Breast cancer and breast health in Vienna
Breast cancer is the most common cancer in women. At the same time, the great majority of changes in the breast are benign. A newly felt lump or an abnormal finding therefore does not automatically mean cancer, but it should be investigated carefully. My task is to assess a finding thoroughly without worrying you unnecessarily. If a diagnosis of cancer is confirmed, I will support you through the further diagnostic and therapeutic steps. At my private practice in 1090 Vienna, I take the time that a subject like this needs. The investigation of breast findings, the early detection of breast cancer and the care of patients with breast cancer have been among my main areas of work as a specialist in gynaecology and obstetrics for many years. For five years I worked in the Division of Special Gynaecology of the University Department of Obstetrics and Gynaecology at Vienna General Hospital (AKH Wien), which focused on diseases of the breast and breast cancer. There I headed the breast ultrasound outpatient clinic, wrote my habilitation thesis (the postdoctoral qualification for university teaching) on an imaging technique used in breast diagnosis, and regularly operated on patients with breast cancer. That experience still shapes my work today.
When should you come to see me about a breast finding?
New or unusual changes in the breast should be assessed by a doctor. These include in particular:
Breast pain is only rarely a sign of breast cancer. Hormonal changes or other benign causes are often behind it. Even so, an examination can be worthwhile, particularly if the symptoms are new, affect one side only or persist.
Abnormal mammogram result
If a mammogram has shown an unclear or abnormal finding, you can also come to me for further assessment or for a second opinion. If possible, please bring the existing images and the written report with you. This allows me to compare the available imaging with the clinical findings and, where appropriate, with an ultrasound examination of my own.
Early detection without symptoms
In women without symptoms, mammography is the most important established examination for the early detection of breast cancer. In the Austrian breast cancer screening programme, women aged 40 and over can have a mammogram every two years. Women between 45 and 74 are sent regular reminders; women between 40 and 44 and those aged 75 and over can register voluntarily.
A breast ultrasound can supplement mammography in certain situations, for example where breast tissue is dense or where a finding needs to be assessed more closely. However, it does not replace mammography, and for women without symptoms it is not generally intended as an annual early-detection examination on its own. In younger women with a palpable lump or other symptoms, by contrast, ultrasound is often the first imaging examination.
Breast cancer or ovarian cancer in the family
If breast or ovarian cancer has occurred repeatedly in your family, or at an unusually young age, there may be an inherited increased risk of cancer. In that case I will discuss with you whether genetic counselling at a specialised centre makes sense. Where an increased hereditary risk has been confirmed, the recommendations for early detection are different, and in some respects involve considerably closer monitoring, than for women at average risk of breast cancer.
How is a breast finding investigated?
Everything starts with a detailed conversation. I would like to know
I then examine both breasts and feel the regional lymph nodes, particularly in the armpits and in the area above the collarbones.
Breast ultrasound
Depending on the question to be answered, this is followed by a breast ultrasound, known medically as breast sonography. I carry this out myself.
Ultrasound makes it possible, for example, to distinguish fluid-filled cysts from solid changes. In the case of a solid lump, I assess among other things:
These features allow the risk associated with a finding to be estimated. However, ultrasound alone cannot determine with certainty for every finding whether a change is benign or malignant. I document the ultrasound images so that a direct comparison is possible at later examinations. What always matters is the overall picture made up of symptoms, findings on palpation, age, personal risk and imaging.
When is a mammogram appropriate?
Mammography and ultrasound do different jobs and complement each other depending on the question to be answered. In younger women with symptoms, an ultrasound is often carried out first. A diagnostic mammogram may be needed in addition, regardless of age, if the finding calls for it. Mammography is particularly important because it can show changes such as microcalcifications that are not reliably visible on ultrasound. In the case of an abnormal finding, I therefore decide whether a diagnostic mammogram is also required not on the basis of age alone, but on the basis of the specific question to be answered.
When is an MRI scan of the breast necessary?
Magnetic resonance imaging (MRI) of the breast is a very sensitive examination, but it is not carried out routinely for every unclear breast finding.
It can be useful in selected situations, for example:
I decide on the basis of the specific finding whether an MRI scan will actually provide additional helpful information. I arrange for mammography and MRI to be carried out at specialised radiology centres and then discuss the results with you.
When is a tissue sample necessary?
If imaging shows a suspicious finding, further observation is often not enough. It then has to be established what kind of tissue change is involved. If the finding is visible on ultrasound, the tissue is usually taken by ultrasound-guided core needle biopsy. Under local anaesthesia, a special hollow needle is guided precisely into the abnormal area and several small tissue samples are taken. The procedure takes only a few minutes and is generally well tolerated. The samples are then examined histologically, that is, under the microscope.
For changes that are visible, for example, only on the mammogram as microcalcifications, other image-guided procedures such as a vacuum-assisted biopsy may be required. For many years I carried out and taught the ultrasound-guided investigation of breast findings at the breast ultrasound outpatient clinic at AKH Wien. As soon as the histology report is available, I will discuss with you in person what the result means and what further steps, if any, are necessary.
