Breast diseases
How we diagnose and treat changes in the breast.
Most changes in the female (or male) breast are not malignant - however, a number of important examinations are required to clarify whether breast cancer or other breast diseases are present. Often, several different examinations have to be combined in order to arrive at the correct diagnosis and then treatment.
What causes breast pain and breast tenderness or lumps in the breast and what we recommend.
These are not usually a sign of malignant breast disease. They often have hormonal causes and can be treated with herbal remedies, for example. Hormonally induced (cyclical) breast pain can often occur before menstruation and is usually not a sign of breast cancer.
In this breast disease, various changes in the milk ducts lead to fluid leakage (secretion) - this often occurs in the first 1-2 years after giving birth, for example, 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 color changes. Clarification of the cause and correct treatment are very important, as in some cases breast cancer is also associated with skin changes.
A palpation examination alone cannot usually rule out the diagnosis of breast cancer with sufficient certainty. Although most breast lumps are benign (e.g. fibroadenoma, cyst, etc.), breast cancer can also be the cause.
This malignant tumor of the breast occurs in around 6,000 women in Switzerland every year. The process of determining whether breast cancer is present is described below and usually involves several examinations. Breast cancer is almost always curable at an early stage and can also be treated very well at an advanced stage. The close cooperation of various specialists (radiologists, gynaecologists/surgeons, medical oncologists, nurses, plastic surgeons and radiotherapists) in the certified Breast Centre at the Stephanshorn Clinic enables fast, competent and sensitive treatment of this most common tumor disease in women.
In adolescents, this breast disease occurs quite frequently due to hormonal changes and usually disappears on its own. There are many causes (medication, anabolic steroids, hormonal disorders). Sometimes an operation is advisable.
What causes breast pain and breast tenderness or lumps in the breast and what we recommend.
These are not usually a sign of malignant breast disease. They often have hormonal causes and can be treated with herbal remedies, for example. Hormonally induced (cyclical) breast pain can often occur before menstruation and is usually not a sign of breast cancer.
In this breast disease, various changes in the milk ducts lead to fluid leakage (secretion) - this often occurs in the first 1-2 years after giving birth, for example, 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 color changes. Clarification of the cause and correct treatment are very important, as in some cases breast cancer is also associated with skin changes.
A palpation examination alone cannot usually rule out the diagnosis of breast cancer with sufficient certainty. Although most breast lumps are benign (e.g. fibroadenoma, cyst, etc.), breast cancer can also be the cause.
This malignant tumor of the breast occurs in around 6,000 women in Switzerland every year. The process of determining whether breast cancer is present is described below and usually involves several examinations. Breast cancer is almost always curable at an early stage and can also be treated very well at an advanced stage. The close cooperation of various specialists (radiologists, gynaecologists/surgeons, medical oncologists, nurses, plastic surgeons and radiotherapists) in the certified Breast Centre at the Stephanshorn Clinic enables fast, competent and sensitive treatment of this most common tumor disease in women.
In adolescents, this breast disease occurs quite frequently due to hormonal changes and usually disappears on its own. There are many causes (medication, anabolic steroids, hormonal disorders). Sometimes an operation is advisable.
Which diagnostic methods we frequently use in addition to mammography and computer tomography (CT):
A physical examination by a specialist often provides an indication of which breast diseases are possible. The palpation examination includes an examination of both breasts and the lymph nodes.

Ultrasound (breast sonography) is the examiner's extended arm. Various changes in the breast can be seen in real time without radiation exposure. If necessary, a tissue sample (biopsy) can be taken immediately. Ultrasound can be a complement to mammography and is the examination method of first choice, especially for young women and those with dense mammary glands.

Mammography is an X-ray examination of the mammary gland, which is usually performed from two sides. The finest changes in the tissue can be seen. The radiation exposure is minimal with modern devices - the slightly uncomfortable pressure when the breast is compressed reduces the radiation dose even further.

