Western medical etiology
1. Age between 40 and 59 years old is the high incidence age group of breast cancer in China, accounting for about 75% of all patients.
2. The first menstruation is less than 12 years old and amenorrhea is later than 55 years old.
3. Those who are unmarried, not pregnant or whose first full-term birth is older than 35 years old and have not breast-fed after delivery are over 40 years old. The risk of breast cancer increases gradually with the postponement of the age of first birth, and the total duration of breastfeeding is negatively correlated with the risk of breast cancer.
4. The risk of breast cancer is 2 to 3 times higher than normal if there is a family history of breast cancer.
5.Patients with breast cancer on one side have higher incidence than normal people on the opposite side.
6.Patients with chronic cystic hyperplasia with papillary tumor and active pathological structure may increase the risk of breast cancer.
Those who have a history of multiple X-ray chest fluoroscopy or chest radiography, or those who have received radiation therapy to the breast area, have a higher dose of radiation to the breast, and the ionizing radiation is also related to the development of breast cancer.
8. Those who have suffered from functional uterine bleeding or uterine adenocarcinoma, or those who have used estrogen and contraceptive pills for a long time may increase the risk of breast cancer.
9.Postmenopausal patients who are significantly obese or with diabetes or hypothyroidism are important risk factors for the development of breast cancer.
10. Changes in dietary habits, especially the increase of fatty diet, can change the endocrine environment and strengthen or prolong the stimulation of estrogen on breast epithelial cells, increasing the risk of breast cancer. The relationship between other factors such as alcohol consumption, smoking and application of hair dyes with the development of breast cancer is not yet certain.
TCM etiology It is believed that the etiology of breast rock involves both internal and external causes, while the internal cause is the main one.
1, the internal cold gas, through the deficiency of blood knotting “the source of diseases of the treatise on the origin of the disease・volume 40・stone carbuncle wait” said: “there is down in the breast, its path deficiency, for the wind and cold gas guest, then the blood astringent knot,…… no dog fever, but nodules such as stone.” It means that breast rock also has external pathogenic disease factors “internal cold gas”.
2, the seven emotions of internal injury, liver and spleen are not harmonious “Danxi Xinfa – Volume 5 – breast carbuncle” said: “anger and depression, Xin night accumulation, spleen qi is blocked, liver qi cross-reverse, so it becomes a hidden nucleus, such as a large chess piece, not painful, decades later, the party for the sore trapped, the name is rock”. In the book, “The Surgical Canon: The Twenty-sixth Treatise on Breast Canker”, the cause of breast sores is recognized as “depression and injury to the liver, thought and injury to the spleen, accumulation of thoughts in the heart, and the wish of those who do not get what they want, resulting in gangrene and astringency of the meridians and nuclei.”
Similarly, there is also a record in the Collection of Ulcerology Insights. According to “The Golden Book of Medicine and Surgery: The Essentials of the Heart of Surgery: Breast Rock”, “Breast rock is a hidden pain in the beginning of tuberculosis, and the liver and spleen are both damaged and depressed. All of the above indicate that mastitis is caused by internal injury of the seven emotions, such as liver qi discomfort, liver depression and qi stagnation, depression and injury to the spleen, and deficiency of both liver and spleen. In conclusion, this disease is mainly due to liver stagnation, liver and spleen disharmony, obstruction of the meridians, stagnation of Qi, blood stasis, and stasis of toxins.
According to Chinese medicine, the pathogenesis of breast rocks lies in: deficiency of righteousness, deficiency of the meridians and blood, internal injury of the seven emotions, depression of the liver and spleen, and dysregulation of the flushes and the appetites, resulting in dysfunction of the internal organs and the mammary glands, obstruction of the meridians, stagnation of qi and blood, congestion of phlegm and dampness, and mutual obstruction of phlegm and stagnation of phlegm and toxins in the breasts. 1. Liver and spleen depression, the liver likes to be organized and depressed, such as the seven emotions hurt, the wish is not fulfilled, the liver is not organized, qi is not smooth, qi depression is blood clotting; liver disease and the spleen, the spleen is not healthy, phlegm and dampness within.
