Fudan university affiliated cancer hospital shao zhimin hu xichun zheng yingliu guangyu ke da zhang jian
October is breast cancer prevention month,also known as pink ribbon month.The pink ribbon is a recognized symbol of the global campaign to prevent and treat breast cancer.Pink ribbon,an interpretation of breasts,love and beauty,and the temperature of life.This issue,fudan university affiliated cancer hospital expert team to explain the topic of breast cancer.
Breast cancer has become the most common malignant tumor among Chinese women.According to the latest national cancer statistics,in 2014,the number of new cases of breast cancer nationwide was nearly 280,000,accounting for 16.51%of the incidence of all malignant tumors in women,ranking first.
In 2018,the lancet research report on the trend of global cancer survival rate monitoring from 2000 to 2014 showed that the 5-year survival rate of breast cancer patients in China increased from 75.9%in 2000 to 2004 to 83.2%in 2010 to 2014,close to the treatment level of developed countries.For patients with early breast cancer,the 5-year survival rate after treatment exceeds 90%;The 5-year survival rate for patients diagnosed as advanced stage was only 30%.With the phenomenon of high incidence of breast cancer,the treatment of breast cancer not only pays attention to the curative effect,but also pays more attention to the influence of disease on patients'physical and mental health.
Compared with other cancer types such as liver cancer,breast cancer is not dangerous,and the treatment methods are more diverse,so for patients who cannot be cured in the late stage can gradually achieve survival with tumor,the real"beauty killer"breast cancer as a chronic disease to manage and treat.Patients with advanced breast cancer should strengthen whole-course management mode and maintain effective treatment mode for a long time while living with tumor.Timely change to effective treatment after disease progression,so that patients get the best curative effect.With the diversification of treatment methods for breast cancer,the survival rate of patients has been improved from the simple surgical treatment in the early years to the application of chemotherapy drugs,as well as the later emergence of endocrine therapy and targeted therapy drugs.In addition,in recent years,the concept of individualized treatment and precision medicine has also brought more possibilities for improving the prognosis of breast cancer patients.
Since breast cancer is a chronic disease,comprehensive treatment after surgery is more important.The postoperative pathological indicators of breast cancer are related to the treatment regimen of patients.After surgery,positive HER2 in pathological indicators not only indicates a higher risk of recurrence within 5 years,but also serves as the basis for the decision of biological targeted therapy.Endocrine therapy decisions depend primarily on the detection of estrogen receptors(ER).Each treatment method has corresponding basis and the best plan,according to the doctor's instruction,the active cooperation treatment is the best self-management.In addition,for postoperative follow-up of breast cancer patients,we recommend every 3 months within 2 years after surgery;Inspection every six months for three to five years;After 5 years,annual review can be considered.If there is any maladjustment during follow-up,timely visit the doctor.
Five years after cancer treatment is a high risk period for recurrence.That's why we often measure the effectiveness of a particular cancer treatment by the five-year survival rate.However,breast cancer patients are different.Some breast cancer patients relapse in the following years despite no abnormal findings in follow-up within 5 years after surgery.The reason is that Luminal breast cancer has such biological characteristics.Therefore,the current clinical trial evidence supports the extension of the duration of endocrine therapy from 5 years to 10 years for these patients.Most breast cancers are Luminal type,and these patients are sensitive to endocrine therapy.However,due to the long treatment time,some patients have poor compliance,which brings potential risks for long-term treatment.Therefore,only by popularizing the concept of whole-course management for such patients can long-term therapeutic effects be guaranteed.
A recurrence of breast cancer is not the end of the world
Yao bena,Chen xiaoxu,assange,mention these names,we think of breast cancer this"beauty killer".Early diagnosis(routine physical examination and screening),early treatment and standard treatment are very helpful for the radical treatment of breast cancer.However,over time,patients who had received radical treatment still had 20%to 30%recurrence and metastasis,or the rate of metastatic breast cancer initially reached 3.5%to 7%due to late detection.According to the latest statistics,breast cancer kills nearly 50,000 people every year in China,accounting for 12.2%and 9.6%of the global total,respectively.However,once the recurrence and metastasis of breast cancer is really so terrible?Not really.Breast cancer recurrence and metastasis are not the end of the world.Soong mei-ling,77,was diagnosed with breast cancer,underwent surgery,relapsed and lived to 105,even in the absence of new drugs and other treatments.
