The incidence of breast cancer is increasing year by year and has become a major disease that endangers women’s health. Early prevention, early detection and early standardized treatment are the keys to breast cancer prevention and treatment. The following are some of the issues that need to be taken into account in the prevention and treatment of breast cancer.
I. Prevention strategies before breast cancer occurs
The correct prevention and treatment strategy in the pre-cancerous stage is to avoid and reduce the influence of environmental carcinogenic factors as much as possible, to assess the risk of individual breast cancer and then take targeted measures, and to provide active preventive treatment for high-risk groups or pre-cancerous diseases, with the ultimate goal of minimizing the occurrence of breast cancer and facilitating early detection even if breast cancer occurs.
1. How to prevent the occurrence of breast cancer
Prevention of breast cancer in terms of its etiology is still a worldwide challenge. Despite this, some encouraging progress has been made in recent years in the prevention of breast cancer by drugs. The results of the US NSABP P-1 chemoprevention clinical trial showed that the oral estrogen receptor modulator tamoxifen (20 mg daily for 5 years) reduced the risk of breast cancer by 50% in high-risk groups, but also had side effects such as blood clots and increased risk of endometrial cancer. Subsequent studies have shown similar preventive effects with fewer side effects for postmenopausal women at high risk with ranolifene (NSABP P-2) and the aromatase inhibitor anastrozole (IBIS-2). For a high-risk individual, the medication should be used under the strict guidance of a physician, and the decision of chemoprevention in a high-risk group should be made with careful consideration of the risk assessment of breast cancer, the possible benefits and side effects of the medication.
Medical studies have found that extracts of some foods and vegetables have a protective effect on normal cells and are beneficial in the prevention of breast cancer. Although most of these findings are still in the laboratory stage and lack the support of prospective clinical trials, they are still of interest due to the absence of side effects. Foods with clear cancer prevention effects include reishi, garlic, green tea, cruciferous vegetables (such as broccoli), mushrooms, black fungus, nuts, and deep-sea fish.
Estrogen has been shown to be a specific promoter in the development of breast cancer. In terms of prevention for women at risk, the use of estrogen-containing cosmetics, health products, and foods such as royal jelly, high-fat and high-protein diets, fried foods, and fish and poultry fed with estrogen (e.g., turtle) should be minimized. The preventive effect of soy milk and phytoestrogens soy isoflavones on breast cancer is controversial. Most opinions believe that isoflavones antagonize estrogen by competing for receptors, which has a protective effect on the breast; however, some studies have found that low concentrations of isoflavones promote the growth of breast tumors. My opinion is that until authoritative conclusions are available, breast cancer patients and those at high risk for breast cancer should not consume too much soy foods in their diet, and supplementation with the phytoestrogen soy isoflavones is not recommended.
As with the development of other malignant tumors, breast cancer begins with a mutation or cluster of normal cells moving toward cancer and has been shown to be associated with physical (e.g., radiation), chemical, and genetic factors. It is an undisputed fact that environmental pollution leads to higher cancer incidence. Therefore it is extremely important to care about your work, life, living environment and diet and water. You should stay in fresh air, avoid newly renovated houses for a while, eat less pickled products, food with too many chemical additives, avoid moldy food, and drink clean water.
Besides defending against foreign germs, the immune system of the body also plays the role of immune surveillance against the cancer of its own cells. Under normal circumstances, the body relies on the complete immune mechanism to effectively monitor and reject cancerous cells, so most individuals do not develop tumors. However, if the immune system is damaged for some reasons, the immune function is reduced and the “monitoring” of tumor cells fails, the occurrence of tumor is inevitable. Therefore, to improve the immunity of human body becomes an important way to prevent tumor. It is important to pay attention to physical exercise, develop healthy habits, and avoid factors that cause immunity decline such as poor nutrition, long-term overwork, mental depression or mental stress.
2. Breast cancer risk assessment
Breast cancer risk assessment is a comprehensive evaluation of an adult woman’s risk of developing breast cancer in the future. The purpose is to screen out women at high risk and take targeted measures to facilitate early detection of breast cancer and provide a basis for chemoprevention in high-risk groups. Individual risk assessment of breast cancer is based on a combination of epidemiological and pathological risk factors, and some promising biomarkers are still in the research stage.
