The accuracy rate of intraoperative section freezing is only 80-90%, and it cannot be excluded that some patients’ breasts are “mistakenly cut”.
Breast conservation does not depend on the patient’s wish alone. Patients with more than one lump and those who cannot receive radiotherapy after surgery are not suitable for breast conservation.
3 to 5 years after surgery is the peak period of breast cancer recurrence, endocrine therapy should not be “absent”
Ms. Zhang, 38 years old, was lying on the operation bed, feeling apprehensive. Just 15 minutes ago, the doctor cut open her breast and took out the lump and sent it to the pathology department for a biopsy.
Every day in China, thousands of women are put on the operating table for breast cancer and receive their final diagnosis in a pattern that has continued for decades. But today in Europe and the United States, this model of breast cancer diagnosis has long since become a thing of the past.” Because the accuracy of intraoperative section freezing is only 80 to 90 percent, that is, some patients are at risk of having their breasts ‘mistakenly cut’. Therefore, it is better to obtain a definitive pathological diagnosis of whether a lump on the breast is benign or malignant before surgery, rather than waiting until you are on the operating table to biopsy it.”
New practice of coarse needle aspiration instead of intraoperative biopsy
According to current practice in most hospitals in China, a woman with a lump in her breast will be scheduled for surgery and have the lump tissue removed on the operating table and sent for a frozen biopsy. The biopsy results are usually available in half an hour, and if it is malignant, the surgeon will decide whether to remove the entire breast or preserve it based on a preoperative conversation and patient consensus. However, the downside of this practice is that since the patient is already on the operating table and under anesthesia, the doctor cannot communicate with the patient after getting the pathology results, and in order to avoid risks, some patients are clearly not suitable for breast conservation, but because they have already signed the pre-operative consent form, the doctor can only “uphold the original decision”.
Therefore, nowadays, in countries with more advanced medical technology, such as Europe and the United States, it is the practice of doctors to determine the nature of the patient’s tumor through a preoperative biopsy with a coarse needle puncture.” This practice we started in the 1990s and today it is even a procedure that is adopted for every patient.” Professor Ian Grady from the Patient Hospital in Redding, California, USA, describes.
Breast cancer treatment has become increasingly individualized, with very different treatments for malignant and benign tumors, and even though they are both malignant, there are differences in treatment for different molecular staging, different stages of tumors, and even whether the patient is menopausal or not.” This type of puncture biopsy allows doctors and patients to obtain a clear pathological diagnosis before surgery, and then determine the direction of surgery, chemotherapy and endocrine therapy, making it possible for both doctors and patients to take many less detours.”
Many patients worry that needle biopsy may cause cancer cells to spread and metastasize. In this regard, it can be clearly informed that with the improvement of technology, today’s puncture needles have an additional “jacket” outside, and even if cancer cells do fall, they will be caught by the “jacket” and will not increase the risk of metastasis and spread.
New guidelines Breast conservation is not recommended for people under 35 years old who are at high risk of breast cancer
In recent years, breast cancer treatment in China has increasingly emphasized “breast conservation”, which has given many women with breast cancer the illusion that as long as they have early stage breast cancer, their breasts should be preserved.” During my fellowship, I met many patients who asked, ‘Can I save my breast, doctor?'” And what’s more, some patients even use this as a criterion for judging the doctor’s skill.
But in fact, the proportion of breast-conserving surgery for breast cancer in Europe and the United States is decreasing year by year, from 60 to 70 percent to 50 percent now.” This is because they are introducing more impactological evaluations prior to surgery to determine whether a patient is a good candidate for breast-conserving surgery or not. In fact, in some cases patients are not suitable for breast conservation.” For example, there are multicentric lesions, meaning more than one lump. In addition, since breast-conserving patients are treated with radiation therapy after surgery, they are also not eligible for breast conservation if they also have diseases that are not suitable for chemotherapy, such as lupus erythematosus. In addition, if the patient is relatively young, such as only in her 20s, she has a high risk of recurrence for decades to come, and therefore must be carefully evaluated by her physician.
It is understood that breast conservation is not recommended for breast cancer patients under the age of 35 with a high risk of recurrence, according to the latest NCCN guidelines for breast cancer treatment in the United States.
The implantation of a breast implant does not increase the risk of cancer
However, does not the inability of breast conservation mean that patients have to lose their breasts as a valuable female feature from now on? Well, I can tell you responsibly that it does not. Today, in Europe and the United States, doctors prefer to give patients who need it immediate intraoperative breast reconstruction, i.e., breast implants.
”For many Chinese women, the first thing that comes to mind when breast implants are mentioned is carcinogenicity.” In fact, this fear is completely unnecessary, as there have been many international studies showing that implantation of qualified implants does not increase the risk of breast cancer.
Reminder: 3-5 years after surgery, endocrine therapy is indispensable
In addition to surgery, breast cancer patients should also pay attention to endocrine therapy after surgery. Studies have shown that about one-third of patients with estrogen receptor-positive early-stage breast cancer will experience recurrence, with the peak period of recurrence being 3 to 5 years after surgery. Seventy-five percent of these recurrences occur in other organs and tissues and are the leading cause of death in breast cancer patients.
Studies have found that estrogen is the “main culprit” in the development of breast cancer, promoting the growth and spread of tumors. Therefore, reducing or blocking the effect of estrogen on tumors can effectively eliminate tumors and reduce metastasis and recurrence, and the fundamental role of endocrine therapy is to prevent tumor recurrence by reducing estrogen levels or preventing estrogen from stimulating tumor cells in patients with hormone-sensitive breast cancer. Therefore, in the treatment of breast cancer, endocrine therapy should be equal to the traditional treatments such as surgery, radiotherapy and chemotherapy. According to a study presented at the 32nd Annual San Antonio Breast Cancer Symposium, letrozole, a next-generation aromatase inhibitor, significantly improved patients’ disease-free survival over time and significantly reduced the risk of distant disease spread over time compared to conventional aromatase inhibitors.