Pink Ribbon
Breast cancer is the main malignant tumor that endangers the physical and mental health of all women. About 200,000 women worldwide develop breast cancer every year, and about 500,000 die from it. In China, the incidence of breast cancer is 20/100,000 per year, and in some big cities, it reaches 40-50/100,000. In the past 20 years, breast cancer has accounted for the first place of female malignant tumors.
Therefore, it has become an urgent task for preventive medicine and clinical medicine workers to actively and seriously implement the tertiary prevention strategy for breast cancer and control the occurrence and development of breast cancer.
The Pink Ribbon, a symbol of the global breast cancer prevention and treatment movement, has a 12-year history. It was founded by Evelyn Lauder, senior vice president of Estee Lauder Group. It was launched in 1992 in the United States by Evelyn Lauder, senior vice president of Estée Lauder, and Ms. Penny, editor-in-chief of Self magazine. World Breast Cancer Awareness Month is celebrated every October. During this month, women from all over the world wear pink ribbons on their chests and volunteer to distribute breast cancer awareness brochures to inspire women to prevent and beat the disease.
The three levels of breast cancer prevention
Level 1: Primary prevention is the prevention of the cause of the disease. It mainly refers to the measures to address the causes and enhance the body’s ability to resist breast cancer. Since the mechanism of breast cancer is not fully understood, primary prevention is still in the exploratory and experimental stage.
I. Lifestyle changes
Many risk factors for breast cancer are unavoidable, such as menstrual history, childbirth history, family history, etc. However, many factors are man-made. However, there are also many factors that are man-made, such as dietary habits. Although the increased risk of cancer from obesity and high-fat diet is not fully proven yet, it is believed that the adjustment of diet and other aspects will play a role in the prevention of breast cancer.
1. During adolescence, the intake of fat should be properly controlled, and the intake of meat, eggs, butter and sweets should be restricted in large quantities. Increase the intake of fresh vegetables, fruits and carotenoids. Increase physical activity appropriately to reduce excessive fat accumulation in the body, maintain a better body shape, delay the age of sexual maturity, postpone the time of the first menstruation, and also help the establishment of regular menstrual cycle.
2.Unnecessary radiation exposure should be avoided during puberty, especially on the eve of the first menstrual period.
3. Breastfeeding is strongly promoted and encouraged. Breastfeeding is not only beneficial to the health of the baby, but also reduces the risk of breast cancer.
4. Menopausal women should avoid the use of estrogen. When using exogenous estrogen therapy for menopausal syndrome, the dosage and course of the drug should be strictly controlled.
5.After menopause, they should participate in more physical activities within their ability to reduce excess body fat so that the process of estrogen synthesis can be minimized.
6. Actively treat various precancerous lesions of breast cancer, such as breast fibroadenoma and high hyperplasia of breast lobular epithelium.
II. Health care promotion
The prevention and treatment of breast cancer, just like the prevention and treatment of infectious diseases, must be carried out with the participation of relevant governmental functions and the combination of professionals and grass-roots medical and nursing workers, using mass media such as pictures, slides, radio, television, movies and pamphlets to popularize the knowledge about breast cancer prevention to thousands of households and to stimulate the conscious preventive behavior of women, so that they can realize that losing weight, Maintaining an ideal body shape, avoiding or reducing the use of estrogenic drugs after menopause, drinking less alcoholic beverages, participating in more social activities and physical exercise, avoiding or reducing mental stimulation, and maintaining a healthy psychological state are very important for breast cancer prevention.
Secondary prevention: Secondary prevention is pre-hospitalization prevention, which includes screening, self-examination and outpatient examination by physicians.
I. Screening of breast cancer
In 1993, Miller et al. observed and analyzed the relationship between breast cancer screening and breast incidence and mortality in the United States. Among them, 42% were detected by X-ray photography alone, 9% by physical examination by physicians, and 47% by a combination of both. Among all detected cases, small breast cancers less than 1.0 cm in diameter accounted for 30%, and those with lymph node metastasis were less than 20%, which fully illustrates the significance of screening.
(I) Principles of screening
The principles of breast cancer screening, which are mainly carried out in high-risk groups, were proposed by the American Cancer Society in 1980 as follows
1.Women older than 20 years old should self-examine their breasts once a month.
Women aged 20-40 years should be examined by a specialist once every 3 years.
3.Women over 40 years old should be examined by a specialist once a year.
4.Women aged 30-35 should have a mammogram for future comparison.
