The incidence of breast cancer is increasing year by year and has become a major disease that endangers women’s health. Early detection and standardized and reasonable treatment are the keys to improve the survival rate of breast cancer. Based on our clinical experience and scientific research results, we will discuss some issues that need to be noted regarding breast cancer prevention and treatment.
I. Risk assessment and preventive treatment of breast cancer
Breast cancer risk assessment is a comprehensive evaluation of an adult woman’s risk of developing breast cancer in the future, with the aim of screening out high-risk women and then taking targeted measures: disease surveillance and preventive treatment. A three-pronged analysis of epidemiological risk factors, breast pathology risk factors and relevant biomarker tests can assess a woman’s risk of developing breast cancer. Epidemiological factors include age, family history of breast cancer in the direct blood line, menstrual and reproductive breastfeeding factors, dense breasts, and obesity; pathological risk factors include atypical hyperplasia of lobular or ductal epithelium, papillomatosis, etc.; some biomarkers such as BRAC-1, BRAC-2, ER, PR, IGF-1, COX-2 in breast biopsy tissue or serum have been found to be associated with breast cancer development. It is important to note that having high-risk factors does not necessarily mean that you will get breast cancer, but only an increased relative risk. As long as you can do active and regular imaging, even if you develop breast cancer in the future, you will be able to detect it early and get a chance to cure it.
Preventive treatment for high-risk groups includes excision of local precancerous lesions in the breast, prophylactic mastectomy and chemoprevention with oral drugs. The clinical manifestations of precancerous lesions are mainly breast masses or localized glandular thickening, bloody nipple discharge, etc., or just imaging changes such as irregular hypoechoic, localized glandular hyperdensity with blood flow signal, calcification, etc. Pathologically, they are manifested as ductal and lobular epithelial atypical hyperplasia, papillomatosis, etc.
Pre-cancerous lesion excision and prophylactic mastectomy should be strictly controlled by specialist physicians for indications. Currently, drugs such as oral tamoxifen to prevent breast cancer have made promising progress in clinical trials, but there are side effects such as blood clots and increased risk of endometrial cancer. For a high-risk individual, the decision of preventive drug therapy should be carefully considered before making a decision: risk assessment of breast cancer, possible benefits and drug side effects.
Breast self-examination and early detection of breast cancer
Most early stage breast cancers are completely curable, so early detection becomes the key to breast cancer prevention and treatment. Unlike countries in Europe and the United States, where universal medical checkups are available, most breast cancer patients in China come to the clinic only when they find a lump on their own. Although some prospective studies have not found any association between breast self-examination and improved survival rate, breast self-examination is still worth advocating in China, as reasonable breast self-examination can enable tumors to be detected at a younger age. We suggest that women should first familiarize themselves with their breasts and pay attention to any local abnormal changes in the near future, such as thickening and hardening of local glands or suspicious swelling, especially if there is no sign of remission after menstruation. Many women go to the doctor only because of breast pain, but ignore the more important manifestations of breast cancer: breast swelling, nipple indentation and bloody overflow, orange peel-like skin changes and enlarged axillary lymph nodes.
For breast cancer that has already occurred, breast imaging is the main measure for early detection. It is important to detect malignant lesions that cannot be felt as masses and to distinguish benign lesions such as breast enlargement nodules from breast cancer. Color Doppler ultrasound and mammography are the most commonly used and valuable diagnostic imaging methods, and their sensitivity and diagnostic compliance rate are above 85%, and the combined examination can improve the diagnostic rate. Although expensive CT, MRI and PET can help improve the diagnostic accuracy of some patients, they are not the first choice for breast examination.
Third, the correct understanding and management of breast enlargement
”Mastocytosis is a common disease that affects women. It is necessary to know the following about mastocytosis.
More than 70% of mammary gland hyperplasia has more than three pathological components, the main components are ductal epithelial hyperplasia, cyst formation, lobular hyperplasia, sweat gland hyperplasia, etc. Some of these lesions such as lobular or ductal epithelial atypical hyperplasia, papillomatosis, etc. are precancerous and their incidence accounts for about 4-5% of mammary gland hyperplasia.
