In recent years, the incidence of young breast cancer patients has shown a significant increase worldwide. In the United States, about 11% of breast cancer patients are 35-45 years old, while the rate of young breast cancer patients in Asian population is significantly higher than that in the West, accounting for 9.5%-12% of all breast cancer patients in Asia. In 2008, the proportion of breast cancer patients younger than 40 years old accounted for 12.56% of all breast cancer cases in China. According to the Shanghai Center for Disease Control, between 1990 and 2007, the proportion of breast cancer patients younger than 40 years of age in Shanghai accounted for 10-20% of all breast cancer cases in the city. Currently, the poor prognosis of young breast cancer patients is receiving more and more attention from the international academic community.
Treatment】
Myth 1: The larger the scope of surgery, the better
This concept is more deeply rooted in some older patients. However, with the development of modern medicine, people gradually have a more correct understanding of this, but still do not exclude some patients just can not break through the psychological barrier, for the surgery always hope to do the larger the more at ease. In fact, breast-conserving surgery has been performed worldwide for decades, and was only introduced to China in the 1990s. Although the risk of recurrence of breast-conserving surgery is high compared to total mastectomy, with radiotherapy, the risk of recurrence can be reduced to about 10%, while even with total mastectomy, it is impossible to achieve the goal of curing breast cancer, and the recurrence rate may still be 2-5%.
For improving the survival rate of patients, local recurrence is not terrible, but effective prevention of distant metastasis is the key. It is important to emphasize that this is not necessarily related to breast conservation or total excision, but is mainly determined by the type of tumor the patient has. Modern medicine has been able to subdivide the tumor types of patients, and doctors will provide comprehensive treatment for different types of tumors according to the tumor staging report. Therefore, breast-conserving surgery itself will not cause substantial impact on the ultimate survival rate of patients, but can enhance patients’ self-confidence and better participate in social life; on the contrary, some patients with total excision tend to think that the surgery has been done cleanly, and neglect the follow-up systemic treatment.
Misconception 2: A thousand surgeries are supreme
Although surgery plays a very important role in the treatment of breast cancer, it is very difficult to cure the disease by surgery alone. Breast cancer is a systemic disease and cancer cells will metastasize through bloodstream. Surgery is only the removal of localized lesions, and systemic treatments such as chemotherapy, endocrine therapy or targeted therapy are necessary to ensure the possibility of obtaining a cure. Statistics show that breast-conserving patients have a better prognosis than total excision. Of course, this is partly due to the fact that breast-conserving patients tend to have smaller masses, but also because some patients with total excision believe that they have already cut the lesion cleanly and there is no need for follow-up treatment, while breast-conserving patients are more active in cooperating with complete treatment. Therefore, it is more important for patients with total excision to establish the concept of actively cooperating with complete treatment in order to obtain better treatment results.
In addition, there are different types of breast cancer, and the analogy is that there are those with low IQ and those with high IQ. For example, although some lumps seem to be very large, but the proliferation rate is not fast, even if distant metastases occur, their malignancy is not high, chemotherapy is not effective for them, but endocrine therapy can achieve very good results, they are low IQ, we call it cavity surface type A; while some types can not be completely controlled by endocrine drugs alone, but need chemotherapy, radiotherapy, targeted therapy and other means. Combined, to achieve better treatment results, we call them high IQ.
Myth 3: Chemotherapy blindly seeks small
For chemotherapy, patients are often afraid of its side effects, hoping that the shorter the course of treatment the better, the smaller the dose the better. However, in order to get the desired effect of chemotherapy, the course of treatment and dose must meet certain requirements. Of course, doctors will also carry out chemotherapy under the premise of ensuring safety according to the patient’s physical ability to tolerate it.
In fact, chemotherapy itself does not exist between large and small, but only according to the cell growth characteristics, different drug properties, through a certain rhythm of drug administration, to achieve better tumor killing effect. Weekly unit chemotherapy is actually a course of treatment based on three weeks. Therefore, the so-called major and minor chemotherapy is just an agreed statement given by people according to the time of drug administration.
Myth No. 4: Endocrine therapy is not taken seriously
Due to the long-term nature of endocrine therapy and the problem of tolerating side effects, some patients are unable to adhere to it for a long time, or they cannot take the medication regularly, or they discount the medication, which are very dangerous practices.
For estrogen receptor positive breast cancer patients, endocrine therapy is a very important and effective way to control the disease. Because estrogen is necessary for the growth of these cancer cells, if estrogen is controlled, the cancer cells are “cut off” from food. Therefore, long-term drug use can prevent cancer cells from obtaining a suitable environment for growth, and although they cannot be killed by chemotherapy drugs for the time being, they can be kept dormant for a long time. Moreover, the time and method of using endocrine therapy are still being explored in the academic field, and it is even possible to require lifelong medication in order to achieve better treatment effect. However, if the medication is not taken according to the standard, it may allow the cancer cells to gain “nutrients”, thus exposing the patient to the risk of recurrence and metastasis. Statistics show that although the overall rate of recurrence and metastasis of this type of breast cancer is not high, the risk does not decrease over time, so it is especially critical to adhere to long-term standardized medication to control cancer cells.