Additional radiological examinations are sometimes useful for specific questions - but not for every question:
Magnetic resonance imaging (MRI): High-resolution images of the mammary gland are taken in a tube in around 30 minutes. These are sometimes required for planning an operation.
Computed tomography (CT): The X-ray examination of the chest, abdomen and pelvis is often required to find out whether breast cancer has already metastasized in the body (environmental clarification).
PET-CT: Here, computed tomography is combined with a slightly radioactive contrast agent in order to better visualize various tumour foci.
Taking a tissue sample enables precise diagnosis
In women with new changes in the breast that require clarification, a tissue sample must be taken to confirm the diagnosis. The tissue is taken under local anesthesia. General anesthesia and hospitalization are not necessary.
Why is a tissue sample important?
- Most changes are benign (approx. 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 you are dealing with. The diagnosis tells us whether additional examinations are necessary. Above all, however, knowing the type of breast cancer helps to determine the extent of the operation.
Whether the tissue sample is taken by mammography (vacuum punch biopsy) or by ultrasound depends on the change - which examination technique is best able to visualize it.
Are there any disadvantages to a biopsy or can a tumor spread more easily afterwards?
Many people think that a tumor can only spread after a biopsy:
Fortunately, this fear is completely unfounded!
Only the application of the local anesthetic is painful for a few seconds. The puncture site is treated with a pressure bandage, which you can remove the next day. Showering is possible after the dressing has been removed. A bruise may develop at the puncture site itself, which will disappear within a few days.

The earlier breast cancer is detected, the better the disease can be treated. The aim is not only to reduce the mortality rate from breast cancer, but also to provide gentler treatment at an early stage - if possible without chemotherapy and without removing the entire breast and often with little or no additional drug therapy.
In recent years, mammography screening has been the subject of heated debate as to whether or not the reduction in breast cancer mortality that has been propagated for years is as great as claimed. In addition, mammography repeatedly reveals changes that ultimately have no pathological value - so-called "false-positive" findings.
That is why the St. Gallen mammography screening is of the highest quality, with double diagnosis by two radiologists using the latest technology and strict quality control - the Breast Center of Eastern Switzerland recommends participation in donna screening for women aged 50 to 69, as this is the age group in which the information is most significant and breast cancer is most common.

More information about the Donna program:
https://www.donna-programm.ch/de/willkommenzum-donna-programm.html
Which diagnostic methods we frequently use in addition to mammography and computer tomography (CT):
A physical examination by a specialist often provides an indication of which breast diseases are possible. The palpation examination includes an examination of both breasts and the lymph nodes.

Ultrasound (breast sonography) is the examiner's extended arm. Various changes in the breast can be seen in real time without radiation exposure. If necessary, a tissue sample (biopsy) can be taken immediately. Ultrasound can be a complement to mammography and is the examination method of first choice, especially for young women and those with dense mammary glands.

Mammography is an X-ray examination of the mammary gland, which is usually performed from two sides. The finest changes in the tissue can be seen. The radiation exposure is minimal with modern devices - the slightly uncomfortable pressure when the breast is compressed reduces the radiation dose even further.

Additional radiological examinations are sometimes useful for specific questions - but not for every question:
Magnetic resonance imaging (MRI): High-resolution images of the mammary gland are taken in a tube in around 30 minutes. These are sometimes required for planning an operation.
Computed tomography (CT): The X-ray examination of the chest, abdomen and pelvis is often required to find out whether breast cancer has already metastasized in the body (environmental clarification).
PET-CT: Here, computed tomography is combined with a slightly radioactive contrast agent in order to better visualize various tumour foci.
Taking a tissue sample enables precise diagnosis
In women with new changes in the breast that require clarification, a tissue sample must be taken to confirm the diagnosis. The tissue is taken under local anesthesia. General anesthesia and hospitalization are not necessary.
Why is a tissue sample important?
- Most changes are benign (approx. 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 you are dealing with. The diagnosis tells us whether additional examinations are necessary. Above all, however, knowing the type of breast cancer helps to determine the extent of the operation.
Whether the tissue sample is taken by mammography (vacuum punch biopsy) or by ultrasound depends on the change - which examination technique is best able to visualize it.
Are there any disadvantages to a biopsy or can a tumor spread more easily afterwards?
Many people think that a tumor can only spread after a biopsy:
Fortunately, this fear is completely unfounded!
Only the application of the local anesthetic is painful for a few seconds. The puncture site is treated with a pressure bandage, which you can remove the next day. Showering is possible after the dressing has been removed. A bruise may develop at the puncture site itself, which will disappear within a few days.
The earlier breast cancer is detected, the better the disease can be treated. The aim is not only to reduce the mortality rate from breast cancer, but also to provide gentler treatment at an early stage - if possible without chemotherapy and without removing the entire breast and often with little or no additional drug therapy.
In recent years, mammography screening has been the subject of heated debate as to whether or not the reduction in breast cancer mortality that has been propagated for years is as great as claimed. In addition, mammography repeatedly reveals changes that ultimately have no pathological value - so-called "false-positive" findings.
That is why the St. Gallen mammography screening is of the highest quality, with double diagnosis by two radiologists using the latest technology and strict quality control - the Breast Center of Eastern Switzerland recommends participation in donna screening for women aged 50 to 69, as this is the age group in which the information is most significant and breast cancer is most common.

