certainty. Although most breast lumps are benign (e.g., fibroadenoma, cyst, etc.), breast cancer may also be the cause.
This malignant tumor of the breast occurs in approximately 6,000 women annually in Switzerland. The evaluation to determine whether breast cancer is present is described below and usually involves several examinations. Breast cancer is almost always curable in the early stages and very treatable even in advanced stages. The close collaboration of various specialists (radiologists, gynecologists/surgeons, medical oncologists, nurses, plastic surgeons, and radiation therapists) in the certified breast center of the Klinik Stephanshorn enables the rapid, competent, and empathetic treatment of this most common tumor disease in women.
In adolescents, this breast condition is quite common due to hormonal changes and usually disappears on its own. The causes are varied (medications, anabolic steroids, hormonal disorders). Sometimes surgery is helpful.
Here are some of the diagnostic methods we frequently use, in addition to mammography and computed tomography (CT):
A physical examination by a specialist often provides an initial indication of possible breast conditions. The physical examination includes examination of both breasts and the lymph nodes.
Ultrasound (mammosonography) is an extension of the examiner's capabilities. Without radiation exposure, various changes in the breast can be seen in real time. If necessary, a tissue sample (biopsy) can be taken immediately. Ultrasound can complement mammography and is the preferred method of examination, especially for young women and those with dense breast tissue.
Mammography is an X-ray examination of the breast, usually performed from two angles. It can detect the slightest changes in the tissue. The radiation exposure is minimal with modern equipment. The slightly uncomfortable pressure during compression of the breast further reduces the radiation dose.
For specific questions, additional radiological examinations are sometimes useful, but not for every question:
Magnetic resonance imaging (MRI): High-resolution images of the breast are taken in a tube in about 30 minutes. These are sometimes needed to plan surgery.
Computed tomography (CT): X-ray examination of the chest, abdomen, and pelvis is often required to check if breast cancer has already formed metastases in the body (staging).
PET-CT: Here, computed tomography is combined with a slightly radioactive contrast agent to better visualize various tumor sites.
Taking a tissue sample enables an accurate diagnosis
For women with newly occurring changes in the breast that warrant investigation, a tissue sample is necessary to confirm the diagnosis. The tissue is obtained under local anesthesia. General anesthesia and a hospital stay are not necessary for this.
Why is a tissue sample important?
- Most changes are benign (approximately 2/3). In these cases, surgery is usually not necessary.
- In the case of malignant changes, it is important to know what type of breast cancer is present. The diagnosis gives us information about whether additional examinations are necessary. Above all, knowing the type of breast cancer helps to determine the extent of the surgery.
Whether the tissue sample is taken during mammography (vacuum-assisted core biopsy) or by ultrasound depends on the change and which examination technique shows it best.
Are there any disadvantages to a biopsy, or can a tumor spread more easily afterward?
Many people think that a tumor can only spread through a biopsy:
Fortunately, this fear is completely unfounded!
Only the application of the local anesthetic is painful for a few seconds. The removal itself does not cause any pain. The puncture site is covered with a pressure bandage, which you can remove the next day. Showering is possible after removing the bandage. A bruise may develop at the puncture site itself, which will disappear within a few days.
The earlier breast cancer is detected, the better it can be treated. This is not only about reducing mortality from breast cancer, but also about gentler treatment in the early stages – ideally without chemotherapy and without removing the entire breast, and often with no or only minimal additional drug therapies.
In recent years, the mammography screening program has been heavily discussed, questioning whether the reduction in breast cancer mortality, which has been promoted for years, is as significant as claimed or not. In addition, mammography repeatedly finds changes that ultimately have no disease value – so-called 'false-positive' findings.
That's why the St. Gallen mammography screening is high-quality, with a double assessment by two radiologists using state-of-the-art technology and strict quality control. The Breast Center Ostschweiz recommends participation in the donna screening program for women aged 50 to 69, as the validity is greatest in this age group and breast cancer also occurs most frequently.
More information about the Donna program:
https://www.donna-programm.ch/de/willkommenzum-donna-programm.html
Here are some of the diagnostic methods we frequently use, in addition to mammography and computed tomography (CT):
A physical examination by a specialist often provides an initial indication of possible breast conditions. The physical examination includes examination of both breasts and the lymph nodes.
Ultrasound (mammosonography) is an extension of the examiner's capabilities. Without radiation exposure, various changes in the breast can be seen in real time. If necessary, a tissue sample (biopsy) can be taken immediately. Ultrasound can complement mammography and is the preferred method of examination, especially for young women and those with dense breast tissue.