There are many factors that lead to recurrence and metastasis after breast cancer surgery.In addition to pathological types,age<35 years old,the number of lymph node metastases,the larger the tumor,the higher the grade,vascular carcinoma thrombus,low expression of hormone receptor,and high expression of HER2(human epidermal growth factor receptor 2)also lead to increased risk of recurrence.Patients can communicate with the competent doctor.Recurrence actually includes local recurrence and distant metastasis.For breast cancer with recurrence and metastasis in local areas that are considered to have a chance of radical retreatment after a comprehensive evaluation by doctors,it is strongly recommended to remove the local recurrence focus.For example,total mastectomy is feasible for patients with recurrence after breast-conserving surgery,and surgical resection is feasible for recurrent nodules on the chest wall.These patients are subsequently recommended to consolidate chemotherapeutic plus or negative targeting therapy(evidence has been shown to improve survival time)and subsequently to the radiotherapy department to assess the need for chest wall and regional lymph node radiotherapy.Patients with distant postoperative metastasis or who are advanced at the time of initial diagnosis should not be overly frightened.At present,drug treatment for metastatic breast cancer is diversified,but how to choose is very important,which needs to be based on evidence of evidence-based medicine and good communication between doctors and patients.
After the recurrence and metastasis of breast cancer,it is not recommended to give up waiting blindly.Instead,aggressive individualized interventions based on supportive care can significantly extend survival.Although breast cancer is A complex disease,it has been fully recognized internationally and classified into four subtypes with different molecular characteristics,such as hormone receptor positive type(A and B),HER2 positive type and tri-negative type.Different subtypes have different therapeutic sensitivities and drug resistance mechanisms.
There are many misunderstandings in the recognition and treatment of breast cancer recurrence and metastasis.These myths affect people's enthusiasm to treat breast cancer.Only correct understanding and scientific treatment,through good and close cooperation between patients,family members and medical staff,can improve the quality of life and survival of patients with recurrent and metastatic breast cancer.Although breast cancer has recurrence and metastasis,multidisciplinary cooperation and individualized treatment are not terrible,let alone the end of the world.
Mammary gland disease diagnosis and treatment mo enters 4 big misunderstanding
Currently,the incidence of breast cancer in China is growing at twice the global average.Breast cancer is a multifactorial disease,not only related to our susceptibility and genes,but also related to our lifestyle.In the process of diagnosis and treatment of mammary gland disease,many people will have cognitive biases.
Myth 1:lobule hyperplasia of mammary gland
It's an early sign of breast cancer
Mammary gland lobule hyperplasia can more and more fierce,although temporarily benign,but inevitable development toward malignant direction,must deal with immediately so,immediate operation.
Analysis:the mammary gland is an endocrine regulatory organ,regulated by estrogen and progesterone.Mammary gland cells sometimes proliferate and sometimes shrink in response to fluctuations in estrogen and progesterone caused by the menstrual cycle.When estrogen levels are high,breast cells swell and grow.When estrogen recedes,gland body contracts flabby,lobular hyperplasia degree and female normal physiology cycle often coincide.Therefore,lobular hyperplasia is only a normal female essential characteristics,is a physiological phenomenon,rather than a pathological phenomenon.From normal lobule hyperplasia arrives breast cancer,intermediate want to experience mild hyperplasia,height hyperplasia,mild atypical hyperplasia and medium severe atypical hyperplasia to wait for a process,the opportunity that this kind worsens ceasely is very low.Therefore,lobular hyperplasia is not necessarily associated with breast cancer.Those who try to treat or remove lobular hyperplasia,the starting point is unreasonable.Because drugs can't treat normal physiology,just like you can't take drugs to make your normal nose or ears disappear.But some breast cancer can be mistaken for lobule hyperplasia,when a certain mammary gland lump is not painful not urticant,also do not appear apparent change along with menstrual cycle,need to look to the hospital at this moment.
Myth 2:breast ultrasound is better than molybdenum target,
Molybdenum target radiation is large
A lot of patients come into the clinic and just ask for a certain test,like a mammogram,and think that mammogram is more accurate than ultrasound;Or insist on only doing ultrasound,that molybdenum target radiation is strong.
Each imaging examination has its own characteristics,advantages and disadvantages.Each has its merits and demerits,so they can't replace each other.Ultrasonic examination of nodules has obvious advantages,especially cystic nodules.Ultrasound can accurately describe the size,boundary,cystic solidity or mixture of nodules.Molybdenum targets have the advantage of looking at calcification foci,especially small calcification foci(which may be a manifestation of very early breast cancer).The molybdenum target is very sensitive,but the B-scan does not show it.Of course,when ultrasound and molybdenum are not clear,magnetic resonance can play.It's more accurate,but it's also more sensitive.This means that sometimes the diagnosis can be overdiagnosed,increasing the patient's unnecessary burden of surgery.However,whether it is molybdenum target,ultrasound,or mri,each has its own blind spot.Some lesions can only be seen under one examination,while others can't be seen at all.Therefore,it is very important to cooperate with each other.
