What is breast cancer?
1) Breast cancer is one of the most common malignant tumors in women, accounting for about 98% of malignant tumors in the breast. It is a malignant tumor that originates from the ductal epithelium of the breast.
2) In recent years, the incidence of breast cancer in China has increased significantly, and it has become the first or second most common malignant tumor among women, and the second leading cause of cancer death among Chinese women.
3) Although the incidence of female breast cancer is increasing year by year, with the improvement of early screening, diagnosis and treatment, the mortality rate of breast cancer in developed countries has decreased significantly.
What are the causes of breast cancer?
The causes of breast cancer are still unclear, and there are many studies on the risk of breast cancer, mainly related to the following factors:
1. Endocrine factors
The occurrence of breast cancer is related to the increased sensitivity of normal breast tissues to estrogen and other factors.
2.Menstrual period
As the menstrual cycle increases, the incidence of breast cancer increases. The risk of breast cancer decreases by 15% when the age of menarche is delayed by one year, while the risk of menopause increases by 3% when the age of menopause is delayed by one year. Compared with natural menopause, artificial menopause has a similar or even slightly better protective effect.
3.Lactation can reduce the risk of morbidity by 4.3%.
4.Hormone replacement therapy
The risk of breast cancer (mainly ductal carcinoma) increases with the use of hormone replacement therapy.
5.Gender and age
The risk of breast cancer is about 100 times higher in women than in men. This is one of the most important manifestations of estrogen’s influence on the development of breast cancer.
The risk of breast cancer increases with age.
6. Family history
Many studies have found that. In some families, breast cancer is more frequent. The risk of breast cancer in the first-degree relatives of breast cancer patients is 2-4 times higher than that of the general population, especially if the onset of breast cancer is bilateral or occurs before menopause.
The next generation of breast cancer patients will develop the disease about 10 years earlier than the previous generation.
If you have had breast cancer on one side, the chance of recurrence on the other side is two to three times higher than normal.
7. Exposure to radiation
Breast cancer is associated with radiation exposure, and the incidence of breast cancer is increased in patients with a history of chest radiotherapy.
8. Genetic background
In the healthy population, the lifetime risk of breast cancer among BRCA1/2 mutation carriers is as high as 60-70%. Although about 5-10% of breast cancer patients have a family history of the mutation, the true proportion of breast cancer associated with the inheritance of the mutation is about 3-5%.
9. Modifiable risk factors
The main ones include
Obesity (especially postmenopausal obesity)
Lack of exercise (people can reduce the incidence of breast cancer by 60% through long-term physical activity)
Breastfeeding can reduce the risk of breast cancer
Alcohol intake can increase the occurrence of breast cancer
What are the clinical manifestations of breast cancer patients?
General manifestations
The early stage of the disease is a painless, single, small lump in the affected breast, which is hard, not smooth and not clearly demarcated from the surrounding tissues.
2.As the lump increases, it can cause localized breast augmentation
3.If the lump involves Cooper’s ligament, it may shorten and cause depression of the tumor surface, which is called “dimple sign”.
4.The tumor near the nipple and areola may shorten the milk duct and cause flattening, retraction and depression of the nipple.
5. Blockage of subcutaneous lymphatic vessels causes lymphatic flow obstruction and dermal edema, resulting in the “orange peel sign”.
6.Late stage breast cancer invades the chest biscuit and makes the lump fixed and hard to push. Small nodules may appear on the skin and even fuse with each other, and sometimes the skin may break down and form ulcers.
7.Lymphatic metastasis of breast cancer is mostly seen in the armpit at first, the enlarged lymph nodes are hard, painless and can be pushed, but later the number increases and fuses into a mass, even adhering to the skin or deep tissue.
8.Breast cancer metastasizes to lung, bone, liver and brain with corresponding symptoms.
9.Some breast cancers have different clinical manifestations from normal breast cancers
Inflammatory breast cancer: The skin may be inflammatory at first, but soon it will extend to most of the skin of the breast, with redness, edema, thickening, roughness, and increase in surface temperature. Inflammatory breast cancer develops rapidly and has a poor prognosis.
Eczema of the nipple: It starts with itching and burning sensation of the nipple, and then the skin of the nipple and areola becomes rough and vesicular like eczema, and then forms ulcers, sometimes covered with yellowish brown scaly scabs. In some cases, lumps can be found in the areola area. Nipple eczema should be breast cancer: the malignancy is low and the development is slow.
What tests and examinations are needed to diagnose breast cancer in the hospital?
1.Clinical examination
Visual examination and palpation to understand whether there is any abnormality in the shape of the breast, whether a lump can be palpated, and the location, size, texture, mobility and pain of the lump. The lymph nodes in the axilla and the upper and lower clavicle.
