Chinese women are not advised to cut their breasts to prevent cancer
Driven by the “Jolie effect”, hospitals have been busy with calls for genetic testing and mastectomy surgery in recent times. Even some doctors are not immune to this trend. Dr. Yu Ying, a Weibo celebrity and emergency physician at Peking Union Medical College Hospital, said on Weibo that she had a BRCA1/2 gene test done at her hospital after her night shift because “two women in her family have breast cancer.
However, the breast cancer experts at the center of this “Jolie whirlwind” are unanimously cautious.
”I think Jolie’s practice of removing her breast to prevent cancer is a bit radical, because she has to preserve her breast when she has early breast cancer.” Professor Wang Chip, director of the expert committee of breast health care of the China Maternal and Child Health Association and vice president of Guangdong Maternal and Child Health Hospital, while always advocating early diagnosis and treatment of breast cancer, said so bluntly.
”The characteristics of breast cancer in Asian women are obviously different from those in Europe and America, and it is not recommended to imitate Julie’s breast cutting to prevent cancer.” Professor Yang Mingtian, the chief expert of breast cancer monoculture at the Center for Cancer Control of Sun Yat-sen University, put it this way.
87% – overestimated risk of breast cancer?
Jolie claims that she has an 87% chance of developing breast cancer. With such a high risk, why is her “root-and-branch” approach to fighting cancer still not supported and promoted by Chinese experts? A report from a U.S. website gives a glimpse of what’s going on. According to the website, Jolie’s mastectomy was a commercial for a genetic testing company, and she exaggerated her cancer risk, causing women all over the world to panic about breast cancer.
According to Professor Chip Wang, the skepticism is not unreasonable: “Jolie’s cancer risk, to some extent, is overestimated and a bit propagandistic.”
He explained that both BRCA1 and BRCA2 are breast cancer susceptibility genes. Jolie has a mutation in the BRCA1 gene, and her chances of developing breast cancer in the future are indeed higher than normal, but the risk of developing cancer varies by age.
There is a special tool used to estimate the risk of breast cancer – the Gail Risk Model. It is estimated that the lifetime risk of breast cancer for the average person hovers between 2-7%. For BRCA mutation carriers, the chance of breast cancer is 30~50% below the age of 50; the highest risk is 56~87% between the ages of 50 and 70; after the age of 70, the risk decreases.
So, when Jolie reached a certain age, she only may have to face 87% of the risk of cancer. Of course, just the fact that the chance of cancer is more than ten times higher than normal people is also already frightening.
Professor Yang Mingtian pointed out, “Chinese women do not need to be overly panicked and do not need to spend a lot of money on genetic testing. There are obvious ethnic differences in the incidence of breast cancer. The incidence rate of breast cancer in Asian women is lower than that of Western women, and the rate of BRCA mutation in Asian women is also lower. For every 100 breast cancer patients in China, less than 5 have a mutation. Even if there are mutations, the types of mutations in Chinese women are not quite the same as those in Western women, and the Gaelic risk model cannot be fully applied to estimate the risk of developing cancer. The risk is not clear, and whether cutting the breast to prevent cancer is ‘worth it’ or not is something people need to weigh carefully.”
In general, BRCA genetic testing is only recommended for women with a family history of breast cancer. In the general population, BRCA mutations are sporadic and it is difficult to find one or two cases in thousands of people, so if everyone follows the trend of genetic testing, won’t it become over-screening? If everyone follows the trend of genetic testing, it will not be excessive testing, and the cost of thousands of dollars of testing will be wasted.
It is impossible to reduce the risk of cancer to zero by cutting the breast
Having a breast cancer patient in the family is equivalent to having two “time bombs” in front of a woman’s chest. At this time, the fear of cancer may be even more torturing than cancer itself. Prof. Yang met a woman who accompanied her mother and sister to see breast cancer, but when they found out that breast cancer is hereditary, they were under a lot of psychological pressure, but when they were diagnosed with breast cancer, they were able to face the treatment positively.