Mammography is an X-ray examination of the breast, usually performed from two angles. It can detect the slightest changes in the tissue. The radiation exposure is minimal with modern equipment. The slightly uncomfortable pressure during compression of the breast further reduces the radiation dose.
For specific questions, additional radiological examinations are sometimes useful, but not for every question:
Magnetic resonance imaging (MRI): High-resolution images of the breast are taken in a tube in about 30 minutes. These are sometimes needed to plan surgery.
Computed tomography (CT): X-ray examination of the chest, abdomen, and pelvis is often required to check if breast cancer has already formed metastases in the body (staging).
PET-CT: Here, computed tomography is combined with a slightly radioactive contrast agent to better visualize various tumor sites.
Taking a tissue sample enables an accurate diagnosis
For women with newly occurring changes in the breast that warrant investigation, a tissue sample is necessary to confirm the diagnosis. The tissue is obtained under local anesthesia. General anesthesia and a hospital stay are not necessary for this.
Why is a tissue sample important?
- Most changes are benign (approximately 2/3). In these cases, surgery is usually not necessary.
- In the case of malignant changes, it is important to know what type of breast cancer is present. The diagnosis gives us information about whether additional examinations are necessary. Above all, knowing the type of breast cancer helps to determine the extent of the surgery.
Whether the tissue sample is taken during mammography (vacuum-assisted core biopsy) or by ultrasound depends on the change and which examination technique shows it best.
Are there any disadvantages to a biopsy, or can a tumor spread more easily afterward?
Many people think that a tumor can only spread through a biopsy:
Fortunately, this fear is completely unfounded!
Only the application of the local anesthetic is painful for a few seconds. The removal itself does not cause any pain. The puncture site is covered with a pressure bandage, which you can remove the next day. Showering is possible after removing the bandage. A bruise may develop at the puncture site itself, which will disappear within a few days.
The earlier breast cancer is detected, the better it can be treated. This is not only about reducing mortality from breast cancer, but also about gentler treatment in the early stages – ideally without chemotherapy and without removing the entire breast, and often with no or only minimal additional drug therapies.
In recent years, the mammography screening program has been heavily discussed, questioning whether the reduction in breast cancer mortality, which has been promoted for years, is as significant as claimed or not. In addition, mammography repeatedly finds changes that ultimately have no disease value – so-called 'false-positive' findings.
That's why the St. Gallen mammography screening is high-quality, with a double assessment by two radiologists using state-of-the-art technology and strict quality control. The Breast Center Ostschweiz recommends participation in the donna screening program for women aged 50 to 69, as the validity is greatest in this age group and breast cancer also occurs most frequently.
More information about the Donna program:
https://www.donna-programm.ch/de/willkommenzum-donna-programm.html
Whether it's chemo-, immuno-, radio-, or hormone therapy, we will find the best possible treatment for our patients.
Breast cancer cells can be slowed down in their growth and killed with tablets and infusions. The use of these medications depends on the specific situation:
1. Before surgery (neoadjuvant): to shrink the tumor and make it easier to operate on.
2. After surgery (adjuvant): to rid the body of any remaining cancer cells that are suspected to be present.
3. To reduce the size of secondary tumors and control the breast disease when metastases have formed.
A precise histological examination of the tumor allows the therapy to be tailored to the tumor. Depending on the tumor's characteristics, one or more groups of medications (chemotherapy, immunotherapy, hormone therapy) can be used to achieve the best possible control of the disease.
Today, there are many supportive medications available that make chemotherapy well tolerated, so that everyday life is affected as little as possible. Your attending physician, together with your nursing team, will carefully plan the therapy and discuss it with you in detail. During therapy, you will receive comprehensive support so that possible side effects can be quickly identified and treated. Chemotherapy is usually administered through a vein, allowing it to reach all tumor cells in the body. Because tumor cells are more sensitive to chemotherapy than normal body cells, chemotherapy can destroy tumor cells while allowing normal cells to recover.
Chemotherapy is administered once a week to once every 3 weeks and is repeated several times.
The pathological examination determines whether a tumor has hormone receptors for female hormones (estrogen and progesterone). This is the case in the majority of breast cancer tumors. In so-called 'hormone-sensitive' tumors, anti-hormonal therapy can be extremely effective and is usually very well tolerated. Various preparations are available. Most hormone therapies are taken daily as a tablet (Letrozole, Anastrozole, Exemestane). Certain ones are injected monthly under the skin or into the gluteal muscle (Fulvestrant, Zoladex).