More information about the Donna program:
https://www.donna-programm.ch/de/willkommenzum-donna-programm.html
Whether chemotherapy, immunotherapy, radiotherapy or hormone therapy - wewe find the best possible form of therapy for our patients.
Breast cancer cells can be slowed down and killed with tablets and infusions. The use of these drugs depends on the situation at hand:
1. before an operation (neoadjuvant): with the aim of shrinking the tumor so that it can be operated on more easily
2. after an operation (adjuvant): with the aim of ridding the body of suspected remaining tumor cells.
3. to reduce the size of tumors and control breast disease if metastases have formed.
A precise histological examination of the tumor allows the therapy to be tailored to the tumor. Depending on the nature of the tumor, one or more groups of drugs (chemotherapy, immunotherapy, anti-hormone therapy) can be used to achieve the best possible disease control.
Today, there are many auxiliary drugs available that make chemotherapy well tolerated so that everyday life is affected as little as possible. Your attending physician will carefully plan the therapy together with your care team and discuss it with you in detail. You will be closely monitored during treatment so that any side effects can be quickly identified and treated. Chemotherapy is usually administered via a vein and thus reaches all tumor cells in the body. As tumor cells react more sensitively to chemotherapy than normal body cells, tumor cells can be destroyed by chemotherapy while normal cells recover.
Chemotherapy is administered once a week to once every 3 weeks and repeated several times.

The pathological examination determines whether a tumor has hormone receptors for female hormones (oestrogen and progesterone). This is the case in the majority of breast cancer tumors. In the case of 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 once a day in tablet form (Letrozole, Anastrozole, Exemestane). Some are injected monthly under the skin or into the gluteal muscle (Fulvestrant, Zoladex).

Immunotherapy consists of antibodies applied via the vein that recognize tumour cells by means of HER2 receptor-specific sensors on the surface (so-called "HER2-positive" tumour cells) and block them in a targeted manner. These sensors are formed in approx. 15 % of breast cancers. Normal body cells are hardly affected by antibody therapy, which is why these therapies are excellently tolerated and in some cases can be used successfully for many years with very few side effects. Immunotherapy is applied every 3 weeks and can also be administered in combination with chemotherapy. There are various immunotherapies that block the HER2 receptor at different sites (trastuzumab, pertuzumab). A particularly sophisticated drug consists of an antibody to which a chemotherapy molecule is also bound (T-DM1). After docking to the tumor cell, the chemotherapy is introduced into the tumor cell and thus specifically destroys only the tumor cell, while sparing healthy cells.
Certain tumors escape the body's own defenses by immobilizing the immune system. Immune checkpoint inhibitors interrupt this immobilization and "wake up" the immune system again so that immune cells become active against the tumour. This novel mode of action has been used with great success in many tumors in recent years. An immune checkpoint inhibitor is often used in combination with chemotherapy. This therapy is administered via a vein every 2-3 weeks.
Radiation (radiotherapy) is often used as a component of breast cancer treatment. High-energy X-rays are used to prevent tumor cells from growing. The duration and extent (volume/dose) of the treatment is individually tailored to the tumor situation. Radiation treatment can last from a few days (palliative situation) to several weeks (adjuvant situation). The outpatient therapy sessions take place daily (Mon-Fri). Personal consultation, planning and radiotherapy take place in the same building, in the radiotherapy department of the Stephanshorn Clinic.

The procedure at our 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 directly with us. We treat patients of all insurance classes.
We allocate appointments according to urgency. In the event of 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 any changes in the breast or abnormal findings. As part of the initial consultation, we carry out a detailed discussion and, for example, a palpation and ultrasound examination. If there are any abnormal findings, a sample can be taken immediately (biopsy) using a thin needle. The procedure is performed under local anesthesia and takes around 15 minutes.

In most cases, various examinations are necessary for a comprehensive assessment. These are carried out at the Stephanshorn Clinic, among others. We plan these on the same day directly before or after your appointment in our consultation hours. A shuttle service is organized by us and guarantees a quick way to the clinic and back to us.
If necessary, we can organize additional examinations (e.g. MRI) for you via our colleagues in radiology.

