1.The incidence of breast cancer and the danger
Breast cancer is the first malignant tumor among women in the world today, and the latest data released by the World Health Organization in 2014 shows that in 2012, there were 1.67 million new cases of breast cancer and more than 520,000 deaths from breast cancer worldwide; since 2008, the incidence of breast cancer has increased by more than 20%, and the mortality rate has increased by 14%.
According to the 2013 Annual Report of the Chinese Cancer Registry, one of the major changes in the epidemiology of cancer in China is that the incidence of cancer in women has increased significantly, with breast cancer ranking first among female malignant tumors, with about 210,000 new cases each year, 1-2 percentage points higher than in developed countries. The incidence rate of breast cancer in Shanghai is the highest in China.
2.Favourable factors of breast cancer
There are many factors that affect breast cancer, and they often interact with each other to form tumors under the effect of multiple cancer-causing and cancer-promoting factors. The known factors of breast cancer include genetic factors, dietary factors, environmental factors and life style. Women with a family history of breast cancer have a higher risk of developing breast cancer than the general population; high fat and calorie content in food can increase the risk of breast cancer; long-term exposure to ionizing radiation or radiation therapy can also increase the risk of breast cancer in women; the risk of cancer in the opposite breast increases after previous breast cancer in one breast.
3.Popularity of breast cancer
In summary, the following groups are at high risk of breast cancer: family history, early menarche, high intake of red meat before and after puberty, late marriage or unmarried, not having children or not breastfeeding, late menopause, long-term exposure to cancer-causing environment, and specific genes and chromosomal abnormalities such as BRCA mutation. One of the most important factors is that women are prone to breast cancer when their breasts are exposed to high estrogen levels for a long time.
4.How to detect breast cancer early
Early detection of breast cancer depends on the joint efforts of health workers and women. Usually, the measures available include target population screening and general population screening, but decades of experience have shown that general population screening has limited effectiveness. The prevailing recommendation is for women to undergo at least one annual breast examination plus ancillary screening, usually ultrasound or mammography, after the age of 40. The age of physical examination for women with breast cancer predisposition factors should be advanced, the exact age is not yet determined, but the recommendation of the Breast Cancer Committee of the Chinese Anti-Cancer Association is 20 years old.
5.The significance of breast self-examination
In the past, national health authorities as well as clinicians had recommended women to self-examine their breasts, but the results of more than ten years of observation found no obvious benefits. Most female patients, because they have not received professional training, often use a “handful” of techniques when self-examining, so as long as they are not too thin women may mistake the slightly thickened and dense glandular tissue in their hands as a “lump”; conversely, smaller lumps Smaller lumps are also less likely to be found in plump women. If the conditions for consultation are limited, the best way to check yourself is to stretch your hand out flat and slide your fingertips down with slight force in the shower or in bed, and if there is a blocking sensation or a clear outline of a lump, then it may be a breast lump and you should seek medical attention immediately.
6.What circumstances require prompt medical attention
Women with breast discomfort should be examined in a timely manner, especially when fluid or blood is found in the nipples or when a lump is touched, and not to be paralyzed. However, there are some points to note: nipple overflow, blood overflow and breast lumps should be seen as soon as they are found, while common breast pain and discomfort should be avoided during the days of menstruation, because the physiological changes of the breast during menstruation may affect the doctor’s judgment of the physical examination and ultrasound results.
7. Precautions before and after the visit
Regardless of whether the breast disease is an inflammatory manifestation of redness, swelling and pain, or a lump with no obvious symptoms, do not repeatedly and roughly squeeze the breast on your own. Improper touching may aggravate the inflammation or promote the spread of tumor.
Breast specialist is the first choice for medical treatment, and ultrasound, mammogram and MRI are available as auxiliary examination methods. Ultrasound is basically suitable for all kinds of people and has a high accuracy. Mammography is suitable for women over 35 years of age whose breasts are not particularly dense, and repeated examinations are not recommended, but limited to 1-2 times a year. MRI is more accurate, but more expensive. The choice of the specific method should be based on the actual situation and doctor’s recommendation.
8.Interpretation of examination results
Breast imaging, including ultrasound, mammography, and MRI, is based on the American College of Radiology’s Breast Imaging Report and Data System, which describes abnormalities such as lumps and calcifications in the breast. Reports include the following.
BI-RADS0: the assessment is incomplete and additional imaging is required.
BI-RADS1: negative, with no abnormal findings.
BI-RADS2: benign changes with no radiographic signs of malignancy.
BI-RADS3: probable benign changes with short-term follow-up (usually 6 months).
BI-RADS4: suspicious abnormality, biopsy to be considered. Its possibility of malignancy is about 30%, which can be further divided into 4A, 4B and 4C, with a possible progressive increase in malignancy
BI-RADS 5: highly suspicious of malignancy (almost certainly malignant, ≥95%).
BI-RADS 6: biopsy confirmed malignant but not yet treated.
9, which “breast nodules” need surgery
People who have dealt with hospitals should notice that the report in your hand often says “x x site x x cm/mm nodule ……”. When you see this description, don’t panic first, but take a closer look at the full report or consult your doctor directly.