Liver and spleen deficiency, meridian obstruction, phlegm and stagnation of each other in the breast and the onset of disease, depression for a long time, and become breast rock. 2. The dysregulation of the punch is the sea of blood, the main twins. When a woman matures, the blood will fill up and inject into the uterus for menstruation; the Ren Vessel has the function of nourishing the twins. Punch pulse belongs to the liver, the liver collects blood, liver blood is sufficient to moisten the internal organs and injection of punch pulse; Ren pulse belongs to the kidney, the kidney collects essence, kidney essence is abundant, heavenly sap to, then the Ren pulse is open and can be pregnant, secrete milk, etc.. When a woman reaches the age of 49, the liver and kidney deficiency, the two chakras begin to decline, the menstruation gradually stop.
Therefore, if the liver qi is stagnant or the liver and kidneys are deficient, then the ramifications of the ramifications are not regulated and the mammary glands and uterus are not nourished.
Chinese medicine diagnosis (a) Chinese medicine classification
1, liver depression and qi stagnation type: see breast lumps, hard texture, unchanging skin color; emotional and moral disorders, distress and distension, chest tightness and distension, premenstrual breast distension, dark tongue with yellow coating, string or thin pulse.
2, spleen deficiency phlegm-damp type: breast lumps, hard and uneven texture, axillary nuclei, withered face, fatigue, chest tightness and distension, loose stools, light tongue with teeth marks, white greasy moss, smooth and thin pulse.
3.Dysregulation of the flush: see menstrual disorders, premenstrual breast pain, unmarried at an older age or after marriage without childbirth or too many children, or multiple miscarriages, or after childbirth without breastfeeding, hard breast lumps, light tongue with thin coating, thin pulse.
4, internal obstruction of stasis type: lump in the breast, hard texture, burning pain, purple complexion, unclear boundaries, pushing, or lump broken, seepage of blood or yellow water, smell pain; boredom and irritability, headache and poor sleep, dry mouth and drink, dry stool and yellow urine, purple tongue, or petechiae, yellow thick and dry moss, sunken and astringent pulse or strings.
5.Qi and blood deficiency type: lump in the breast, uneven height, like a pile of corn, first rotten and then ulcerated, sewage when Jin, bleeding is smelly, pale face, dizziness, eyes string, short heartbeat, weak back and legs, sweating and poor sleep, loose urine and stool, pale tongue with white fur, sunken and thin pulse.
Western medicine diagnosis based on
1, medical history detailed inquiry breast lumps, pain, nipple overflow, erosion and other symptoms of the date of discovery, side, location, size, nature, development rate, and the relationship with the menstrual cycle or pregnancy or breastfeeding; to understand the previous breast inflammation, trauma, benign and malignant tumors or proliferative diseases; menstruation, marriage, breastfeeding, childbirth history and immediate family history of malignant tumors; these are helpful for diagnosis.
2.Physical examination of the whole body to understand the general condition and functional status of heart, lung, liver, kidney and nervous system. Local examination includes breast and regional lymph nodes. First, observe whether both breasts are located in the same plane and whether the diseased breast is elevated. Next, the skin lesions of the nipples, nipple retraction, inflammatory breast skin manifestations such as cellulite edema, skin ulcers and satellite nodules are observed.
Finally, check whether there is nipple overflow and areola. If breast tumor is found, clarify the size, location, number, shape, texture, boundary, envelope, activity, adhesion with skin, chest muscle and chest wall. The lymph nodes in the axilla and supraclavicular lymph nodes can often be palpated, and the size, number, mutual adhesion, hardness, activity, adhesion with skin and deep tissue should be understood.
3.Biopsy is the most reliable method to confirm the diagnosis of the disease.
4.X-ray examination.
5.Thermogram examination.
6.Ultrasonic imaging examination and CT and MRI examination.
7.Laboratory examination. In recent years, several methods are mostly used for joint examination and the results are used as reference for each other. It is reported that the compliance rate of joint diagnosis of breast cancer can reach 92.6%.