In addition, for patients who do not need endocrine therapy, such as those with triple negative breast cancer, there is no need to be anxious and feel that they are drug-free. It should be said that this type is not drugless, but does not require endocrine therapy. Because for some patients, surgery, chemotherapy and radiotherapy are all very effective treatments in themselves. Moreover, compared with the type of endocrine therapy with long-term risk of recurrence, the risk of possible subsequent recurrence and metastasis decreases dramatically as long as the first three years can be passed peacefully.
Myth 5: Exaggerating the side effects of endocrine therapy
Endocrine therapy is actually a therapy to control hormones in the body, with the aim of preventing cancer cells from obtaining estrogen. However, while this treatment prevents cancer cells from getting estrogen, the estrogen needed by other normal parts of the body is also suppressed, so a series of reactions such as hot flashes, heartburn, insomnia, etc. will occur, and these reactions are all caused by one reason, namely the fading of estrogen, which is actually the menopausal reaction. If the side effects are very intolerable, you may consider consulting a gynecologist and using some of the medications used to treat menopausal syndrome for improvement.
In addition, for endometrial thickening brought about by triamcinolone acetonide, for premenopausal women, along with the menstrual cycle, the endometrium will have a gradual process of thickening and shedding automatically after the end of menstruation, and regular ultrasound examination, from experience, less than 19 mm is currently safe. For postmenopausal women, if endometrial thickening occurs, they need to be alerted and may consider switching to aromatase inhibitors. If irregular vaginal bleeding occurs then prompt medical attention is needed.
The risk of osteoporosis increases with aromatase inhibitors, so postmenopausal women are advised to take calcium supplements and, if necessary, to intervene with bisphosphonates (zoledronic acid). For premenopausal women on pharmacological depot therapy with norethindrone or inhibition, they also require semi-annual to annual bone density monitoring, in conjunction with zoledronic acid therapy as appropriate. Patients are advised to maintain a moderate intensity of exercise and appropriate sun exposure, which will also help in the prevention of osteoporosis.
Myth 6: Over-reliance on non-conventional treatment
Our attitude toward unconventional treatment is that we are not against moderate acceptance of unconventional treatment under the premise of ensuring conventional treatment, but we should treat it rationally and choose it carefully to be careful of being deceived. The so-called unconventional treatment refers to the treatment other than surgery, chemotherapy, radiotherapy, endocrine therapy and targeted therapy.
At present, the most used unconventional treatment is traditional Chinese medicine. The role of Chinese medicine in breast cancer treatment is to increase the resistance, not to fight against tumor. It is not uncommon to see liver and kidney damage caused by the use of herbal medicines, therefore, caution must be exercised. In addition, some so-called anti-cancer miracle drugs with the signboard of Chinese medicine and high price are all fraudulent, including ganoderma spore powder, which has no data to prove its efficacy in fighting tumors.
For some foreign so-called new treatments and new drugs for some relatively advanced patients, if there are conditions to try, it is the last resort. However, it should be reminded that the efficacy of those drugs often lacks clear data support and the risk itself is great.
Therefore, the expensive price does not mean it is necessarily good or effective. One of Liu Guangyu’s patients with bone metastases has been taking triamcinolone acetonide for 4 years and is very well controlled for as little as two dozen dollars a month. Therefore, he advises people not to spend money indiscriminately and use it where it should be used, such as Herceptin.
Recovery]
Myth 1: Talking about cancer
Breast cancer is one of the cancers with the best prognosis and can have a cure rate of about 70%. Therefore, doctors do not want people to be worried, suspicious and depressed all day long because of the other 30%. The most common manifestation is running to the hospital for three days after the treatment is finished.
Misconception 2: Emphasis on treatment rather than review or over-examination Never think that everything is fine once treatment is over
Breast cancer has long-term risk of recurrence and metastasis, so patients need to insist on long-term regular review. The frequency of review can be higher within three years, and after three years, it should be done once a year. Of course, there is another phenomenon of over-checking, always worrying about whether they have metastasized. In fact, even if the frequency of checkups is increased, it will not help the survival rate. Doctors have done a ten-year comparison and follow-up statistics and found that there is no difference in the survival rate between once every three months and once a year.
In addition, regarding tumor markers, because there are more factors that may affect it, it does not achieve early diagnosis of recurrence and metastasis. Therefore, for early stage patients without metastasis, it is not recommended to check this index, which may easily add worries.
Myth 3: Dietary contraindications
So far, there is no evidence to prove that a certain type of food is related to the recurrence or metastasis of breast cancer, such as seafood, chicken, eggs, milk, soy products and so on, which are all folk rumors. In fact, seafood is relatively safer than river farmed ones, and soy products are phytoestrogens, which can alleviate the side effects of endocrine therapy to some extent, and are very good foods. Therefore, the key to diet is to pay attention to a balanced diet, nutritionally balanced and as diverse as possible.
Misconception 4: Fear of conjugal intercourse
Normal conjugal life is not only harmless but also beneficial to patients’ recovery, and can enhance the relationship between husband and wife. Young patients are perfectly capable of having children under the guidance of their doctors. At present, Liu Guangyu collects photos of his patients having babies after treatment and has more than ten of them, which he is going to make into an album as a memento after retirement.
Myth 5: Avoiding social activities
Don’t avoid social activities, return to the physical and mental state before the disease as much as possible, and actively participate in social activities is an important performance of breast cancer recovery. It is also a good way to communicate more with your friends. Staying at home with nothing to do is easy to think, which is not conducive to recovery. I hope you will understand that the purpose of seeing a doctor is to have a better life, not to lie at home all day long.