What does a second opinion on breast cancer involve?
A diagnosis of breast cancer brings a great deal of information and many decisions within a short time. A second specialist assessment can help you to understand the diagnosis and the proposed treatment plan better.
For a second opinion I look in particular at the following documents:
What information determines breast cancer treatment?
Among other things, I explain to you what the following details mean:
HER2 status describes whether the tumour cells have an increased number of HER2 receptors or the corresponding genetic changes. This information can be decisive in choosing a targeted therapy.
What can a second opinion change?
A second assessment often confirms the treatment already proposed. That can provide additional reassurance and resolve open questions. In other cases, points emerge that should be discussed again within the treatment team. These may include, for example:
I explain the options available and discuss with you which questions you should raise with the breast centre treating you or with your oncology team.
How are decisions about your treatment made?
Today, the treatment of breast cancer is planned on an interdisciplinary basis. In specialised breast centres, patients with newly diagnosed breast cancer are presented at a tumour conference, also known as a tumour board or, in Austria, an “Onkokonsil”. Current guidelines recommend an interdisciplinary discussion of this kind both before treatment begins and after surgery. Specialists from several disciplines contribute their expertise, depending on the situation in particular from:
Together they decide which treatment is suitable for the individual tumour and in what order the individual steps take place. These may include surgery, radiotherapy, chemotherapy, endocrine therapy, and HER2-targeted or other targeted therapies.
At AKH Wien I took part regularly in such interdisciplinary case discussions over many years and chaired the tumour board on repeated occasions. Today this experience helps me to explain to you which information is decisive for a treatment decision and what the treatment team's recommendations mean for you in practical terms.
If you would like a second opinion, I can go through your existing reports and the recommended treatment plan with you and work out the open questions for your discussion with the breast centre treating you or with your oncologist.
How do I support you during breast cancer treatment?
The cancer treatment itself takes place at a specialised breast centre, a hospital or a specialist oncology practice. At my practice, between those appointments, we can discuss reports, clarify open questions and, in particular, look after gynaecological symptoms during treatment.
Gynaecological side effects of treatment
Chemotherapy can impair the function of the ovaries temporarily or permanently. Depending on age and treatment, this can cause symptoms similar to those of the menopause, for example:
Endocrine therapy can also cause side effects. Depending on the drug used, these may include hot flushes, symptoms in the genital area, joint and muscle pain or changes in bone metabolism. I discuss with you what options there are for treating such symptoms without unnecessarily impairing the effectiveness of the cancer treatment.
Tamoxifen and the lining of the uterus
Tamoxifen can promote changes in the lining of the uterus, particularly after the menopause. However, regular ultrasound checks of the lining of the uterus in patients without symptoms are not generally recommended, because they do not reliably detect endometrial cancer any earlier.
What matters instead is that unusual vaginal bleeding, spotting or bloodstained discharge while taking tamoxifen is assessed promptly by a gynaecologist. If you have such symptoms, I decide which further examinations are necessary.
Bone health during endocrine therapy
Aromatase inhibitors and drug-induced suppression of ovarian function in particular can reduce bone density. For this reason, the individual risk of osteoporosis and, where appropriate, bone density are taken into account. Depending on the risk, further preventive measures or drug treatment may be necessary.
Wish to have children and fertility preservation
In patients of childbearing age, the wish to have children should be raised, if at all possible, before the start of any treatment that could damage fertility. Depending on age, treatment and personal situation, the options include, for example, freezing (cryopreservation) of eggs or ovarian tissue and, in certain cases, drug-induced suppression of ovarian function during chemotherapy. Current guidelines recommend counselling on fertility and fertility preservation before treatment begins. If this is relevant for you, I will refer you to a specialised fertility centre at an early stage.
What happens in follow-up care after breast cancer?
Once primary treatment has been completed, long-term follow-up care begins. Its purpose is not only to detect a possible recurrence of the disease or a new tumour in the other breast. Just as important are the treatment of side effects, support during longer-term drug treatment, and your physical and psychological quality of life.
How often do follow-up examinations take place?
For invasive breast cancer, current guidelines generally recommend the following for patients without symptoms:
For non-invasive breast cancer such as DCIS, the intervals are in some cases different. The individual follow-up plan also depends on the type of disease and how it was treated, as well as on ongoing treatments and symptoms.
Which examinations are part of follow-up care?
A clinical follow-up appointment consists in particular of a conversation about new symptoms and possible side effects of treatment, together with a physical examination.
Mammography remains the most important imaging examination:
A breast ultrasound is not automatically necessary at every follow-up appointment. It can supplement mammography, for example where the breast is dense, where the images are difficult to assess or where there is a specific clinical finding. An MRI scan of the breast is not a routine follow-up examination either. It is used for particular questions when mammography and ultrasound do not allow a sufficiently reliable assessment.
Likewise, additional laboratory tests or extensive imaging to look for metastases are not carried out routinely in patients without symptoms, but only if there are relevant symptoms or abnormal findings.
