In recent years, the incidence rate of breast cancer has been increasing year by year, and is currently increasing at a rate of 0.2% to 8% per year worldwide. China is a low incidence country in the world, and although the incidence rate is not high, it is increasing rapidly.
The trend of younger age of breast cancer incidence will cause great harm to patients, families and society. Despite the increasing incidence of breast cancer, the percentage of early stage breast cancer patients in China is not high, and only about 30% of stage I breast cancer is detected in Shanghai, while breast cancer without lumps detected through mammography screening is a rarity. In some areas of the world where breast cancer screening is well conducted, breast cancer detected by mammography without lumps can account for about 40%.
2.Women who are prone to breast cancer.
People with high risk factors for breast cancer are prone to breast cancer, but by prone to breast cancer, we mean they have a higher chance of developing breast cancer compared to the normal population, while the majority of them do not develop breast cancer.
The following groups are more likely to develop breast cancer than the normal population.
(1) Women over 30 years of age, especially those with age of menarche before 13 years of age, age of menopause after 53 years of age, and those with menstrual periods and short menstrual cycles.
(2) First-degree relatives, mothers and sisters who have breast cancer.
(3) Those who are infertile after marriage, do not breastfeed after childbirth or rarely breastfeed.
(4) Those who have benign breast diseases such as cystic hyperplasia, fibroadenoma, intraductal papilloma, and those who have had one side of the breast cancer removed.
(5) Those with lumps in the breasts or thickened breast lumps unrelated to changes in the menstrual cycle. Those with repeated nipple overflow or nipple erosion.
3. Epidemiologists call various factors that have a clear causal relationship with the development of cancer as risk factors, and the risk factors that most patients with a certain cancer have are called high-risk factors.
The main risk factors for breast cancer are as follows.
(1) Early age of menarche: If the age of menarche is less than 13 years old, the risk of breast cancer increases 2-3 times compared to that of those who are older than 17 years old.
(2) Late age of menopause: If the age of menopause is more than 53 years old compared to less than 45 years old, the risk of breast cancer in the former increases 2.6 times.
(3) Late age of first birth: If the age of first birth is more than 30 years old compared to less than 20 years old, the risk of breast cancer increases by 2.5 times. The risk of breast cancer is also higher for those who are sterile for life and those who do not breastfeed after childbirth.
(4) Significant weight gain after menopause: the risk of breast cancer increases by 2.3 times for those who weigh more than 60 kg after menopause compared to those who weigh less than 50 kg.
(5) History of benign breast diseases: Women with lobular hyperplasia, fibroadenoma and intraductal papilloma have 3-5 times higher risk of breast cancer than normal women.
(6) Family history of breast cancer: In addition, high-dose radiation exposure to the chest, intake of exogenous estrogen, and long-term excessive alcohol consumption increase the risk of breast cancer.
4.Prevention of breast cancer
The causes of breast cancer are not fully understood, so there is no exact method to prevent breast cancer. However, epidemiological studies have revealed that the occurrence of breast cancer is related to many factors. Research on prevention of breast cancer by changing daily habits and using certain drugs has made great progress, and the prognosis of breast cancer will eventually break through for the benefit of mankind, and mankind will make a major breakthrough in research on the causes of cancer in the 21st century. Studies have shown that the occurrence of breast cancer is closely related to changes in endocrine stimulation, and changes in endocrine stimulation in the human body are related to nutrition, especially excessive intake of fat and animal protein, and excessive intake of fat during the pre-menstrual period or the growth period of children, which can lead to early menarche, with many girls having menarche before the age of 12. Epidemiological studies point out that this may increase the risk of breast cancer. The way to prevent this is to have a balanced nutritional intake during the growth period of children, to pay proper attention to fat and animal protein intake during puberty, and to strengthen physical exercise so that the time of sexual development and maturation is in line with the natural pattern, which will reduce the risk of breast cancer. Breastfeeding is not only beneficial to the growth and health of the baby, but also to reduce the risk of breast cancer in the mother. The risk of breast cancer increases in women who are sterile or do not breastfeed throughout their lives. Many women will be obese after menopause, and the accumulation of excess fat in the body may promote the conversion of androgens into estrogens more often under the action of aromatase, which will help the occurrence of breast cancer. In recent years, the United States, Europe, Italy and other countries and regions to carry out population-based drug studies, such as triamcinolone acetonide, the prevention of breast cancer randomized group study, there are as many as 32,422 participants in the study showed that after taking triamcinolone acetonide 1 year, 2 years and 5 years of breast cancer patients contralateral breast cancer incidence rate decreased by 13%, 26% and 47%, respectively, the current study is still continuing, but the study shows that the use of certain The use of certain antihormonal drugs to prevent the development of breast cancer is very promising. However, since triamcinolone still has certain side effects when taken for a long period of time, it is not entirely clear whether it increases the incidence of endometrial cancer, so the search is on for drugs that are as effective as triamcinolone with fewer side effects. Breast cancer can be prevented.