In the United States, there is Gail model to predict the risk of breast cancer in the next 5, 10 and 20 years (interested parties can visit http://www.cancer.gov/bcrisktool/ and enter their own data by article to get an analysis report, which is suitable for westerners for reference only), but there is no unified assessment model in China yet. Risk factors and breast pathology risk factors can be used to assess a woman’s risk of developing breast cancer, and patients are classified into different risk classes according to the assessment.
Epidemiological factors include primary risk factors: age 40-55 years, family history of breast cancer in the direct blood line, mental depression, dense breasts (3-5 times relative risk) and secondary risk factors: history of breast biopsy, estrogen replacement during menopause, prolonged estrogen exposure, obesity, late childbearing without breastfeeding (1-3 times relative risk). Pathological risk factors include high-risk pathological factors: ductal or lobular carcinoma in situ (8-10 times relative risk); intermediate pathological risk factors: atypical hyperplasia of lobular or ductal epithelium, papillomatosis (4-5 times relative risk); and low-risk factors: simple hyperplasia of the breast, adenopathy, etc. (1.5-2 times relative risk).
It should be noted that having high-risk factors does not mean that you will definitely get breast cancer, but only an increase in relative risk. As long as you can actively perform regular imaging examinations, even if you get breast cancer in the future, you can still be detected early and have a chance to be cured.
3. Active surgical management of pre-cancerous breast lesions
Some benign breast tumors such as fibroadenoma and parametrium have a low chance of becoming cancerous, but the tumors may be very large and affect the beauty, so it is also advisable to remove them. Many women miss the opportunity to get rid of the lesions before cancer because they are worried about leaving unsightly scars on their breasts.
Breast lesions requiring surgical management should include the following features: clear localized lesions; imaging changes such as irregular borders, blood flow signal, calcification, MRI enhanced scan showing enhanced lesion signal, etc.; puncture biopsy pathology for precancerous lesions: ductal or lobular epithelial atypical hyperplasia, papillomatosis.
Minimally invasive breast surgery techniques have made some progress in recent years, and it has become possible to treat both disease and aesthetics. Minimally invasive breast surgery techniques currently used in clinical practice include: cosmetic minimally invasive excision with hidden incision, radiofrequency ablation, ultrasound focused knife (HIFU), McMurdo vacuum suction biopsy system, lumpectomy, etc. Each technique has its own advantages and disadvantages and should be chosen reasonably according to the condition.
For example, ultrasound focused knife (HIFU) inactivates the skin of lesions in the breast without leaving any incision, but it also has the disadvantages of high cost, needing general anesthesia and tumor remaining in the body; McMurdo rotary biopsy system emphasizes biopsy rather than complete removal of lesions; using hidden incisions such as circumareolar and combined with cosmetic surgery is the easiest and cheapest method to ensure complete removal of lesions, which is worthy of It is worth to promote the application. Based on our experience in applying different minimally invasive methods, we should choose the appropriate minimally invasive treatment method according to the specific condition, size and location of the lesion and the patient’s needs, instead of following them blindly.
4. Correct understanding and treatment of breast enlargement
”Mastocytosis is a common disease that affects women. It is necessary to know the following about mastocytosis.
More than 70% of mammary gland hyperplasia has more than three pathological components, the main components are ductal epithelial hyperplasia, cyst formation, lobular hyperplasia, sweat gland hyperplasia, etc. Some of these lesions such as lobular or ductal epithelial atypical hyperplasia, papillomatosis, etc. are precancerous, and their incidence accounts for about 4-5% of mammary gland hyperplasia.
2.Does breast enlargement necessarily lead to breast cancer? The answer is no. The relationship between mammary gland hyperplasia and breast cancer has been studied extensively. For example, the risk of breast cancer increases only slightly with simple hyperplasia, but increases 5 times with atypical hyperplasia, and 11 times with a family history of breast cancer and atypical hyperplasia. For different mammary hyperplasia lesions, it is necessary to take targeted periodic imaging examinations.
3. Do all mastocytosis have to be treated? The answer is also no. Many women suffer from physiological mastocytosis, which is mainly manifested by periodic premenstrual swelling and pain, and no abnormalities in breast imaging, which generally does not require treatment. Pathological breast hyperplasia should be treated reasonably by a specialist based on the degree of hyperplasia, assessment of risk factors, imaging examinations and clear pathological diagnosis from biopsy.