Physical signs
(Breast lumps are the first symptom of breast cancer patients, accounting for more than 80% of the total number of consultations. They are mostly painless and are usually found in the upper part of the outer breast, accounting for 36.1%, followed by the nipple, areola and supra-internal area; most of them are single, occasionally more than two, mostly irregularly spherical, hemispherical or nodular masses with uneven surface, unclear borders, hard and tough, resembling stones or soft rubber. The masses are hard and tough, resembling stones or soft rubber, poorly mobile, or fixed and cannot be pushed. There are also softer masses with cystic sensation. In the later stages, satellite nodules and ulcers may appear, which are sometimes difficult to distinguish from benign tumors in the early stages.
(B) Nipple and areola abnormalities
When the lesion invades the nipple or the subareolar area, the fibrous tissue and duct system of the breast may shorten due to tumor invasion, pulling the nipple and making the nipple deviate to the side of the tumor, and further development may cause the nipple to flatten, retract and sink until it completely shrinks into the subareolar area, and even deform the areola. It is a sign of advanced cancer that the tumor is deep inside the breast and invades widely, causing the large duct to harden and convulse, resulting in fixed nipple.
2. Nipple alteration is a sign of Paget’s disease as itching, desquamation, erosion, ulceration, crusting, accompanied by burning pain, resulting in nipple alteration.
Overflow breast cancer with nipple overflow accounts for more than 5% of cases, which can be milk-like, watery, plasma-like, bloody or blood-purulent, the amount can be more or less, and the interval is not consistent. Nipple overflow is rarely seen alone, and is mostly accompanied by breast lumps; if there is only overflow but no lumps are found, it is mostly early intraductal cancer or large intraductal papilloma or cystic hyperplasia of the breast.
(C) Breast contour and skin changes Abnormalities or defects in the complete curved contour of the breast suggest that the tumor invades the skin of Copper’s fascia. The skin changes are related to the depth and degree of invasion of the tumor in the breast. If the tumor invades a large area and is superficial, it may adhere to the skin even in the early stage, making the skin sunken, which is called “dimple sign”.
When cancer cells block the subcutaneous lymphatic vessels and cause lymphedema, many depressions appear at each hair follicle due to the pulling of the skin by the suspensory ligament, forming an “orange peel-like” appearance, which is a more advanced sign. Longer and larger breast cancers may cause skin ulcers, where the cancerous tissue breaks down and forms cavities with foul-smelling discharge. Inflammatory breast cancer has an inflammatory skin appearance and is accompanied by skin edema.
(IV) Pain About 1/3 of the patients complained of different degrees of hidden pain, dull pain, pulling pain or stabbing pain in the affected breast, paroxysmal or continuous; sometimes there is pulling pain and heavy discomfort in the upper arm and shoulder of the affected side. Few patients come to the clinic because of severe pain.
(E) The corresponding symptoms of distant metastasis of tumor
1.Lung metastasis invading trachea and pleura may cause cough and chest pain, etc. Cancerous lymphangitis may cause dyspnea, cough with sputum, cyanosis and chest pain, etc.
2.Pleural metastasis is hemorrhagic pleural effusion, common chest pain, shortness of breath and cough, etc.
Bone metastases are most frequent in the thoracic and lumbar spine and pelvis, followed by the ribs and femur, and the patient will have persistent pain, which will increase progressively.
4. Liver metastases may initially cause weakness and loss of appetite, and later they often cause abdominal distension and pain. 5. Brain metastases are often multifocal and cause cerebral edema resulting in increased cranial pressure; headache, vomiting, visual impairment, convulsions, and even coma.
(6) Signs of breast cancer metastasis Through lymphatic tract metastasis, enlarged lymph nodes can be palpated in the axilla, which are hard and tough and often fixed; enlarged and hard lymph nodes can also be palpated behind and above the affected medial clavicle, and the diameter of the involved lymph nodes is mostly less than 1 cm. If the cancer cells block the main lymphatic vessels or axillary veins in the axilla, it will cause waxy white edema or cyanotic edema in the affected arm.
Occasionally, there are enlarged axillary or supraclavicular lymph nodes on the opposite side, breast lumps on the opposite side, and enlarged cervical or inguinal lymph nodes on the same side. Metastases to distant organs via blood circulation may present with corresponding signs, such as pleural effusion, hepatomegaly with palpable nodules of various sizes; neurological abnormalities.