5.What are the common symptoms of breast cancer?
There are various clinical symptoms of breast cancer, but the main symptoms of breast cancer patients in China can be summarized as follows.
(1) Breast lumps. At present, the first symptom of about 90% of breast cancer patients in China is breast lumps. Since most breast diseases can form lumps in the breast, patients should not panic when they find breast lumps, but should go to the hospital in time and ask the doctor to clarify the cause of breast lumps. Lobular hyperplasia, breast cancer and breast fibroadenoma are the most common causes of breast lumps, while other relatively rare causes can be inflammatory breast lumps or breast lipomas. The lumps formed by breast cancer show infiltrative growth with unclear borders, uneven surface, hard texture, little activity and painlessness; while benign breast tumors have clear borders, smooth surface, tough texture, obvious activity and enveloping sensation; the lumps formed by lobular hyperplasia of breast are often not real lumps but thickening of tissues, soft texture, often accompanied by distension and pain, and have a close relationship with menstrual cycle.
(2) Nipple overflow, the main cause of nipple overflow is intraductal papilloma and inflammation of breast ducts, less than 5% of nipple overflow is due to breast cancer, most patients can find lumps in breast through further examination, nipple overflow in breast cancer can be bloody, plasma or watery, overflow smear and endoscopy of breast ducts are the main methods for clear diagnosis.
(3) Skin changes. There are various manifestations of skin changes caused by breast cancer. The most common symptom is skin adhesions, which are like “dimples”, so it is also called “dimples”. The most common symptom is skin adhesions, which are like dimples, hence the name “dimple syndrome”. In the early stage, patients usually cannot detect the slightest skin adhesions by themselves and need to be examined by experienced doctors. Skin adhesions are an important clinical sign for the diagnosis of breast cancer. In addition, faster growing or larger tumors may also present with angry superficial skin veins. In inflammatory breast cancer, the skin may become red and the local temperature may increase. If the cancer cells block the lymphatic ducts of the breast, the skin may become edematous, such as orange peel.
(4) Changes of nipple and areola. When the breast cancer lesion invades the nipple and subareolar area, the fibrous tissue and duct system of the breast may shorten due to tumor invasion and pull the nipple, and patients may have nipple deviation, retraction and depression. Bilateral nipples appear asymmetrical. Patients should be aware that some benign breast disorders can also cause nipple retraction and depression. Eczematous carcinoma of the breast is a special type of breast cancer whose typical clinical symptom is nipple erosion, but in the early stages of the disease patients only experience thickening and reddening of the nipple skin, and gradually the nipple surface becomes rough, granular or flaky, and nipple erosion occurs. Patients are often misdiagnosed as eczema, and local medication is applied. Sometimes the erosion can be crusted over, but after the crust is removed, the erosion remains, and further development of symptoms can lead to large erosion of nipple and areola area, and the whole nipple can be eroded by tumor and disappear.
(5) Enlarged axillary lymph nodes. Most of the lymph of the breast flows back to the axilla, so breast cancer can cause enlarged axillary lymph nodes. A small number of patients can also be diagnosed with swollen axillary lymph nodes as the first symptom of breast cancer, so you should seek medical attention promptly if you find unexplained axillary lumps.
6.How to detect breast cancer early
Early detection and diagnosis of any type of cancer can lead to good treatment effect. Therefore, early detection is an important research direction in the fight against cancer in the world. Breast cancer is no exception, and many experiences have been gained and many effective methods have been created. For early detection of breast cancer, the most fundamental thing is to study clearly the causes and development of breast cancer, and significant progress has been made in this regard in recent years, but in the case that the causes and pathogenesis of breast cancer are not fully understood yet.
(1) The current methods of early detection are mainly as follows.
(1) Screening of breast cancer. Data show that the average size of breast cancer in screening is smaller than that diagnosed at the time of clinical diagnosis with symptoms, and the rate of lymph node metastasis is also significantly lower, and the prognosis is relatively much better. At present, physical examination and mammography are the main methods of screening, and sometimes NIR and ultrasound are also used. The target of screening is mainly women over 35 years old, and the general interval is 1-2 years, especially those with family history of breast cancer and those with high risk factors for breast cancer are the key targets of screening.