Immunotherapy involves antibodies that are administered through a vein. These antibodies recognize tumor cells by detecting HER2 receptor-specific sensors on their surface (so-called 'HER2-positive' tumor cells) and selectively block them. These sensors are formed in approximately 15% of breast cancer cases. Normal body cells are hardly affected by antibody therapy, which is why these therapies are very well tolerated and, in some cases, can be used successfully for many years with very few side effects. Immunotherapy is administered every 3 weeks and can also be given in combination with chemotherapy. There are various immunotherapies that block the HER2 receptor at different points (Trastuzumab, Pertuzumab). A particularly sophisticated drug consists of an antibody to which a chemotherapy molecule is also bound (T-DM1). After docking onto the tumor cell, the chemotherapy is introduced into the tumor cell, selectively destroying only the tumor cell while sparing healthy cells.
Some tumors evade the body's immune system by suppressing it. Immuncheckpoint inhibitors counteract this suppression, re-activating the immune system so that immune cells can fight the tumor. This innovative approach has been successfully used to treat many tumors in recent years. Often, an immuncheckpoint inhibitor is used in combination with chemotherapy. This treatment is administered intravenously every 2-3 weeks.
Radiation (radiotherapy) is frequently used as a component in the treatment of breast cancer. High-energy X-rays are used to prevent tumor cells from growing. The duration and extent (volume/dose) of the treatment are individually tailored to the tumor situation. Radiation therapy can last from a few days (palliative situation) to several weeks (adjuvant situation). The outpatient therapy sessions take place daily (Mon-Fri). The personal consultation, planning, and radiation take place in the same building, in the radiotherapy department of the Klinik Stephanshorn.
The process with us at the Tumor and Breast Center
Registration at the TBZ is usually done by your family doctor or gynecologist. If you have any complaints or questions, you can also make an appointment with us directly. We treat patients of all insurance classes.
We assign appointments according to urgency. If there are suspicious changes, you will be offered an appointment for clarification within a maximum of 2 (working) days.
If you are unable to keep your appointment, please inform us as soon as possible.
We can quickly clarify changes in the breast or conspicuous findings. As part of the initial consultation, in addition to a detailed discussion, we perform, for example, a palpation and ultrasound examination. In the case of conspicuous findings, an immediate tissue sample (biopsy) can be taken with a thin needle. The procedure is performed under local anesthesia and takes about 15 minutes.
In most cases, various examinations are necessary for a comprehensive assessment. These are carried out, among other places, at the Klinik Stephanshorn. We plan these on the same day directly before or after your appointment in our consultation. A shuttle service is organized by us and ensures a quick way to the clinic and back to us.
We can organize additional examinations (e.g. MRI) for you if required through our colleagues in radiology.
We will inform you of the results of the examinations as soon as possible and discuss with you the further procedure in your individual situation. Very often it concerns harmless changes that do not require further therapy.
However, if you are diagnosed with cancer, your findings will be discussed in our team and at our interdisciplinary tumor conference. At the TBZ, we will then explain the therapy recommendation to you and advise you on this in detail. We then plan the further steps together with you.
If an operation is planned, we will discuss the procedure with you in detail. We attach great importance to the fact that, whenever possible, you are operated on by the same doctor who carried out the examinations and therefore knows you and all the necessary findings best.
We perform your surgery at the Klinik Stephanshorn.
You will receive all the necessary documents from the Klinik Stephanshorn. If you have any relevant pre-existing conditions, you may be invited separately for an anesthesia consultation. However, you will usually be admitted to the clinic directly on the day of surgery.
You will be operated on by your attending physician from the Tumor- und BrustZentrum Ostschweiz and subsequently cared for during your hospital stay.
You can also find detailed information about your hospital stay directly via the Klinik Stephanshorn link:
www.hirslanden.ch/de/klinik-stephanshorn/ihr-aufenthalt/ablauf-ihres-aufenthalts.html
In the week after the operation, or at any time if needed, we carry out a wound check at the TBZ.
In the case of cancer, a second discussion takes place at the tumor conference after the operation. As part of the wound check, we will explain the findings of the tumor operation and their significance for the further course of treatment in a personal consultation. Additional treatments are often recommended to prevent a recurrence, such as radiation or drug therapies.