Diagnostic imaging
(A) X-ray examination of bilateral breast is a common diagnostic method for breast cancer, which is divided into dry plate radiography and aluminum target radiography. 85% of breast cancers show an irregularly bounded lump or nodule with high density and burr at the edge, which is called a dominant lesion when the burr is longer than the diameter of the lesion.
In 30% to 50% of breast cancers, calcified dots are visible in the film, with very small particles and inconsistent density, in the form of dots, small branches or mud; when the calcified dots are clustered and concentrated in the lcm range, or when there are more than 10 calcified dots, the possibility of malignancy is high. Other signs such as ductal shadow hyperplasia, ductal distortion, and skin thickening changes are often indirect signs.
(B) Thermal image examination has two methods: liquid crystal and far infrared thermal image, which are used to show the thermal area at the site of the mass because the tumor cells metabolize quickly and produce higher heat without glycolysis than the surrounding tissues. However, the detection rate of smaller tumors is low.
(c) Near-infrared scan facilitates the infrared light to show various gray shades through different density tissues of the breast, thus showing the breast lump and at the same time clearly showing the breast blood vessels.
(d) Ultrasonography is mainly used to identify whether the lump is cystic or solid, and its correct rate of breast cancer diagnosis is 80%-85%.
(e) CT and MRI are used as a supplement to mammography for pre-biopsy localization of breast lesions that cannot be reached, and to check whether there are enlarged lymph nodes in the posterior region of the breast, the axilla and the internal breast.
Identification of TCM types of evidence
Breast fetish: Mostly seen in women aged 20 to 40 years old, breast lumps of different shapes and sizes, with tenderness, unclear borders, non-adherent to surrounding tissues, premenstrual breast swelling and pain, alleviated after menstruation, molybdenum palladium x-ray and lump biopsy can help identify.
2, epistaxis: the main symptom is repeated overflow of bloody fluid from the breast orifice, with a lump in the areola, soft and painless, and the lump is visible in the breast ducts on mammography.
3. Nucleus pulposus: Mostly seen in women around 20 years old, the disease progresses slowly, the lump is round or ovoid, with smooth surface, hard texture, clear border, large mobility, and no pain.
4.Pink canker sores: Mostly seen in non-lactating women aged 20-40 years old, mostly with pre-existing large nipple depression or short deformity, often with pink slag-like discharge from the nipple, with acute onset, red, swollen and painful nodules next to the areola, festering pus with foul odor, and no closure for a long time.
5, breast consumption: mostly secondary to consumption, scrofula, mostly seen in women aged 20 to 40 years, breast lumps shaped like plum, no pain or hidden pain, slow progression of the disease, unclear borders of the lump, hard texture, adhesion with the skin, the formation of cold pus ulcers over time, pus with septic-like material, pus smear and histopathological examination can help identify.
Biological immunotherapy
It is currently in clinical trial stage and has certain therapeutic effect, but its clinical efficacy is limited. Commonly used are interferon, anti-breast cancer RNA, Paulkia, LAK cells, interleukin-2, tumor necrosis factor, etc.
Prevention Active propaganda and education to popularize the knowledge of breast cancer prevention and the self-breast examination method for women, as well as early detection of tumors. Regular scheduled screening of breast cancer susceptible people is the key to early detection.
Vulnerable groups.
①Previous history of breast hyperplasia, breast fibroids, nipple overflow.
②Family history of breast cancer.
③Menarche <12 years old, menopause >50 years old, or menstruation period more than 36 years.
④Age 30 years or older unmarried or late married, or women of advanced age who have not given birth or breast-feeding after marriage.
⑤ Receiving multiple x-ray examinations during puberty.
⑥Obesity in adolescence or after menopause.
(7) Women who are introverted, depressed, or have experienced strong mental stimulation.
Measures to prevent the occurrence of breast cancer.
① Moderate the intake of fat and animal protein before puberty and increase physical activity.
②Rational childbirth, marriage at the right age and encourage breastfeeding.
③ Avoid estrogen during menopause, control calorie intake and reduce fat accumulation.
④Less or no alcohol, more fresh vegetables, fruits and mushroom and bean foods, and appropriate amount of royal jelly products.
⑤ Avoid unnecessary chest X-rays during puberty.