4. Breast puncture biopsy is an important method to finally determine the tissue type of breast disease and correctly guide the subsequent diagnosis and treatment. Some people worry that puncture may cause the spread of breast cancer, but so far, no clinical study has found that puncture biopsy is related to cancer metastasis and affects survival rate, so the worry about puncture biopsy is unnecessary. Therefore, it is not necessary to worry about puncture biopsy. The decision of whether a puncture biopsy is needed for breast enlargement should be made by a specialist according to the condition and whether there are abnormalities in the imaging examination.
How to detect breast cancer in early stage
Most early breast cancers can be completely cured, so early detection becomes the key to breast cancer prevention and treatment. Measures for early detection of breast cancer include: regular breast imaging, screening, self-examination and suspicious lesion puncture biopsy.
For breast cancer that has already occurred, breast imaging is the main measure for early detection. It is important to detect malignant lesions that cannot be felt as masses and to distinguish benign lesions such as mammary hyperplasia nodules from breast cancer. Color Doppler ultrasound and mammography are the most commonly used and valuable diagnostic imaging methods, with sensitivity and diagnostic compliance rate above 85%, and combined examination can improve the diagnostic rate; MRI and PET-CT have higher sensitivity and specificity, but are expensive and can be used as follow-up means for difficult cases. Near-infrared ray etc. has low detection rate for early cancer, and can be used as differential diagnosis of masses. Mammography and CT have slight radiation damage, so short-term repeated examinations should be done with caution.
According to the age distribution of breast cancer incidence in Chinese (the peak age group is 40-55 years old), women over 30 years old should receive breast screening at least once a year. The methods of screening are not uniform in China, and the methods of examination vary greatly. Many people attend simple physical examinations organized by units every year, which do not help to detect breast cancer at an early stage. It should be reminded that simple physical examination and transillumination techniques such as near infrared light are of little significance in detecting early cancer. A meaningful breast screening should include at least ultrasound or mammography.
Although some prospective studies have not found any association between breast self-examination and improved survival rate, breast self-examination is still worth advocating in China, as reasonable breast self-examination can enable tumors to be detected at a “smaller” stage. We suggest that women should first familiarize themselves with their breasts and pay attention to any local abnormal changes in the near future, such as thickening and hardening of local glands or suspicious swelling, especially if there is no sign of remission after menstruation. Many women go to the doctor only because of breast pain, but ignore the more important manifestations of breast cancer: breast swelling, nipple indentation and bloody overflow, orange peel-like skin changes, and enlarged axillary lymph nodes.
The final diagnosis of breast cancer must be confirmed by cytological or histological pathological diagnosis, therefore, puncture biopsy or surgical biopsy must be performed for lesions considered as breast cancer, which is the prerequisite for a clear diagnosis and all treatments for breast cancer. Whether to choose fine needle, coarse needle aspiration biopsy or surgical biopsy should be decided by the specialist according to the condition.
Standardized treatment of breast cancer
In recent years, with the impetus of evidence-based medicine and new treatment technologies, a series of remarkable progresses have been made in the comprehensive treatment of breast cancer, and the survival rate and quality of life of breast cancer patients have been significantly improved. It has become a consensus to pursue both curative efficacy and to consider reducing unnecessary side effects. Different stages of breast cancer have completely different treatment strategies. For a patient, a standardized and individualized comprehensive treatment plan starting from the first day of detection of a breast mass is the guarantee of the best outcome. New advances and techniques in breast cancer treatment include neoadjuvant chemotherapy, breast-conserving surgery, sentinel lymph node biopsy to decide whether to perform axillary dissection with more complications, targeted therapy according to the different expression of tumor biomarkers, endocrine therapy, and breast reconstruction to pursue a higher quality of survival with guaranteed efficacy.
It is important to note that inappropriate treatment, especially when a breast tumor is first detected, may cost the patient many opportunities. A breast cancer that can be breast-conserving, if the puncture site is far from the breast-conserving incision, will leave the hidden worry of needle tract implantation metastasis, so the subsequent breast-conserving incision design should be considered at the time of puncture; for example, a 4×5 cm malignant tumor, if hastily excised first simply, will lose the opportunity of neoadjuvant chemotherapy (without tumor, it is impossible to evaluate and screen sensitive chemotherapy drugs), and then lose the opportunity of breast-conservation after descending stage; A multicentric lesion with early-stage breast cancer that is treated only with modified radical treatment will lose the opportunity for immediate breast reconstruction. In conclusion, when a suspicious malignant breast mass is detected, one should promptly visit a regular hospital breast specialist for a comprehensive evaluation of the disease and enter into the optimal treatment procedure from the first step of treatment.