We will inform you of the results of the examinations as quickly as possible and discuss the next steps in your individual situation with you. Very often, the changes are harmless and do not require any further treatment.
However, if you are diagnosed with cancer, your findings will be discussed by our team and at our interdisciplinary tumor conference. At the TBZ, we will then explain the treatment recommendation to you and advise you in detail. We will then plan the next steps together with you.
If an operation is planned, we will discuss the procedure with you in detail. It is very important to us that, wherever possible, you are operated on by the same doctor who carried out your investigations and therefore knows you and all the necessary findings best.

We will perform your operation at the Stephanshorn Clinic.
You will receive all the necessary documents from the Stephanshorn Clinic. If you are known to have any relevant concomitant illnesses, you may be invited separately for an anesthesia consultation. As a rule, however, you will be admitted to the clinic directly on the day of the operation.
You will be operated on by your attending physician from the Tumor and Breast Center Eastern Switzerland and then cared for during your stay in hospital.
You can also find detailed information about your hospital stay directly via the Stephanshorn Clinic link:
www.hirslanden.ch/de/klinik-stephanshorn/ihr-aufenthalt/ablauf-ihres-aufenthalts.html
In the week following the operation, or at any time if required, 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 the disease to you in a personal discussion. Additional treatments are often recommended to prevent a relapse, e.g. radiotherapy or drug therapies.

At the TBZ, surgeons and oncologists work closely together and discuss all cases on an interdisciplinary basis. This also enables a seamless transition to the oncology consultation. Your oncologist will discuss the treatment options and their benefits, procedure and expected side effects with you in detail. 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 procedure at our 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 directly with us. We treat patients of all insurance classes.
We allocate appointments according to urgency. In the event of 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 any changes in the breast or abnormal findings. As part of the initial consultation, we carry out a detailed discussion and, for example, a palpation and ultrasound examination. If there are any abnormal findings, a sample can be taken immediately (biopsy) using a thin needle. The procedure is performed under local anesthesia and takes around 15 minutes.

In most cases, various examinations are necessary for a comprehensive assessment. These are carried out at the Stephanshorn Clinic, among others. We plan these on the same day directly before or after your appointment in our consultation hours. A shuttle service is organized by us and guarantees a quick way to the clinic and back to us.
If necessary, we can organize additional examinations (e.g. MRI) for you via our colleagues in radiology.

We will inform you of the results of the examinations as quickly as possible and discuss the next steps in your individual situation with you. Very often, the changes are harmless and do not require any further treatment.
However, if you are diagnosed with cancer, your findings will be discussed by our team and at our interdisciplinary tumor conference. At the TBZ, we will then explain the treatment recommendation to you and advise you in detail. We will then plan the next steps together with you.
If an operation is planned, we will discuss the procedure with you in detail. It is very important to us that, wherever possible, you are operated on by the same doctor who carried out your investigations and therefore knows you and all the necessary findings best.

We will perform your operation at the Stephanshorn Clinic.
You will receive all the necessary documents from the Stephanshorn Clinic. If you are known to have relevant concomitant illnesses, you may be invited separately for an anesthesia consultation. As a rule, however, you will be admitted to the clinic directly on the day of the operation.
You will be operated on by your attending physician from the Tumor and Breast Center Eastern Switzerland and then cared for during your stay in hospital.
You can also find detailed information about your hospital stay directly via the Stephanshorn Clinic link: www.hirslanden.ch/de/klinik-stephanshorn/ihr-aufenthalt/ablauf-ihres-aufenthalts.html

In the week following the operation, or at any time if required, 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 the disease to you in a personal discussion. Additional treatments are often recommended to prevent a relapse, e.g. radiotherapy or drug therapies.

At the TBZ, surgeons and oncologists work closely together and discuss all cases on an interdisciplinary basis. This also enables a seamless transition to the oncology consultation. Your oncologist will discuss the treatment options and their benefits, procedure and expected side effects with you in detail. 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 where you need us! We offer highly competent oncology and senology advice and treatment close to where you live at our easily accessible location. Individual care in a family atmosphere by our experienced and well-coordinated practice teams is important to us. This gives patients and their relatives the certainty that they will receive empathetic and personal support even in difficult life situations.
Our certification
The Stephanshorn Breast Center was again awarded the coveted quality label for 4 years on August 23, 2022. The Swiss Cancer League and the Swiss Society of Senology (SGS) jointly award a quality label (seal of approval) for breast centers. The label is awarded to breast centers that meet around 100 clearly defined requirements for the quality of treatment and care of women with breast cancer.
The Tumor and Breast Center Eastern Switzerland is an integral part of the certified breast center at the Stephanshorn Clinic - 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.