To relieve this psychological pressure, it is not the only way to follow Julie and remove the breast. “Regular screening, medication and surgery are the three ways to prevent cancer in women with high risk of breast cancer. Among them, drugs and surgery are not universal, and I would rather recommend regular screening for early detection, diagnosis and treatment.” Professor Chip Wang said.
”Removal of the breast, except for the inability to breastfeed and affect the secondary sexual characteristics, does not have much impact on life safety, but the psychological impact is particularly great. Even now everyone understands that what Julie cut is not the breast, but only the breast tissue in the breast, and the body is still hotter after breast augmentation, but not everyone can accept it. Moreover, the breast tissue in the breast is like the roots of a tree in the soil, so whether it is a mastectomy or a full mastectomy, there is no way to cut all the tiny glands and reduce the risk of breast cancer to zero.” Professor Chip Wang said that this type of surgery is also controversial abroad.
Compared with mastectomy, taking estrogen antagonist drugs, which can reduce the risk of breast cancer by 50 percent, seems to be a more “gentle” method of cancer prevention. But unlike the cervical cancer vaccine, which works in three shots, women have to take them for five years and endure all the symptoms of menopause.
Wang found that most of the women who took these drugs gave up after less than a year or two, and eventually returned to regular screenings.
Follow the “biological clock” and stay away from environmental hormones
Surgery and drugs are still radical for women with high risk of breast cancer, and it is even more difficult to spread to the general women. So, how to prevent cancer for ordinary women when the rate of breast cancer is increasing by 3% every year in China?
Professor Yang Mingtian emphasized the word “timely”: “I advocate that women should follow the ‘biological clock’ of life and get married, have children and breastfeed at the right time. This is because high estrogen levels in the body constantly stimulate breast tissue, which may lead to cancerous changes in breast cells. During pregnancy and breastfeeding, the estrogen level decreases, which can prevent breast cancer. The saying that ‘leftover women’ and ‘dinkies’ are prone to breast cancer is not an empty argument.”
Professor Wang emphasized the influence of the general environment: “Why are there so many breast cancers now? It’s because there are too many environmental estrogens in the environment now!”
”The dioxin in car exhaust, BPA in milk bottles, and plasticizers in food are all environmental estrogens. Some farmers, in order to make fish and shrimp livestock grow faster and grow more meat, go so far as to give them estrogen-like substances. These environmental estrogens, although trace amounts, will accumulate when they enter the body, causing endocrine disruption and increasing the risk of breast cancer. Every year at the ‘March 8’ women’s lecture, I tell my female friends that it is best to eat a diet based on cereals, fruits and vegetables, and artificially farmed freshwater fish and shrimp, which must be eaten sparingly.”
Regular checkups are the best prevention
The two medical experts also reminded that although breast cancer is related to hormone levels, overall, it is still a multi-factor caused disease and its prevention is not a quick fix.
In 2009, Yu Juan, a young female teacher at Fudan University, was diagnosed with advanced breast cancer. On her death bed, she kept wondering why she had no family history, she had breastfed for a year after giving birth, and she was only 31 years old, not yet 40 years old, the peak of breast cancer incidence, “Why did I get cancer?”
Finally, she summarized the five reasons: diet, long-term blind eating, overeating and meat-loving; staying up late for a long time; habitual high-intensity surprise work; working with furniture with excessive formaldehyde; competitive personality, too much like to do the best in everything, too much like to lead the big picture, too much unwilling to do nothing.
From this, we can see that the courage to remove the breast to prevent cancer is hard to reach, and the persistence to fight against bad habits and cancer-causing factors in the environment year after year to prevent cancer, and to constantly adjust one’s mentality, is actually even harder to achieve.
Prof. Yang Mingtian suggests that breast cancer cannot be prevented, regardless of high risk or not, women should have regular breast self-examination and breast screening, and go to regular hospitals and seek medical consultation from breast specialists in time if there are any problems. Since 2009, the Ministry of Health has been implementing the “two cancers” screening program for rural women, who can be screened for breast cancer and cervical cancer for free.
