The University of Mainz Breast Cancer Center treats more than 250 breast cancer patients per year. At the University of Mainz Breast Cancer Center, more than 15 board-certified doctors -- including breast surgeons, breast cancer medical oncologists, radiation oncologists, pathologists and radiologists -- work as a multidisciplinary team to provide optimal care to breast cancer patients.
Investigators in the hospital and in the laboratory are exploring how breast cancer develops, devising new methods to diagnose it in its earliest, most curable stages, and developing new treatments for all stages of the disease.
Team Approach to Care
The University of Mainz Breast Cancer Center provides comprehensive, multidisciplinary care to all patients, including a full array of supportive services such as nutritional and genetic counseling, gynecologic and endocrinological (hormone-related) care, physical therapy, and psychosocial support for patients with breast cancer:
Select from the list below to learn more about our breast cancer specialists, their education, training, board certifications, current publications, and specific areas of clinical expertise.
Types of Breast Cancer
Cancer is not one disease, it is a group of diseases that can appear in any part of the body, and take many forms. But all cancers share a basic trait -- the abnormal growth, multiplication, and spread of cells in the body. Once the cells begin to grow uncontrollably, they can form a tumor. Benign tumors are not cancerous -- they do not invade surrounding tissue and spread throughout the body. Malignant tumors have the capacity to grow beyond their original site and into other tissues.
Carcinoma is the term used to describe most malignant tumors. Most breast cancers are ductal carcinomas -- they originate in the ducts that carry milk to the nipple. Less common are lobular carcinomas. These form in the cells that line the lobules that produce milk. Tumors that originate in bone, muscle, fat, or connective tissue are called sarcomas. Sarcomas of the breast are very rare. Much less common types of tumors also include tubular, medullary, mucinous, papillary, and adenocystic tumors.
If the cancer cells are confined to the duct or lobule, the cancer is in situ, meaning it hasn't left the site. Ductal carcinoma in situ (DCIS) is usually found by mammography, as no tumor mass has formed and, as a result, a woman couldn't find the cancer during breast self-examination. When a cancer has moved beyond the duct, it is called invasive or infiltrating cancer. Infiltrating ductal carcinoma is the most common type of breast cancer. As the cells invade surrounding areas, scar tissue or other fibrous growth surrounds the tumor cells forming a lump that can be seen on a mammogram or felt during a physicians examination.
Infiltrating lobular carcinoma doesn't produce the same kind of fibrous growth, so it may be harder to detect on a mammogram. This type of cancer produces a softer lump -- sometimes it is describes as a thickening. If a lobular cancer is found in one breast, it may also be in the other breast. Therefore it is important to carefully monitor the second breast.
Scaliness, oozing, or hardening of the skin, areola, or of the nipple itself may be a sign of Paget's disease, a relatively rare cancer in which a tumor grows out on to the surface of the skin. A biopsy may be done to look for the presence of malignant cells, and to rule out other conditions such as eczema.
More than 70 percent of women who develop breast cancer have no known risk factors. Nevertheless, there are several risk factors that can increase a woman's chances of developing cancer. The most important risk factor is age -- the older a woman is, the greater her chance of getting breast cancer.
A woman is at increased risk for breast cancer if she is childless, or if she had her first child after age 30. Early menstruation and the consumption of alcohol (3 or more drinks a day) are also associated with an increased risk for breast cancer. The role of oral contraceptives in relation to breast cancer risk is still unclear at this time. Evidence suggests that exercise and good nutrition may help reduce a woman's risk of developing breast cancer
With the exception of age, the greatest risk factor for breast cancer is a family history of this disease. About 20 percent of women with breast cancer have a family history of one or two relatives with the disease.
About five percent of women with breast cancer have several relatives who have had breast cancer and/or ovarian cancer. Two genes, called BRCA1 and BRCA2 have been linked to these families. When someone inherits an altered form of one of these genes (called a mutation), that person has a markedly increased risk of breast and/or ovarian cancer. This genetic mutation can be inherited from the mother's side of the family or from the father's side. In these families, the risk for a woman developing breast cancer or ovarian cancer can approach 90 percent by age 70. Men inheriting BRCA1 or BRCA2 mutations also have an increased risk of breast cancer, although breast cancer is much less common in men.
Identification of Genetic Risk Factors for Breast Cancer
Women with a family history of breast or ovarian cancer should consider genetic counseling. (This is particularly important for those whose family members developed these cancers at an early age -- generally before menopause). The University of Mainz Breast Cancer Centre has a approved laboratory that offers genetic counseling services. Our Clinical Genetics Service can discuss your options for genetic testing in a counseling session. There are special issues of privacy of genetic information that must be considered. In some cases, research studies may cover the costs of the laboratory testing.
Screening & Prevention Options for Those at Increased Risk
For women with family histories of breast or ovarian cancer, and those with mutations of BRCA1 or BRCA2, there are an increasing number of options for early detection or prevention. These include breast self-examination, physician examination, mammography, sonography, and magnetic resonance imaging (MRI). Risk-reducing surgery is also an option. In some cases women opt to remove breast tissue or ovaries (generally after childbearing) to reduce the risk of hereditary cancers.
Women who would like to discuss their family risk factors for breast or ovarian cancer should first speak to their physicians and then can schedule a genetic counseling session by calling 06131 175303.
