On June 23rd , the American College of Obstetricians and Gynecologists (ACOG) issued updated breast cancer screening guidelines.
Which principles should be updated!
Comparing the latest guidelines at home and abroad, we found a number of ideas that we take for granted are being updated, some ineffective ones are pointed out, and some confirmed effective ones need to be paid more attention to.
1. Self-examination by breast palpation cannot reduce the risk of breast cancer
Breast palpation self-examination is a method of “prevention” of breast cancer that has been mentioned in many “popular science” articles. Unfortunately, all existing guidelines (including Chinese guidelines) do not recommend patients to perform breast self-examination by themselves.
The guidelines believe that it cannot reduce the detection rate and mortality of breast cancer, but rather, due to over-examination, it is easy to mistake normal breasts and isolated nodules for breast cancer (false positives), leading to panic and even excessive surgical treatment. However, knowledge of breast diseases, especially warnings about breast cancer, can improve its self-detection rate.
The first judgment of clinical manifestations specific to breast cancer, such as lumps, nipple overflow, and “orange peel” changes in breast skin, can effectively increase the rate of timely hospital admission for examination, and patients should be the first to seek medical consultation when they find themselves with similar symptoms.
2, mammography, only mammography is reliable!
Currently, the most common and effective breast cancer screening test is mammography. Its clinical reliability has been proven and recognized by this guideline.
In addition to mammography, MRI and B-ultrasound are also widely used in clinical practice; MRI is mostly used as a supplemental test for suspected cases and screening for high-risk groups, while B-ultrasound is mostly used as a supplemental test to mammography in areas of China with inadequate facilities (but its reliability has not yet been proven in large-scale epidemiology.) Besides, other respective modalities such as infrared scan, nuclear scan, ductal lavage, and blood oxygen test are not supported by clinical evidence!
3.High risk of breast cancer = gene mutation + family history
In recent years, the relationship between breast cancer and BRCA1 and BRCA2 gene mutations has been increasingly confirmed due to advances in gene sequencing and related research.
A recent JAMA trial showed that of 10,000 patients with BRCA1 and BRCA2 gene defects who survived to age 80, 72% of those with BRCA1 mutations eventually developed breast cancer and 44% developed ovarian cancer; among those with BRCA2 mutations, the numbers were 69% and 17%, respectively.
Also, if you have an immediate family member with breast cancer. Generally speaking, your risk of developing breast cancer again is very high.
Various studies have now concluded that the high risk factors for breast cancer are both genetic mutations and family history, the complete list is as follows.
(1) Those who have a significant genetic predisposition to breast cancer.
(2) Those who have a blood relative who is a carrier of the BRCA1 / BRCA2 gene mutation.
(3) A relative with one or more breast cancer patients.
(4) Patients with ovarian epithelial cancer, fallopian tube cancer, or primary peritoneal cancer.
(5) A male with breast cancer in the family.
(6) Patients with previous moderate to severe atypical hyperplasia of breast ducts or lobules or lobular carcinoma in situ.
(7) Patients with previous chest radiotherapy.
How to standardize the screening?
The frequency of clinical examination and examination by other means is generally recommended as follows
1. The frequency of clinical breast examination can be done once every 1 to 3 years starting from the age of 25 with the patient’s consent;
2. In non-high-risk groups, mammography screening should be performed from the age of 40 (at the latest 50 years) and every 1-2 years until the age of 75;
3. Screening before the age of 40 and after the age of 75 should be done under the joint decision of the patient and the doctor.
Symptoms of breast cancer
1.Typical symptoms
Typical signs of breast cancer include: breast lumps, 80% of breast cancer patients are first diagnosed with breast lumps; nipple overflow; skin changes, a small depression in the breast skin, like a small dimple; abnormal nipples and areolas; enlarged axillary lymph nodes.
2.Other symptoms
Patients may also have wasting, fatigue, weakness, have low fever, poor appetite and other manifestations.
Diagnostic basis
1.Mammography: Mammography is currently the first choice for diagnosing breast diseases and is one of the means to detect microscopic tumors that are not yet clinically accessible.
2.B ultrasound scan: It has unique superiority in showing axillary lymph nodes and distinguishing cystic masses, and ultrasound should be performed for patients with dense breast.
3.Fine needle aspiration cytological examination: a small amount of tissue smear is taken, and the nature of the lesion is determined under the microscope based on the cell morphology, and its conclusion can be used as a basis for confirming the diagnosis.
Daily care
1.Establish a good lifestyle, adjust the rhythm of life, and keep a relaxed mood.
2.Adhere to physical exercise, actively participate in social activities, avoid and reduce mental and psychological tension factors, and maintain a calm state of mind.
3.Actively treat breast diseases.
4.Do not use exogenous estrogen indiscriminately.
Diet regimen
Consume more fresh vegetables, fruits, vitamins, carotenoids, olive oil, fish, bean products, etc., without excessive intake of meat, fried eggs, butter, cheese, sweets, etc., and less pickled, smoked, fried and baked foods.