Figure 1: Breast structure diagram
Figure 2: Causes of breast cancer
l Having BRCA1/2 gene mutation
First-degree relatives in the family (parents, children, siblings) with breast cancer
Early menarche (before the age of 12) and late menopause (after the age of 55)
Celibacy, late marriage and short duration of marriage
No children or late childbearing (first child after 30 years of age)
No breastfeeding experience
l Using estrogen replacement therapy for 5 years or more
High-fat, high-protein diet
Obesity and overweight
Figure 3: Breast Cancer Screening Schedule
Women at average risk
l 20 years ≤ age < 40 years.
Annual clinical breast examination or additional ultrasound examination of the breast
l 40 years ≤ age < 60 years.
Annual clinical breast examination and one mammogram; dense breast (less fatty tissue in the breast and more breast tissue) women can be screened with breast ultrasound
l Age ≥ 60 years.
Mammogram once a year
High risk women
Refers to carriers of BRCA1/2 gene mutation, those with family history of breast cancer without gene mutation, those with previous histologically diagnosed atypical breast hyperplasia
l Age <25.
Clinical breast examination once a year
l 25 years ≤ age < 35 years
Clinical breast examination every 6 to 12 months and annual breast ultrasound examination
l Age ≥ 35 years
Clinical breast examination every 6-12 months
Mammography and ultrasound every 1-2 years, with additional breast MRI recommended
Figure 4: How to self-examine the breast
Some studies have shown that breast self-examination does not improve the early diagnosis of breast cancer. However, some studies suggest that self-examination can help detect small or lymph node negative breast cancer and also reduce the incidence of interstage cancer. Self-examination reveals abnormalities to be reviewed at a specialist hospital, which can be a more economical method for early detection of breast cancer.
l Examination time
Once a month, 1 week after each menstrual period, when the breast is the most tender and the least painful to touch. For menopausal women, it can be done at the most memorable time of the month.
l Examination methods
Visual examination
The upper half of the body is exposed, standing upright in front of the mirror.
First look: whether the parts of the breast are symmetrical, whether the size changes, whether there is swelling, atrophy, bulging, skin depression, etc.
Second look: whether the nipples on both sides are on the same level, and whether there is any sunken nipple or deviation towards the nipple.
Third look: whether there is any discharge overflowing from the nipples, and not to ignore the underwear and bras replaced down to observe whether there are water stains or blood stains in the corresponding positions of their nipples.
Palpation
Lie flat on the bed and use a pillow or towel folded under the shoulder to elevate it.
Put the left fingers together and place them flat on the surface of the right breast, touch the breast gently and flatly using the palm surface of the fingertips, check one circle along the clockwise or counterclockwise direction, then reduce the radius of the circle and check 2 to 3 more circles, touching for lumps.
Next, gently squeeze the nipple and observe for overflow.
Finally, check the axilla for enlarged lymph nodes.
The same method is used to examine the left breast with the right hand.
Figure 5: Typical symptoms of breast cancer
1. Breast lump. Most of them are solitary, hard, with irregular edges and less smooth surface. Most of them are painless lumps, only a few of them are accompanied by varying degrees of hidden pain or stabbing pain.
2. Nipple overflow. Blood, plasma, milk or pus flowing from the nipple during non-pregnancy period, or milk still flowing even after stopping breastfeeding for more than six months, is called nipple overflow. Unilateral single hole of bloody overflow should be further examined, and if accompanied by breast lumps more attention should be paid.
3, skin changes. Such as sunken skin, orange peel-like changes.
4. Nipple and areola abnormalities. Nipple retraction or elevation, nipple skin scratching, erosion, rupture, crusting, flaking, with burning pain.
5. Enlarged lymph nodes in the axilla. The enlarged lymph nodes are hard, scattered and pushable.