2.Color ultrasound examination of both breasts and armpits
3.Mammography
4.Nuclear magnetic examination of the breast
5.Mammary ductoscopy
6.Puncture biopsy (fine needle aspiration, coarse needle aspiration, McMurdo biopsy, surgical biopsy)
V. What are the similar symptoms of breast cancer and other diseases?
It is not difficult to diagnose when there is a clear lump in the breast, but we should not ignore some early signs of breast cancer, such as thickening of local breast gland, nipple overflow, nipple erosion, local skin invagination, etc.
Breast cancer is easily confused with the following clinical manifestations and should be distinguished.
Fibroadenoma: It is common in young women, and most of the tumors are round or oval, with clear borders, high mobility and slow development. But women over 40 years old should not be easily diagnosed as fibroadenoma, and the possibility of malignant tumor must be excluded.
2, cystic hyperplasia of the breast: mostly seen in middle-aged women, characterized by swollen breasts, lump size with menstrual cycle changes.
3, plasmacytoid mastitis: is a sterile inflammation of the breast tissue. Most of the acute inflammatory manifestations, part of the chronic inflammatory manifestations. Performance of the areola lump, the boundary is unclear, there may be skin adhesions and nipple invagination, the skin can be orange peel-like changes when the lump is large.
4, breast tuberculosis: long course, slow development. Local manifestations of lumps in the breast, lump boundaries are sometimes unclear, activity can be limited, there may be pain.
5.Fat necrosis: with a history of trauma, the lump is hard in texture.
How to detect breast cancer in early stage?
How to treat breast cancer?
The most effective treatment strategy for breast cancer is “early detection, early diagnosis and early treatment”. Generally speaking, the 10-year survival rate of early stage breast cancer is over 90%, while the 10-year survival rate of advanced breast cancer is less than 30% or even lower.
(A) Early detection of breast cancer
The effective methods of early detection are self-examination and regular medical check-ups.
1. Steps of self-examination
1) Stand in front of a high dressing mirror.
2) Lower your arms naturally and put your hands on your hips.
3) Observe whether the bilateral breasts are roughly symmetrical, whether one side is enlarged, whether there are local skin bulges, depressions and skin color changes. Observe whether the nipples are at the same level and whether they are retracted and invaginated.
4) Raise one arm above the head.
5) Examine the contralateral breast with alternating hands. Touch the subcutaneous and deep tissues of the breast with the fingertips to detect any lumps, especially painless single isolated swellings.
6) Carefully examine the entire breast. One way to prevent omission is to divide the breast into four quadrants centered on the nipple and carefully examine each quadrant, paying special attention not to omit the “axillary tail of the breast” protruding from the upper outer quadrant toward the armpit.
7) Lie on your back and alternate hands to palpate the contralateral breast for lumps.
8) Palpate the nipple and its lower tissues for lumps, and gently squeeze the nipple and its lower tissues to see if there is fluid flowing from the nipple.
2. Time for self-examination
For pre-menopausal women, self-examination is recommended to be performed at a fixed time within two or three days just after menstruation, when the menstrual cycle has the least impact on the breast and the breast is the softest, so it is easy to find breast abnormalities. Postmenopausal women can choose the first or last day of the month.
3, self-examination of the “seven P” method
1) Position: Observe your breasts in front of a mirror and palpate them in different positions. When lying down, first put a pillow under one shoulder and check the same side of the breast, check the opposite side in the same way, and then lie flat and check both breasts alternately.
2) Perimeter: A complete examination of the entire breast, including the nipple, axillary caudal part of the breast, and axillary lymph nodes.
3) Palpation: Touch the entire breast with the fingertips and do not take your fingers off the breast during the entire procedure.
4) Pressure: First touch the breast with a small amount of pressure, then with a medium amount of force, and finally with a larger amount of pressure.
5) Mode (Pattern): There are different orders and modes of examination, and each woman can choose the mode she feels most comfortable with. You can move your fingers up and down along the breast and examine from the inside out with the nipple as the center, or you can palpate outward in a circular motion with the nipple as the center. Do not forget to examine the axillary tail and axillary fossa.
6) Practice: Repeated practice makes you familiar with the sensation of palpating your own breast tissue so that you are aware of changes when they occur. A professional doctor can provide feedback on the correctness of your examination method to improve the level of self-examination.
7) Plan: You should know exactly what to do when you become aware of abnormal changes in your breast tissue. You should know your family’s history of breast cancer and have regular mammograms (mammograms) and other ancillary examinations as recommended by your medical professional.
Although seven or eight out of ten breast lumps found by breast self-examination are harmless, they should still be reported promptly to a medical professional. Although most breast cancers are first detected by the patient herself, breast self-examination combined with regular annual checkups by a medical professional is the best way to detect breast disease early. A lump in the breast that can be detected by a medical professional can easily be missed by a woman who self-examines. For the same reason, it is ideal to learn about self-examination from a medical professional.
Self-breast examination is not a substitute for examination by a medical professional, nor is it a substitute for trusted ancillary examinations such as mammograms (mammograms), breast ultrasound and breast MRI.