5.Women between the ages of 35 and 50 should consult a specialist to determine the number of mammograms, depending on the circumstances.
6.Women over 60 years old should have one mammogram per year.
(B) Determination of high-risk group for breast cancer
High-risk group refers to those who have a high chance of developing breast cancer. There is no unified standard for determining the high-risk group, but it is based on the incidence of breast cancer in a certain population and the combination of risk factors. Common risk factors include: female, increasing age, family history of breast cancer at low age, early menarche, late menopause, advanced age without childbearing, hormone replacement therapy, benign proliferative breast disease BRCA1 and BRCA2 gene mutations, etc.
(C) Screening methods
1.Mammography
Although some data show that the lesions detected by screening precede the clinical manifestations and the average advance time is up to 6.5 years, the number of new cases of breast cancer caused by X-ray may be roughly equal to the number of breast cancer deaths prevented by screening, therefore, it should not be applied to young (breast tissue is in sensitive stage), and menopausal women can be examined once at an interval of 2-3 years.
2.Breast puncture biopsy
After mammography, further puncture biopsy is needed for cases with suspicion of breast cancer. This method is highly sensitive, specific and accurate in diagnosis, and is especially suitable for cases with lumps or nodular lesions in the breast that are difficult to characterize.
Qualitative diagnosis of breast swelling fast.
Determination of whether there is hyperplasia in the breast tissue and the degree of hyperplasia.
Cytologic and histologic diagnosis of suspected breast tumor cases.
Hormone receptor determination of breast tissue or breast tumor tissue.
3.Breast ultrasound
The detection rate is slightly lower than that of X-ray, and it is non-invasive and can be repeatedly examined at any time.
4.Magnetic resonance
High sensitivity, but expensive.
Second, self-examination of the breast
According to some data, the 5-year survival rate of breast cancer is 75% in the self-examination group and 57% in the non-self-examination group. Self-examination of the breast can indeed detect breast cancer at an earlier stage.
(i) Advantages
No damage to the body. Not limited by economic conditions and time. Does not require professional participation and does not affect women’s self-esteem. Self-examination reveals small breast cancer lumps, low lymph node metastasis rate and better prognosis.
(II) Methods of breast self-examination
1.Professionals should first let women understand the normal physiological anatomy of breast, and then conduct 1-2 times of instruction on specific methods.
2.See and examine.
(1) Sitting position: arms crossed at the waist, so that the pectoralis major muscle is in a contracted state, or both upper limbs are stretched upward.
(2) Standing position: both upper limbs straightened to the sides, bending forward at 90°, with breasts naturally drooping.
(3) Content: Observe the bilateral breast shape in front of the dressing mirror to see if it is symmetrical and if there are any skin depressions, “orange peel-like” changes, bulges, edema and other abnormalities. Whether there is nipple retraction, erosion, overflow and change of orientation, etc.
3. Palpation: Lie flat on the bed, with the arm of the side being examined stretched upward and the shoulder slightly padded with a pillow. The fingers of the opposite side are stretched out together, the palm fingers are in a plane, touch the breast and axillary lymph nodes with the finger belly (palm surface), do not grasp and pinch the breast gland with your fingers.
4. Check yourself once a month 7-10 days after your period and compare the results with the previous month. If you find any of the following conditions, you should go to a specialist clinic for consultation and examination in a timely manner
Bilateral breast asymmetry.
Nodules and lumps are found in the breast, the size and hardness of which are not related to the menstrual cycle.
Edema, indentation, and unsmoothness of the breast skin.
Breast overflow, retraction or change in orientation.
Eczema-like changes in the areola area.
Third, specialist examination
1.Screening of breast disease by specialists in units with high concentration of women.
2.Tell women with high risk factors of breast cancer to go to the specialist clinic regularly for examination.
3. To establish breast disease files for scattered high-risk groups that are located in inaccessible areas, and to monitor and follow up them closely (letter visits).
Tertiary: Tertiary prevention of breast cancer refers to the active and comprehensive treatment of breast cancer patients, especially those in the middle and late stages, in order to prolong their survival and improve their quality of life. Although the correct diagnosis rate of early breast cancer is gradually increasing, 30%-80% of patients in some economically underdeveloped countries and regions are still diagnosed at advanced stages of breast cancer. Even in economically developed regions, stage II-IV breast cancer accounts for 29% of all breast cancers. Therefore, active comprehensive treatment of these patients, mainly surgery, as well as perioperative, chemotherapy and radiotherapy care, is of vital importance to improve the quality of tertiary prevention of breast cancer.