Most breast cancer patients don’t need to have their breasts cut out
Henan Newspaper – Dahe Daily
At a global congress on breast disease held in Switzerland this year, when a Chinese doctor asked, “What is the difference between radical breast cancer surgery and breast-conserving surgery in terms of long-term outcome,” the foreign expert asked back in surprise, “Are you still doing radical surgery?” Why were the foreign experts so surprised? Because there is no difference in the long-term outcome between breast-conserving surgery and radical surgery,” said Li Meng Circle, Breast Surgery Department, First Affiliated Hospital of Zhengzhou University.
It takes courage to write this title. This is because the vast majority of breast cancer patients in China opt for radical surgery, which means cutting off the breast. This is only the level of awareness in the world in the late 19th century.
According to Cui Shude, director of the breast department of Henan Cancer Hospital, at that time, medical doctors believed that cancer cells first infiltrated locally, then metastasized along lymph nodes, and then spread through blood. In other words, within a certain period of time, breast cancer was a local disease and could be cured as long as the tumor and regional lymph nodes were completely removed. super radical surgery emerged again in the 1950s, and people hoped to cure the tumor by removing as much tissue as possible.
However, the idea of maximizing the extent of resection and eliminating the tumor in one fell swoop was dashed.
Currently, medical doctors recognize that breast cancer is a systemic disease and the size of the surgical excision does not affect patient survival. In other words, there is no difference between the long-term efficacy and radical surgery if the patient preserves the breast and removes only the local tumor, together with radiotherapy, chemotherapy, endocrine therapy, etc.
Director Cui Shude showed data from a survey involving thousands of people in Europe and the United States over a 20-year follow-up period to prove this point: the 10-year survival rate in the breast-conserving group was 46%, compared to 47% in the radical group. Another large survey showed identical survival rates in the breast-conserving and cure groups.
”Cleaner excision is better” prevents breast-conserving surgery from being performed
In Europe and the United States, more than 50 percent of early-stage breast cancer patients underwent breast-conserving surgery, and in Singapore, the rate was as high as 70-80 percent, said Director Cui Shude: “In China, only 6 percent of patients underwent breast-conserving surgery, and this is probably the case in our hospital.” The answer from Li Meng Circle, director of breast surgery at the First Affiliated Hospital of Zheng University, is even more surprising: “I have done 4,000 breast cancer surgeries, of which breast-conserving surgery is less than 10.”
Why is it difficult to promote breast-conserving surgery? Cui Shude and Li Meng Circle, two breast specialists, believe that the problem of people’s awareness is the primary factor. Foreign women have a strong desire to preserve their breasts, and they even want their breasts for their lives. In contrast, domestic patients and their families do not have high requirements for post-operative quality of life, and “life preservation is important” and require “clean removal” as much as possible.
In addition, whether it is breast-conserving or radical treatment, there is a certain recurrence rate. Once a breast-conserving patient has a recurrence, the patient may think that the tumor was not cut cleanly. The doctor confessed that it is the fear of medical disputes that has prevented the application of breast-conserving surgery.
As an “emerging” surgical procedure in China, breast-conserving surgery can only be carried out in a small number of large hospitals. This is an important reason why breast-conserving surgery is not widely available.
Late consultation is also an important reason why doctors complain that breast-conserving surgery cannot be performed. The head nurse at one hospital had breast cancer that grew to 10 centimeters before she went to the doctor, which is understandable for the average woman with little medical knowledge. Li Jingruo said that it was hard to “touch” a patient who could have breast-conserving surgery, but they did not agree to do it.
Director Cui Shu De said that if doctors and patients’ perceptions are improved, “the number of people who accept breast-conserving surgery will rise from the current 6 percent to 60 percent”.
Breast-conservation is expected for tumors under 5 cm
Which breast cancer patients can undergo breast-conserving surgery? Director Li Meng Circle said that breast-conserving surgery can be done for tumors below 1 cm and far from the nipple. According to Cui Shu De, the indications for breast-conserving surgery are: tumor under 3 cm, more than 3 cm away from the nipple, and breast large enough. 3~5 cm tumor should undergo neoadjuvant chemotherapy before surgery, and after the tumor shrinks, breast-conserving surgery can also be done.
In the past, patients with early breast cancer not only had to have their breasts removed, but also had to have axillary lymph node dissection surgery. It was believed that the lymph nodes were the “transit point” for cancer cells to spread, so clearing them would help prevent cancer cells from metastasizing to distant places.
Later, medical doctors found that in many tumors, there is a pattern of station-by-station metastasis. Sentinel lymph node is the first lymph node of tumor lymphatic drainage, which can reflect the status of the whole axillary lymph node. If the biopsy of the anterior sentinel lymph node shows no metastasis, it is also unable to metastasize to distant places, and the more invasive axillary lymph node dissection can be avoided, thus avoiding a series of complications caused by the dissection: such as lymphatic leakage, upper limb mobility disorder, nerve damage, etc.
According to Director Cui Shu De, an anterior lymph node biopsy is a prerequisite for breast-conserving surgery. He gave an example of a retired physician who had a negative anterior lymph node biopsy and was able to preserve the breast without axillary lymph node dissection. However, the patient only agreed to breast conservation and eventually had an axillary lymph node dissection.
Two “sins” of radical surgery that affect function and damage aesthetics
The adverse effects of radical surgery on patients after surgery are many, said Li Meng circle director, radical surgery removed the pectoralis major and minor muscles, the patient’s arm function will be lost 40% to 50%. If you can lift 100 pounds before surgery, you can only move 50 pounds after surgery.
Many women who underwent radical surgery regretted it after surgery. After all, the breast is an important part of a woman’s physical beauty. During the interview, Director Cui Shu De opened several slides for reporters to watch, breast-conserving surgery has little “harm” to women’s body shape, while the flat breasts of radical surgery patients are alarming. The lack of female beauty is a big blow to the couple’s relationship, and also brings some impact to the social life of some patients.
Fortunately, breast reconstruction can make up for the lack of these women, said Director Cui Shude. Reporter Liu Kun Responsibility Editor: Ren Yuanfei