Breast cancer is one of the most common malignant tumors in women, mainly manifested as painless lumps in the breast. Since the 20th century, the incidence of breast cancer has been on the rise all over the world, and it has become the first malignant tumor among women in Europe and the United States, as well as in metropolitan areas such as Shanghai and Beijing in China. Early detection and late detection of breast cancer have a great impact on the prognosis, so it is very important to have regular self-examination and/or go to the hospital for regular breast examination.
Self-examination includes two main methods: visual examination and palpation. “Visual examination” means that after bathing, you can look at your breasts in the mirror to see if there is any change in their shape, whether they are symmetrical or not. Are there any lumps? Are there any sunken nipples, etc.? “Palpation” means lying in bed or standing, touching the right breast with the left hand and the left breast with the right hand to check for lumps and nipple overflow. Generally speaking, the time for self-examination should be about one week after menstruation, and for postmenopausal women, a breast self-examination can be done once a month at the beginning or end of the month.
After the age of 25, women should go to the hospital once every six months; before the age of 40, ultrasound examination is the main focus, and women over 40 and postmenopausal women should have a mammogram every one to two years.
Methods of breast self-examination.
Visual examination: Take off your shirt and do a bilateral breast visual examination in bright light, facing a mirror: drop your arms and observe whether the curved contours of both breasts have changed, whether they are at the same height, whether the skin of the breasts, nipples and areolas has flaking or erosion, whether the nipples are raised or retracted, then cross your arms and rotate your body left and right to continue to observe whether there are any abnormalities.
Palpation: Take a standing or supine position, place the left hand behind the head, check the left breast with the right hand, fingers together, gradually move clockwise from the top of the breast to check, in the order of upper outer, lower outer, lower inner, upper inner and underarm, systematically check for lumps. Be careful not to miss any part, and do not press or squeeze with your fingertips. After examining the breast, use your thumb and middle finger to gently squeeze the nipple to see if there is any blood-tinged discharge. If any lumps or other abnormalities are found, go to the hospital for further examination.
The best time for mammogram
For women with normal menstruation, the best time to have a mammogram is on the 7th to 10th day after the onset of menstruation. This is the time when estrogen has the least effect on the breast and the breast is in a relatively static state, making it easy to detect lesions. To put it simply, it is the most appropriate time to check about 1 week after menstruation.
High risk factors for breast cancer refer to some factors that have a higher chance of occurring in certain specific groups of people than the normal population. They include the following conditions.
(1) Family history of breast cancer.
(2) Early onset of menstruation, late menopause, long years of menstruation or prolonged absence of ovulation.
(3) Infertility or failure to breastfeed.
(4) Long-term use of estrogen drugs.
(5) History of breast cancer on one side.
(6) Benign breast disorders.
All women with the above mentioned high-risk factors must have regular self-examinations and should seek medical attention promptly if problems are detected, preferably by a breast specialist at least once a year.
Early symptoms of breast cancer.
It is very important to know the early symptoms of breast cancer, if it can be diagnosed and treated early, the prognosis can be significantly improved. Most of the lumps are painless (about 95%) and only a few (about 5%) are painful, so patients often think that there is no problem and delay the diagnosis and treatment. Breast cancer lumps are most commonly found in the upper and central part of the breast (about 70%). Sometimes breast lumps are not obvious, but you should also seek medical attention when you find a lump in the armpit because the lymph nodes in the armpit are the earliest site of breast cancer metastasis.
Etiology of breast cancer.
There is no definite conclusion, there may be some factors as follows.
Endocrine factors, such as early menarche at age 12, delayed menopause at age 55, first birth after age 30, and infertility, can increase the incidence of breast cancer. 45-49 years old is the age of prevalence, which also indicates that the incidence is related to changes in sex hormone levels. Breast cancer can occur in both men and women, and the incidence rate of men and women is 1:100, which indicates that endocrine, especially female hormones, is closely related to breast cancer.
(2) Genetic factors: If a mother or a sister has breast cancer, her mother is more likely to develop the disease than the normal population, and often has the characteristic of early age of onset of bilateral breast cancer.
③Nutritional factors: high fat and high animal protein diet, obesity, and higher economic standard of living are all associated with higher incidence of breast cancer than the normal population.
The incidence of breast cancer in the second generation of people from countries with low incidence of breast cancer who migrate to countries with high incidence of breast cancer is consistent with the incidence in the country of residence, and the more obvious environmental factor is ionizing radiation, according to the survey, the incidence of breast cancer in women with multiple chest X-rays during tuberculosis treatment in the atomic bombing area is higher than that in the control population.
Clinical manifestations of breast cancer.
Breast cancer most often occurs in the outer upper quadrant of the breast (~%), followed by the nipple-areola area (~%) and the inner upper quadrant (~%). The earliest manifestation is the appearance of a small, painless, solitary lump in the breast with a hard surface that is not smooth and poorly demarcated from the surrounding tissue.
Metastatic pathways of breast cancer.
Breast cancer can spread in the following ways: 1) direct spread: cancer cells can expand in the breast and invade the subcutaneous suspensory ligament, which can shorten the skin and make the skin sunken (dimple sign); or invade the large milk ducts under the areola and constrict the nipple, causing nipple invagination; cancer cells can also block the subcutaneous lymphatic ducts and cause edema of the breast skin (orange peel-like changes); cancer cells invading the subcutaneous lymphatic ducts can form many small nodules on the skin surface (satellite nodules). ②Lymphatic metastasis: it can invade the ipsilateral axillary lymph nodes externally (incidence of ~%) and then enter the subclavian and supraclavicular lymph nodes medially, it can invade the internal breast lymph nodes next to the sternum and then reach the supraclavicular lymph nodes when the tumor is located in the medial part of the breast or the central region and has axillary lymph node metastasis. The incidence of internal breast lymph node metastasis can reach ~%.
Treatment of breast cancer.
The treatment of breast cancer mainly includes surgery, radiotherapy, chemotherapy, endocrine therapy and biologically targeted therapy, which advocate standardized and individualized comprehensive treatment. The first treatment of breast cancer is very important and whether it is standardized and reasonable directly affects the prognosis.
Regular review after breast cancer treatment is an indispensable “homework”, neither to worry about the recurrence and metastasis of tumor every day nor to take it lightly. Generally speaking, it is recommended to review every three to six months within one year after surgery, and every six months to one year after the first year.