2.Does breast cancer necessarily occur if you have mastopexy? The answer is no. The relationship between mammary gland hyperplasia and breast cancer has been studied extensively. For example, the risk of breast cancer increases only slightly with simple hyperplasia, but increases 5 times with atypical hyperplasia, and 11 times with a family history of breast cancer and atypical hyperplasia. For different mammary hyperplasia lesions, it is necessary to take targeted periodic imaging examinations.
3. Do all mastocytosis have to be treated? The answer is also no. Many women suffer from physiological mastocytosis, which is mainly manifested by periodic premenstrual swelling and pain, and no abnormalities in breast imaging, which generally does not require treatment. Pathological breast hyperplasia should be treated reasonably by a specialist based on the degree of hyperplasia, assessment of risk factors, imaging examinations and clear pathological diagnosis from biopsy.
4. Breast puncture biopsy is an important method to finally determine the tissue type of breast disease and correctly guide the subsequent diagnosis and treatment. Some people worry that puncture may cause the spread of breast cancer, but so far, no clinical study has found that puncture biopsy is related to cancer metastasis and affects survival rate, so the worry about puncture biopsy is unnecessary. Therefore, it is not necessary to worry about puncture biopsy. The decision of whether a puncture biopsy is needed for mammary gland hyperplasia should be made by a specialist according to the condition and whether there is any abnormality in the imaging examination.
Minimally invasive surgical techniques for breast diseases
Some benign breast tumors such as fibroadenoma and parametrium have a low chance of becoming cancerous, but the tumors may grow very large and affect the beauty, so it is also advisable to remove them. Many women miss the opportunity to get rid of the lesions before cancer because they are worried about leaving unsightly scars on their breasts.
Minimally invasive breast surgery technology has made some progress in recent years, and it has become possible to treat both disease and aesthetics. Minimally invasive breast surgery techniques currently used in clinical practice include: cosmetic minimally invasive excision with hidden incision, radiofrequency ablation, ultrasound focused knife (HIFU), McMurdo vacuum suction biopsy system, lumpectomy, etc. Each technique has its own advantages and disadvantages and should be chosen reasonably according to the condition.
For example, ultrasound focused knife (HIFU) inactivates the skin of lesions in the breast without leaving any incision, but it also has disadvantages such as high cost and the need for general anesthesia; the McMurdo biopsy system emphasizes biopsy rather than complete excision of lesions; the use of hidden incisions such as circumareolar areola and excision combined with cosmetic plastic surgery is the easiest, inexpensive method that can ensure complete excision of lesions, and it is worth promoting the application. Based on our experience in applying different minimally invasive methods, we should choose the appropriate minimally invasive treatment method according to the specific condition, size and location of the lesion and the patient’s needs, instead of following them blindly.
V. Standardized and individualized treatment of breast cancer
In recent years, with the impetus of evidence-based medicine and new treatment technologies, a series of remarkable progresses have been made in the comprehensive treatment of breast cancer, and the survival rate and quality of life of breast cancer patients have been significantly improved. It has become a consensus to pursue both curative efficacy and to consider reducing unnecessary side effects. Different stages of breast cancer have completely different treatment strategies. For a patient, a standardized and individualized comprehensive treatment plan starting from the first day of detection of a breast mass is the guarantee of the best outcome. New advances and techniques in breast cancer treatment include neoadjuvant chemotherapy, breast-conserving surgery, sentinel lymph node biopsy to decide whether to perform axillary dissection with more complications, targeted therapy according to the different expression of tumor biomarkers, endocrine therapy, and breast reconstruction to pursue a higher quality of survival with guaranteed efficacy.
It is important to note that inappropriate treatment, especially when breast tumors are first detected, may cost patients many opportunities. For example, a 4×5 cm malignant tumor that is hastily excised first alone will lose the opportunity for neoadjuvant chemotherapy (without tumor, it is impossible to evaluate and screen for sensitive chemotherapy drugs), and thus lose the opportunity for breast conservation after downstaging; an early stage breast cancer with multicentric lesions that is treated only with modified radical treatment will lose the opportunity for immediate breast reconstruction at the same time. In conclusion, when a suspected malignant breast mass is detected, one should promptly visit a regular hospital breast specialist for a comprehensive evaluation of the condition and enter into the optimal treatment procedure from the first step of treatment.