The global incidence of breast cancer is steadily increasing, but the mortality rate is on the decline, mainly due to early detection and standardized treatment.
There are three major characteristics of breast cancer patients in China
Incidence rate is increasing year by year
A trend of youthfulness
High proportion of middle and late stage.
The most prominent clinical problems of breast cancer exist at present.
Irregularities are common.
The prognosis of patients is not optimistic.
There are nine common misunderstandings in the diagnosis and treatment of breast cancer
Etiology Treatment strategy Endocrine drug selection
Imaging, selection of surgery, timing of radiotherapy indications
Pathological examination Dosage of chemotherapy regimen Treatment of recurrent metastatic cases
Myth 1: Lobular hyperplasia is a precancerous lesion
Giving patients long-term “anti-proliferative” drugs to prevent breast cancer is a huge waste of social resources and adds an unnecessary psychological burden to patients.
The pathology report of breast lumps after excision is highly atypical hyperplasia of breast epithelium is indeed precancerous, but do not confuse these two types of hyperplasia.
Misconception 2: Excessive trust in “infrared” examination results
”Infrared” examination has many interfering factors and large errors, and its independent diagnostic value is small. Experienced breast surgeons rarely choose this test.
Ultrasound and mammography are the most important imaging examinations to detect breast cancer.
The use of MRI has increased in recent years, especially to assess the extent of local infiltration of the lesion and the presence of occult lesions before breast cancer patients undergo breast-conserving surgery.
Ultrasound is more suitable for younger patients p with smaller breasts, and it has its unique value in identifying the cystic nature of the mass p observing blood flow.
X-ray mammography is more appropriate for patients aged 35 years or older with sagging breasts and has advantages in detecting microcalcified foci.
Myth 3 Fine needle aspiration p hollow needle aspiration, intraoperative freezing is of unclear value
Fine needle aspiration is to puncture the lump with an ordinary syringe, aspirate it, and then do a smear examination, which can be used for clinical reference and further examination if there is any abnormality, and cannot be used as a basis for confirming the diagnosis.
Hollow needle puncture Is to use a cannula needle, placed inside an ejection device (also called a puncture gun) to excite, with several strips of tissue, to do pathology can confirm the diagnosis, can do immunohistochemistry at the same time, 5-10% miss rate and underestimation rate.
Intraoperative freezing It is direct surgery to remove the lump and immediately send it to pathology department for quick freezing and doing section to see if it is malignant. This method can confirm the diagnosis but has 2-3% underestimation rate, not suitable for locally advanced breast cancer or inflammatory breast cancer, and rarely carried out in county level or below.
Misconception 4 Treatment strategy All treatment methods are used in one go.
It should be analyzed on a case-by-case basis to decide those means and choose the appropriate timing and treatment according to different situations.
Surgeons often focus only on surgery and not on systemic treatment. However, most breast cancer patients eventually die from distant metastases.
Systemic therapies such as chemotherapy, endocrine therapy and the recently developed biologically targeted therapies should be given more attention by doctors, especially surgeons.
Highlighted are direct surgery for locally advanced breast cancer (LABC) or inflammatory breast cancer.
Routine management should be
Locally advanced breast cancer → hollow needle puncture to confirm the diagnosis → neoadjuvant chemotherapy (individual endocrine therapy) → lump shrinkage (preferably disappearance) → surgery → completion of chemotherapy → radiotherapy → decision of endocrine therapy according to ER or PR status
It is better to do HER-2,positive specimen after puncture or surgery, and do FISH to see if biological targeting therapy is needed.
Misconception 5: Selection of surgery
Many surgeons think that breast cancer surgery is equal to mastectomy + axillary lymph node dissection, which is very common in hospitals with backward medical level or among non-professional doctors.
At present, the breast cancer breast conservation rate in China is less than 10%, while it is about 50% in the United States.
For stage IpII breast cancer patients, doctors should assess whether the patient can undergo breast-conserving surgery, inform the patient, and negotiate with him/her about the surgical method and treatment strategy.
The prognosis and recurrence rate of breast-conserving + radiotherapy for early-stage breast cancer patients are not statistically different compared to conventional surgery.
The detection of anterior lymph nodes gives hope to preserve the axilla, but if there is no metastasis in the axillary lymph nodes, axillary dissection is traumatic and has no therapeutic value.
The conventional procedure has a 3% axillary lymph node miss rate, and axillary preservation is permissible if the anterior missed rate is <5%.
Breast preservation and axillary preservation are the perfect combination of technological development and humanistic care.
Myth #6: Choosing a medically accepted and effective option is not based on the results of evidence-based medicine
Outstanding issues
1 Self-created chemotherapy regimen
2 Low dose, not strictly calculated according to body surface area, and arbitrarily reduced dose to prevent toxic side effects
3 Initial treatment selection of non-first-line drugs such as cisplatin, mitomycin and other drugs
4 arbitrary change of regimen, should be effective adherence, ineffective must be changed
5 Healthy life for many years, preventive chemotherapy
Misconception seven endocrine therapy is not understood, do not pay attention to the side effects of drugs
Expressed in.
1 Premenopausal women use aromatase inhibitors (menopause is not equal to menopause)
2 Patients taking oral tamoxifen do not pay attention to liver and uterine ovarian condition
3 Patients are advised to have their ovaries removed as long as they are ER or PR positive, regardless of the stage of the disease
Misconception 8: Radiotherapy is not indicated as long as there is no metastasis in axillary lymph
If the tumor diameter exceeds 5 cm before surgery or invades the skin and chest muscle, radiotherapy is required for the chest wall even if there is no lymphatic metastasis.
Patients with locally advanced breast cancer, who have been treated with neoadjuvant therapy, must be treated with radiotherapy after surgery
Emphasize that the pathology department should detect as many lymph nodes as possible to provide accurate and comprehensive information for the comprehensive treatment of postoperative patients
Clinicians assess the size of the tumor with a ruler and a strict attitude.
Selection of radiotherapy timing
Radiotherapy immediately after surgery.
Radiotherapy after six months after surgery
This is not suitable. Generally, radiotherapy should be completed within six months after the end of conventional chemotherapy and after surgery.
Myth 9: Once the metastatic breast cancer is recurrent, chemotherapy is the only treatment.
The patient wants to destroy the lesion through chemotherapy.
Patients often have poor quality of life due to the toxic side effects of chemotherapy.
The patient’s regression is far more important than the regression of the tumor itself.
If the patient is a recurrent metastasis after many years, there is no visceral crisis, progress is slow, and patients with positive ER or PR can give priority to endocrine therapy.
Summary
Breast cancer is a common disease p multi-morbidity, its diagnosis and treatment is not simple, there are still many controversies and problems, and the progress is very fast.
Only by keeping pace with the times and giving patients scientific p standardized p reasonable comprehensive treatment can doctors strongly guarantee the long-term survival of breast cancer patients.