Mammography is the most widely used method for detecting breast cancer. When breast cancer is suspected, a doctor will perform a biopsy -- a procedure to remove some cells from the suspicious area so that they can be examined more closely. The cells are examined by a pathologist, who will characterize them and determine whether they are cancerous. A biopsy may be performed with surgery. Surgical biopsies are generally performed in a hospital. The surgeon may remove all or part of a tumor during a biopsy. This tissue is immediately examined by a pathologist.
The University of Mainz Breast Cancer Center radiologists use digital mammography to produce an image of the breast in about five seconds (compared to four to five minutes with a traditional mammogram), and to refine the contrast of the image so that lesions can be seen more clearly.
A biopsy can be done in a number of ways. In fine-needle aspiration, a needle is inserted through the skin into a lump. Any fluid present is drawn into the syringe. If the lump is solid, the doctor will try to pull some cells into the syringe. During a core biopsy, a larger needle is inserted into a lump and a small piece of tissue is retrieved. In mammatome biopsy, a needle is inserted into a lump to obtain several slivers of tissue. This procedure is used to look for microcalcifications seen on mammogram.
Stereotactic-Core Needle Biopsy (Mammotome®)
The University of Mainz Breast Cancer Centre's breast-imaging specialists are now refining and demonstrating the benefits of stereotactic-core needle biopsy, a procedure for diagnosing a suspicious area that can be seen on a mammogram but is too small to be felt. The procedure uses computer-imaging techniques to guide a needle into the breast to collect abnormal cells from a suspicious area observed on an x-ray. For many women, stereotactic needle biopsy can spare them a more uncomfortable and expensive surgical biopsy. It can also allow them to start their treatment sooner.
Surgery is usually the first choice of treatment for breast cancer. At one time, most women were treated by a radical mastectomy -- the removal of the entire breast and the muscles of the chest wall. Surgical techniques have been refined over the years, and it is now possible to remove less of the normal breast tissue. The University of Mainz Breast Cancer Centre surgeons can offer a patient the best possible chance of saving her breast (if this is an appropriate treatment for her). Here, some 70 percent of women undergo breast-conserving treatments like lumpectomy, rather than mastectomy -- far more than the national rate.
Breast conserving surgery (e.g. lumpectomy) involves the surgical removal of the lump, a margin of normal tissue surrounding the lump, and the underarm lymph nodes (followed by treatment with radiation). The amount of breast tissue removed depends on the size and location of the tumor. If 20 percent to 25 percent of the breast is removed, the procedure is called a quadrectomy.
Women who are not candidates for lumpectomy may be treated by mastectomy -- the removal of the breast tissue. It is uncommon for women to be treated by a radical mastectomy. Some women may be treated by simple mastectomy. Unlike a radical mastectomy, this procedure does not involve the removal of the axillary lymph nodes. This procedure is commonly used to treat ductal carcinoma in situ.
When cancer spreads, or metastasizes, from the initial site in the breast, it often does so through the lymph system. If a woman's lymph nodes contain cancer, she may need more aggressive treatment, such as chemotherapy.
To prevent cancer cells from establishing themselves elsewhere in the body, the lymph nodes that drain the breast area are often removed during surgery. Most of the lymph nodes are located in the armpit. The nodes are not arranged in a trail leading away from the breast, but in more of a web or network. It is difficult for surgeons to look at the nodes and determine whether or not they contain cancerous cells. Generally, about 75 to 80 percent of the women diagnosed with breast cancer will need to have 12 to 15 under-arm lymph nodes near the affected breast surgically removed and examined for cancer cells. Until now, such "axillary node dissection" has been the only way doctors could reliably tell if cancer had spread beyond the breast to nearby lymph nodes. But it may leave women with a disorder called lymphedema -- a painful swelling of the arm due to fluid accumulation -- or put them at increased risk for infection.
Sentinel Lymph Node Biopsy
Today more breast cancers are being diagnosed at an early stage, thanks to improved screening. In 80 percent of the patients whose cancers have been detected early, axillary node dissection shows that the lymph nodes are cancer free. Rather than removing all the lymph nodes draining from the breast, our doctors offer a procedure called sentinel node biopsy. The new technique spares many women from extensive surgery to remove a cluster of lymph nodes from under the arm to see if they contain cancer cells.
With sentinel node biopsy, surgeons need to remove only one lymph node for examination -- the "sentinel" node, where cancer cells from a breast tumor would travel first, if they were to spread. Here's how it works: Before surgery, a radiolabeled dye is injected into the area around a woman's breast tumor. At the next day, in the operating room, surgeons make a small incision in the armpit. To identify the sentinel lymph node, the surgeons use a device that detects the radioactive source. They remove the sentinel node and, while the woman is still in the operating room, send it to a laboratory for examination.
If this lymph node turns out to be free of cancer, the remaining nodes can be left intact, and the surgery to remove the tumor is completed. If it contains cancer cells, the remaining nodes are also removed and analyzed using standard axillary node dissection. Sentinel node biopsy can be performed on patients who opt either for lumpectomy or mastectomy.
Besides reducing the chances of developing lymphedema, sentinel node biopsy offers other benefits: It decreases the risk of surgical complications, and results in lower medical costs.
For women who have had a mastectomy, our surgeons offer innovative reconstructive techniques like "skin-sparing mastectomy with latissimus dorsi flap." The surgeon removes the inner breast tissue and nipple, leaving a shell of skin in place; then the surgeon fills in the shell with tissue from the woman's back and, later, reconstructs the nipple, resulting in a natural-looking breast.