The etiology of breast cancer is still unknown, but surveillance in the high-risk group is likely to increase the detection of early breast cancer, especially in women with family history of breast cancer, by molecular biology examination, searching for relevant characteristic genetic markers, evaluating their family risk, and providing surveillance for early detection of individual breast cancer. However, the specific implementation is subject to progressive research.
(iii) Breast f-targeting, a combination of clinical examination and breast f-targeting is the most widely used and effective method for early breast cancer diagnosis. Currently, some developed countries advocate that women should have a mammogram at the age of 35 as the basic information, and then have a mammogram every 1-2 years to compare with it.
In fact, most of the patients are self-detected. If we popularize the knowledge of prevention and teach people the method of self-examination, it is an effective way to improve the early diagnosis of breast cancer.
7. Regular and systematic self-examination of the breast
It is possible to detect early breast cancer in time, to obtain the initiative of early and timely treatment, and to obtain good treatment effect, so as to achieve the purpose of eradication.
(1) Self-examination.
① Take off your shirt, face the mirror, watch the shape of both breasts, pay attention to whether there is any change in the contour of the breast, whether the skin is wrinkled and sunken, whether the bilateral nipples are at the same level, whether there is a ‘high and a low or nipple retraction, whether there is nipple overflow, when there is nipple overflow it often stains the bra.
②Arms up, cross your fingers behind the pillow and bend forward slightly or cross your arms with force, while paying attention to the shape of the breast and whether the skin is wrinkled abnormally.
③ one arm up, show (index) finger, middle finger, ring (ring) finger together, gently touch the inner upper, inner lower, outer upper, outer lower area of the breast with the belly of the finger in a certain direction, carefully touch all of the breast, especially the outer upper and axillary areas, and compare with the previous – the examination to see if there are any abnormal changes, and finally you can gently press the areola area and gently Do not use your hands to grasp and squeeze the breast during the examination, otherwise it is easy to mistake normal breast tissue for breast lumps, but use your fingers to feel whether there is thickening or lumps and other abnormalities in the breast. After completing a mammogram, the opposite side is examined in the same way. If you take a supine position, your arm is raised and a small pillow is placed on your shoulder to flatten the breast, which makes it easier to examine and gives better results.
It is best to compare each examination with the previous one and ask your doctor to review and diagnose any abnormalities in time to achieve early detection and early diagnosis. Breast self-examination should be done once a month, and the best time for examination is the 9th-11th day after each menstrual period, when the breast is softer and less painful, and it is easy to find abnormalities.
The development of surgical treatment of breast cancer can be divided into three stages.
Stage I: Radical mastectomy was founded by Halstad in 1894 and has been the standard procedure for the treatment of breast cancer. During this period, breast cancer was considered to be a local or regional disease that developed in an anatomical model, i.e. local lesions developed to a certain extent and then metastasized to regional lymph nodes, which later caused hematologic dissemination. In recent years, Fisher et al. have argued that breast cancer is a systemic disease from the beginning and that regional lymph nodes do not have a defensive function, and that there are many ways to reduce the extent of surgery for perfect postoperative appearance and function. However, the goal of surgical treatment for curable breast cancer is to maximize local and regional lymph node control to improve survival, and then to consider the shape and function, the closer to normal the better.
The second stage: Breast-conserving surgery has emerged since the 1970s, and after more than two decades of development, the surgery has become quite mature and has been fully promoted abroad. However, in China, due to living habits and standard of living, this procedure is only available in a few hospitals for clinical trials and is quite immature.
The third stage: Since the 1990s, foreign countries have started to explore the biopsy technique of sentinel lymph nodes. The decision to clear the axillary lymph nodes is based on the pathological diagnosis of the sentinel lymph nodes. Positive ones are cleared, and vice versa are abandoned. Foreign literature reports an accuracy rate of more than 90%. This procedure can be considered another milestone in the surgical treatment of breast cancer after breast-conserving surgery. The improvement of patient’s appearance and local function has been improved after surgery.
The comprehensive treatment of breast cancer has also been developed greatly in recent years. For example, neoadjuvant chemotherapy represented by paclitaxel and iso-vincristine has better efficacy for patients with large lymph nodes and metastases in preoperative masses. Endocrine therapy represented by tamoxifen has better efficacy in preventing postoperative recurrence and in the treatment of patients with advanced breast cancer.