In general, imaging BI-RADS score 1-3 is not necessary; small lesions that are clearly mammary fibroadenoma can also be followed and observed without surgery, but surgical removal is recommended when there are symptoms, or if the lump is larger than 3cm, or if there is an increase in size within a short period of time; a score of 4 or more requires surgical biopsy or radical surgery; the results of any two of the three tests, namely physical examination, imaging and fine needle aspiration, are not consistent or definitive in determining the benignity or malignancy. The results of any two of the three tests, namely physical examination, imaging and needle aspiration, are indications for surgical biopsy if the results are inconsistent or uncertain.
10.What to do if you have breast cancer
Knowing that you or your family members have breast cancer is undoubtedly a great shock. However, the most correct way to face the difficulties is to gather courage to solve them and need to think and cope with them calmly. Patients and family members should listen carefully to doctors’ advice and cooperate with them in diagnosis and treatment.
The first thing is to get a confirmed diagnosis as much as possible. Breast cancer related tests including blood test, ultrasound, mammogram, MRI, etc. are not considered to be confirmed diagnosis in the real sense. The clinical diagnosis is usually obtained by lump aspiration or lump excision biopsy. However, not all tumor cases can be diagnosed preoperatively, and a larger proportion of tumors require surgical biopsy to confirm the diagnosis. Therefore, I say that preoperative diagnosis should not be forced as much as possible, and excessive preoperative examination may sometimes delay the diagnosis and treatment.
The next step is to determine whether surgery is possible. Based on the initial examination, the doctor will get a general impression of whether the disease is early or late and whether it can be operated. Even operable breast cancer sometimes requires preoperative adjuvant treatment, while some cases should be operated directly. Don’t give up the pre-operative treatment that should have been done because of the fear of delaying the surgery, and don’t delay the surgery because of the superstitious effect of drugs.
11.Selecting breast cancer surgery method
The true sense of radical breast cancer surgery began in the 1890s, followed by a modified phase and an expanded phase, accompanied by controversies and advances during this period. At present, the common surgical methods for operable breast cancer are divided into three categories: modified radical surgery, radical breast cancer surgery with breast preservation, and radical breast cancer surgery with breast reconstruction. The latter two have the advantages of cosmetic effects and psychosocial aspects compared to the classical modified radical breast cancer surgery.
12.What are the requirements for breast-conserving surgery?
Early stage of disease, small lump (standards vary from country to country, usually requiring a lump less than 3 cm), only one lump or more than one lump but confined to a small area (the latter requires great caution), no invasion of skin or chest wall, no connective tissue disease (which can affect post-operative radiation therapy, i.e. light), too young or with other high-risk factors such as family history should be carefully selected. Breast-conserving surgery, where the mass is far from the nipple areola (relatively speaking, in practice it depends mainly on whether the tumor can be completely removed while preserving the nipple areola, and some people do breast-conserving surgery to remove tumors in the central region).
The special cases of breast-conserving surgery include two types of cases: one is the very early stage of the disease, which only requires lump excision and axillary lymph node biopsy; the other is a large lump but the overall assessment of the stage of the disease is not too late, so neoadjuvant treatment (including chemotherapy, radiotherapy and endocrine therapy) can be done first before breast-conserving surgery.
13.Breast reconstruction surgery
If the assessment of the disease is not suitable for breast-conserving surgery, but you want to get a better cosmetic effect, then modified radical breast cancer surgery with breast reconstruction is a good choice. The common methods of breast reconstruction include implant placement and tissue grafting. However, there are risks of infection, deformation and rupture of the implant, and foreign body reaction to the implant. Tissue grafting is mainly done with autologous tissues, including vascularized tissue grafting, free tissue grafting and fat grafting. The first two are more traumatic, and the survival of the transplanted tissue is a priority, while fat transplantation is prone to saponification and atrophy leading to deformation of the reconstructed breast, and is also not conducive to postoperative radiation therapy. My own experience is that allogeneic tissues are better than autologous tissues, distant tissues are better than adjacent tissues, and breast preservation is possible if breast preservation is possible.
14.Will breast conservation or breast reconstruction affect the efficacy of treatment?
The current literature and domestic and international experiences show that breast conservation or breast reconstruction will not affect the outcome of breast cancer treatment as long as the cases are properly selected. I have focused on breast cancer surgery for ten years, and among the more than one thousand breast cancer surgeries I have performed independently, breast-conserving surgery has been performed in nearly 25% of cases, and breast reconstruction in dozens of cases, all of which have achieved good therapeutic and cosmetic results. There are more than 90% of cases with follow-up, no local recurrence and only 6% of cases with distant metastasis.
15.Is metastatic breast cancer still operable?
About 3.5-7% of all breast cancer patients have metastases at the time of initial diagnosis. There is a group of metastatic breast cancer that is most likely to benefit from aggressive combination therapy, which is characterized by a single detectable metastasis, or a small number of metastases confined to a single organ.
In general, younger patients, smaller tumors, single or few metastases or limited to a single area, no visceral metastases, and negative surgical margins tend to have a survival benefit, and axillary debridement also helps to improve survival.
Tumor conditions are highly variable and certainly cannot be generalized. My belief is that some advanced breast cancers previously thought to be incurable may achieve unexpected results with aggressive treatment as long as the conditions allow, the case is properly selected, and the treatment plan is comprehensive and reasonable.