More than looking for a recurrence
Depending on treatment and personal needs, long-term care can also include:
Regular physical activity has been particularly well studied. Among other things, it can improve physical fitness, fatigue and quality of life. The current guideline recommends regular exercise with endurance and strength training for breast cancer patients. My practice can take on part of this long-term gynaecological and clinical care. Mammograms and other radiological examinations, however, are carried out at the appropriate radiology centres; ongoing cancer treatments and specialised questions continue to be coordinated with the breast centre treating you or with your oncology team.
Why come to Prof. Obwegeser for breast cancer and breast findings?
Many years of experience at the university department
I worked at the university department at AKH Wien from 1989 until the end of 2023, from 1994 as senior consultant. From 1994 to 1999 I was the consultant in charge of the ward in the Division of Special Gynaecology, whose focus included the treatment of breast cancer. During that time I headed the breast ultrasound outpatient clinic, deputised for the head of the division on several occasions and regularly chaired the interdisciplinary tumour board. My research focus included breast imaging and gynaecological questions connected with breast cancer treatment. From 2000 I worked in the Division of Gynaecology and Gynaecological Oncology. There, gynaecological cancers were also part of my clinical focus.
Today, at my private practice, I continue to care for patients with breast findings and breast cancer, from the initial investigation and second opinions through to gynaecological support during and after treatment. I combine my many years of university experience with the time to explain findings, treatment options and open questions to you in detail.
What does the investigation cost and how is it billed?
I run a private practice without a health-insurance contract. After the appointment you will receive an invoice, which you can submit to your health insurance fund for reimbursement. The amount reimbursed depends on the insurance fund concerned and the services provided. Depending on your policy, supplementary private insurance may cover all or part of the remaining costs.
Mammography, MRI and other radiological examinations are carried out at the respective radiology centres. Whether costs arise there, how high they are and whether they are covered by your health insurer depends on the examination, the medical indication and your insurance status.
We will be happy to tell you the exact fee for the examination at my practice in advance by telephone.
I have felt a lump. How quickly can I get an appointment?
If you have newly felt a lump, we do our best to offer you an appointment at short notice. When you book, please tell us that you have noticed a new change in your breast.
The conversation, the physical examination and, where medically appropriate, a breast ultrasound can generally all take place at the same appointment. Whether further examinations such as a mammogram or a tissue sample are necessary is decided on the basis of the findings.
Is breast ultrasound a substitute for mammography?
No. Ultrasound and mammography have different strengths and complement each other in certain situations. Ultrasound is particularly helpful for investigating palpable changes and where breast tissue is dense. Mammography, on the other hand, can show microcalcifications, for example, that are not reliably detectable on ultrasound.
For women without symptoms, mammography is the established examination of the Austrian breast cancer screening programme. Between the ages of 45 and 74, your e-card is automatically activated for it every two years. Women between 40 and 44 and those aged 75 and over can register voluntarily. An additional breast ultrasound is carried out depending on the findings and breast density, not automatically with every mammogram.
Does an ultrasound-guided core needle biopsy hurt?
The tissue sample is taken under local anaesthesia. During the procedure you may notice pressure or the movement of the instrument; more severe pain is not normally to be expected. After the biopsy there may be a small bruise or temporary tenderness.
Can I come to you for a second opinion even though I am being treated elsewhere?
Yes. If possible, please bring all the documents you have, in particular the histology report, the imaging, any operation reports and the proposed treatment plan. I will explain the diagnosis and the proposed treatment to you and discuss which questions or alternatives, if any, should still be clarified with the team treating you.
What is the difference between breast cancer prevention and early detection?
In everyday German, the term “Brustkrebsvorsorge” (literally “breast cancer prevention”) is often used for examinations aimed at early detection. Early detection means finding a breast cancer that has already developed as early as possible, before it causes symptoms. The Austrian screening programme is therefore based on regular mammography. It does not prevent breast cancer from developing.
Alongside this, there are measures that can influence your personal risk of breast cancer. These include, for example, exercise, a healthy body weight and drinking as little alcohol as possible. For women with a greatly increased hereditary risk, special preventive measures may also be an option.
How long does follow-up care after breast cancer last?
Follow-up care is designed for the long term. In the first few years the clinical follow-up appointments are closer together; after that the intervals become longer. For invasive breast cancer, clinical follow-up is generally recommended every three months in the first three years, every six months in the fourth and fifth years and once a year from the sixth year onwards. After that, too, regular early-detection and follow-up examinations remain important. We decide individually which parts of follow-up care take place at my practice and which examinations are organised through radiology, the breast centre or oncology.
From 1989 to 2023 at the University Department of Obstetrics and Gynaecology at Vienna General Hospital (AKH Wien), senior consultant from 1994; founder and long-standing head of the ZEM outpatient clinic for cysts, endometriosis and fibroids.
If you would like to have a breast finding investigated or would like a second opinion on a breast cancer diagnosis, call us on +43 1 317 660 0 or write to ordination@prof-obwegeser.at. I offer appointments by prior arrangement by telephone. My practice is at Hörlgasse 14, Top 11, 1090 Wien. The entrance is at Liechtensteinstraße 8.