At the TBZ, surgeons and oncologists work closely together and discuss all cases in an interdisciplinary manner. This means that a seamless transition to the oncology consultation is possible. Your oncologist will discuss in detail the treatment options and their benefits, procedure, and expected side effects with you. All therapies, including chemotherapy, immunotherapy, and anti-hormone therapy, take place on an outpatient basis at one of our locations. You will always be accompanied by your oncologist and the team of specially trained nurses.
The process with us at the Tumor and Breast Center
Registration at the TBZ is usually done by your family doctor or gynecologist. If you have any complaints or questions, you can also make an appointment with us directly. We treat patients of all insurance classes.
We assign appointments according to urgency. If there are suspicious changes, you will be offered an appointment for clarification within a maximum of 2 (working) days.
If you are unable to keep your appointment, please inform us as soon as possible.
We can quickly clarify changes in the breast or conspicuous findings. As part of the initial consultation, in addition to a detailed discussion, we perform, for example, a palpation and ultrasound examination. In the case of conspicuous findings, an immediate tissue sample (biopsy) can be taken with a thin needle. The procedure is performed under local anesthesia and takes about 15 minutes.
In most cases, various examinations are necessary for a comprehensive assessment. These are carried out, among other places, at the Klinik Stephanshorn. We plan these on the same day directly before or after your appointment in our consultation. A shuttle service is organized by us and ensures a quick way to the clinic and back to us.
We can organize additional examinations (e.g. MRI) for you if required through our colleagues in radiology.
We will inform you of the results of the examinations as soon as possible and discuss with you the further procedure in your individual situation. Very often it concerns harmless changes that do not require further therapy.
However, if you are diagnosed with cancer, your findings will be discussed in our team and at our interdisciplinary tumor conference. At the TBZ, we will then explain the therapy recommendation to you and advise you on this in detail. We then plan the further steps together with you.
If an operation is planned, we will discuss the procedure with you in detail. We attach great importance to the fact that, whenever possible, you are operated on by the same doctor who carried out the examinations and therefore knows you and all the necessary findings best.
We perform your surgery at the Klinik Stephanshorn.
You will receive all the necessary documents from the Klinik Stephanshorn. If you have any relevant pre-existing conditions, you may be invited separately for an anesthesia consultation. However, you will usually be admitted to the clinic directly on the day of surgery.
You will be operated on by your attending physician from the Tumor- und BrustZentrum Ostschweiz and subsequently cared for during your hospital stay.
You can also find detailed information about your hospital stay directly via the Klinik Stephanshorn link:
www.hirslanden.ch/de/klinik-stephanshorn/ihr-aufenthalt/ablauf-ihres-aufenthalts.html
In the week after the operation, or at any time if needed, we carry out a wound check at the TBZ.
In the case of cancer, a second discussion takes place at the tumor conference after the operation. As part of the wound check, we will explain the findings of the tumor operation and their significance for the further course of treatment in a personal consultation. Additional treatments are often recommended to prevent a recurrence, such as radiation or drug therapies.
At the TBZ, surgeons and oncologists work closely together and discuss all cases in an interdisciplinary manner. This means that a seamless transition to the oncology consultation is possible. Your oncologist will discuss in detail the treatment options and their benefits, procedure, and expected side effects with you. All therapies, including chemotherapy, immunotherapy, and anti-hormone therapy, take place on an outpatient basis at one of our locations. You will always be accompanied by your oncologist and the team of specially trained nurses.
Our locations
We are there where you need us! We offer highly competent oncological and senological consultation and treatment close to your home at our easily accessible locations. Individual care in a familiar atmosphere by our experienced and well-coordinated practice teams is very important to us. This gives patients and their families the certainty of receiving empathetic and consistent support, even in difficult life situations.
Our certification
On August 23, 2022, the Stephanshorn Breast Center was awarded the coveted quality label for another 4 years. The Swiss Cancer League and the Swiss Society of Senology (SGS) jointly award a quality label (seal of approval) for breast centers. The label recognizes breast centers that meet around 100 clearly defined requirements for the quality of treatment and care for women with breast cancer.
The Tumor- und BrustZentrum Ostschweiz is an integral part of the certified breast center at the Klinik Stephanshorn – our core team members for breast surgery and medical oncology hold leading positions at the clinic. Our certified breast center is the largest in Eastern Switzerland – every year, around 300 women with breast cancer entrust themselves to our team for treatment.