In addition,some people insist that they can only do molybdenum target once a year,or they will overradiate.This is also a misconception.Because once did molybdenum target if do not have a problem,basically ok and safe one year,the disease development is not so rapid.Increasing the number of mammograms does not yield early diagnostic benefits,so conventional wisdom has it that once a year is enough.But this view has been misinterpreted by a lot of people as not being able to do molybdenum targets twice a year.In fact,for some patients with calcification lesions as the main problem,semi-annual observation is also reasonable.
Myth 3:breast cancer patients can't have children.
No more sex
After a lot of people suffer from breast cancer,on the one hand,they may feel inferior to their own body;On the other hand,they will be told that they can no longer live as a couple and have no children.
Analysis:first of all,in the issue of fertility,the currently accepted view is that after a certain period of sufficient and effective treatment,such as two to five years after surgery,fertility can be achieved.Fertility does not cause tumor recurrence and metastasis.Retrospective studies of large samples suggest that the reproductive process itself does not affect the prognosis of breast cancer in patients with both hormone-receptor-positive and hormone-receptor-negative breast cancer.So it's safe to have children after adequate treatment.Of course,when deciding to bear,must undertake endocrine medicine elution first,can bring about fetal malformation otherwise.Secondly,the life of husband and wife will not cause abnormal fluctuations of hormones in the body.A harmonious family life and the life of husband and wife will be more conducive to the physical and psychological rehabilitation of breast cancer patients and their reintegration into the society.
Myth 4:once a gene mutation is found,complete breast resection should be done immediately
With the improvement of gene testing level and the popularization of medical consciousness,gene testing is becoming more and more common.Some women have been diagnosed with breast cancer-related mutations and believe that if the mutation is found,a full mastectomy should be performed as soon as possible.
Analysis:the mutation mentioned in the gene test report should be treated with caution.Genetic variation itself is a very complex and professional problem,including transcoding mutation,insertion/deletion mutation,point mutation,etc.Only those major mutations that affect the function of proteins are pathogenic mutations.Many mutations may cause changes in individual amino acids but do not cause significant changes in protein function.So although there are two words mutation in the report,be sure to consult a professional doctor,see this mutation is clear and harmful after all,or the meaning is not clear.For really harmful mutations,the risk of breast cancer is cumulative.The longer the time is,the older the age is,the higher the cumulative risk is.Therefore,for women with pathogenic gene mutations,preventive resection combined with breast reconstruction can be recommended after pregnancy,childbirth and lactation.Of course,do not need excision necessarily,can choose the close monitoring that gives priority to with mammary gland magnetic resonance,or use chemical medicaments to prevent,reduce the risk of breast cancer.Women with brca1/2 mutations should also be aware of ovaries and fallopian tubes,which are associated with a higher risk of ovarian and fallopian tube cancers.
Multi-weapon joint hunt for early signs of breast cancer
Chinese guidelines recommend breast screening for women over the age of 40.People at high risk for breast cancer(defined as those with a clear genetic predisposition,or a history of atypical hyperplasia or lobular carcinoma in situ,or previous radiation exposure to the chest)may be screened before age 40.Evidence-based medical evidence shows that mammography can reduce the mortality rate of breast cancer in women over 40 years old.Therefore,mammography examination is recommended for women over 40 years old every 1 to 2 years.However,the accuracy of this examination in diagnosis of dense mammary gland under 40 years old is not good.Molybdenum screening is not recommended for women under the age of 40 who have no clear risk factors for breast cancer and no abnormalities found in clinical examination.For women with dense mammary gland or molybdenum target examination indicating bi-rads level 0,b-ultrasound of mammary gland can be combined as a supplement.When b-ultrasonography finds breast space occupying,benign and malignant can be judged by fine needle puncture or hollow needle puncture biopsy of the mass.
Genetic testing for BRCA mutations in high-risk populations is closely associated with breast and ovarian cancer.Carriers of the mutation have a lifetime risk of developing breast cancer two to six times that of normal women.However,the mutation rate of BRCA gene is low in the general population,so large-scale gene screening is of little significance.Clinical recommendations onset age 45 years old or less,has a primary ovarian cancer,fallopian tube carcinoma,medical history,such as breast cancer and primary peritoneal carcinoma has obvious family history(in the family of bilateral primary breast cancer patients,at least two relatives with breast cancer,ovarian cancer,pancreatic cancer or prostate cancer,relatives or a male breast cancer,or relatives with has confirmed that carry the BRCA mutations,etc.)of the patients with BRCA genetic testing.
Regular breast self-examination and self-microscopic pre-examination include visual examination and palpation.The examination time is recommended to be 7~14 days after the end of menstruation.At this time,estrogen in the female body has the least impact on the mammary gland,easy to find lesions.Visual diagnosis should be taken to sit,hands akimao,pay attention to the presence of asymmetry on both sides of the breast,whether the skin convex,broken,color changes,whether the nipple and areola erosion,desquamation and other changes.If discover the breast local asymmetry that appears recently,or the change such as skin sunken,bulgy,redness,swollen,should see a doctor in time.Palpation to adopt the cross-examination method,that is,the left hand to check the right breast,the right hand to check the left breast.Start from the outside of the mammary gland,touch the breast along the same direction(clockwise/counterclockwise)with the abdomen of the three fingers of food,middle finger and ring finger.The intensity is appropriate to touch the mammary gland and cause slight pain.Feel whether there is a lump in the breast and compare the two sides.Palpation should include axillary tail,areola area and accessory breast.If there is a painless mass,seek medical advice immediately.In addition,it is recommended to wear underwear lined with light color at ordinary times,so as to observe whether it is stained with non-emulsion overflow.If unilateral breast spontaneous(non-human extrusion)hemorrhagic,transparent or yellowish discharge occurs,it may indicate the presence of breast ductal lesions,and further examination is recommended to the breast specialist.
Change bad habits breast cancer walks around you
The pathogenesis of breast cancer is a very complex process,which is related to both individual genetic factors and environmental factors.Genetically,if one of your first degree relatives has breast cancer,you double your risk.If more than one first-degree relative has breast cancer,the risk increases threefold to fourfold.People who carry mutations in certain genes,such as BRCA1,BRCA2 and p53,have a higher lifetime risk of developing breast cancer,but those who carry these mutations are rare,accounting for only 2%to 5%of all cases.
Reducing exposure to estrogen and progesterone plays an important role in the development of some breast cancers.Therefore,many hormone-related events in a woman's lifetime are associated with her risk of breast cancer.Early menarche(as early as 12 years old),late menstruation(>55 years old),nonfertility,and first pregnancy(over 30 years old)all increase exposure to estrogen and progesterone and increase the risk of breast cancer.And the age of girl menstruation menarche is affected by nutrition element again,the dietary habit of tall calorific tall protein can make adolescence advance in advance,delay the time of postmenopausal at the same time.Many women use hormone replacement therapy(HRT)to relieve menopausal symptoms during perimenopausal period,but the use of drugs containing estrogen(with or without progesterone)also increases the risk of breast cancer in women,and this risk needs to be understood during the use process.
Maintaining weight there is now established evidence that obesity is an important factor in postmenopausal breast cancer.Body fat directly affects the concentration of insulin,insulin-like growth factor,estrogen,a variety of adipokines and growth factors in the human body,creating a carcinogenic environment,thereby promoting the occurrence of breast cancer.For every 5kg/m2 increase in body mass index(BMI),the risk of breast cancer increases by 12%.Too much body fat can lead to an increased risk of breast cancer,while too little weight can affect normal body function.
Smoking cessation alcohol prohibition alcohol itself is a definite carcinogen.Because alcohol can undertake metabolization inside mammary gland tissue,because this can cause injury to mammary gland tissue,alcohol also can pass level of human body estrogen at the same time,affect lipid metabolization,increase the happening risk of breast cancer.For every 10 grams of alcohol consumed per day,the risk of breast cancer increases by 8 percent.Even an occasional heavy drink can increase the risk of breast cancer.Both tobacco and alcohol are recognized as class 1 carcinogens,which do not have a safe threshold.The best way to prevent cancer is to stop smoking and drinking.
Regular exercise WHO recommends no less than 150 minutes of moderate-intensity exercise or 75 minutes of high-intensity aerobic exercise per week.Exercise is not only good for maintaining a healthy weight,but it can also help prevent cancer.People who exercised regularly had a lower risk of breast cancer than those who did not,and the difference persisted even after adjusting for weight.
Eat a balanced diet rich in non-starchy vegetables(such as leafy greens),fruits and beans.Maintaining a nutritionally balanced diet also contributes to maintaining a healthy weight.Some international studies have suggested that consuming more non-starchy vegetables,carotene-rich foods and calcium-rich foods may reduce the risk of certain types of breast cancer,but these findings need to be verified by further studies.
Regular check-ups while maintaining a healthy lifestyle,it is also essential to develop a good habit of check-ups.After the age of 30,a woman needs to have an annual breast ultrasound examination.After the age of 40,she needs to have a mammogram every 1 to 2 years.Women who have a family history or other high risk factors should start screening 10 years earlier,so that they can be detected at an earlier age.
Eat tonic to want discreet a lot of people always feel to need to complement through health care article,in order to achieve healthy goal,after giving birth to a disease,should complement more.In fact,the use of health care products should be cautious.Most nutrients in the body can be obtained through a balanced diet.Some health care products with unknown ingredients are not only ineffective,but may be harmful.Health care products rich in estrogen,such as bird's nest,are banned for breast cancer patients.If you need to use health care products,you should fully communicate with your doctor and obtain the consent of the medical staff before using them.