Source: People's Daily Overseas Edition
Photo by Hu Xiaofei (People's Vision)
On August 19, in Jinhua Central Hospital, Zhejiang Province, experts from the hospital's thoracic, infectious, breast and other departments communicated face-to-face with the consultants during the Doctor's Day free clinic to see and solve their doubts.
World Breast Cancer Awareness Month is celebrated annually in October, and Breast Cancer Prevention Day is celebrated on October 18. Breast cancer is one of the most common cancers in women worldwide, but it is still poorly understood by many people. How to stay away from breast cancer? Recently, Fang Yi, chief physician of the Department of Breast Surgery of the Cancer Hospital of the Chinese Academy of Medical Sciences, made an interpretation.
How far is "breast nodules" from "breast cancer"?
"Breast cancer is a malignancy that originates in breast tissue, often starting in the ducts or lobules of the breast." According to Fang Yi, the latest data from the National Cancer Registry Annual Report shows that breast cancer ranks second in the incidence of malignant tumors among Chinese women. In 2022, there will be about 357,200 new cases of breast cancer in mainland women, and the age-standardized incidence rate is 51.17 per 100,000.
"The causative factors of breast cancer are very complex." According to Fang Yi, the main causes of breast cancer include genetic factors, hormonal factors, population aging, changes in fertility patterns, unhealthy lifestyles, environmental pollution, etc. For example, in terms of genetics, BRCA1 and BRCA2 gene mutations are the most well-known hereditary breast cancer-related genes, and the lifetime risk of breast cancer can be as high as 80% in carriers. Early menarche, late menopause, nulliparity, or late childbearing may increase the risk of breast cancer, and long-term use of estrogen replacement therapy may also increase the risk of breast cancer; In terms of lifestyle, long-term drinking, smoking, sedentary, lack of exercise, high-fat diet, irregular work and rest, obesity (especially postmenopausal obesity) will increase the risk of breast cancer; In terms of the environment, long-term exposure to ionizing radiation and environmental pollutants may also increase the risk of breast cancer.
The most common abnormal result in a physical examination of the breast is "breast nodules" or "breast hyperplasia". When these abnormalities are detected, many people are most worried about - will it develop into breast cancer?
"There is indeed an association between breast nodules, breast hyperplasia and breast cancer, but this association is complex and needs to be properly understood." According to Fang Yi, breast nodules are not the name of a disease, but a descriptive term that refers to a palpable or localized mass visible on imaging in the breast, which may be benign (such as fibroadenoma) or malignant (such as breast cancer). Most breast nodules are benign but require regular follow-up; If the nodule is not well shaped or continues to grow larger, it is a sign that it is malignant and requires further investigation for breast cancer.
According to Fang Yi, breast hyperplasia refers to an increase in the number or volume of breast tissue cells. According to the pathological features, it can be divided into common hyperplasia and atypical hyperplasia. Among them, atypical hyperplasia is considered to be a prodromal lesion of breast cancer, and the risk of developing breast cancer is 4-5 times that of the general population. If atypical hyperplasia is found in the breast, it is necessary to go to a regular breast specialist for follow-up examination in time, follow the doctor's advice, and take corresponding examination and treatment.
The more frequent the breast nodules and the higher the grade of the nodules, the greater the risk of developing breast cancer?
Fang Yi introduced that the following aspects should be considered for the risk assessment of breast nodules-
Number of nodules: Multiple benign nodules do not necessarily increase the risk of cancer.
Characteristics of nodules: malignant nodules usually show irregular morphology, blurred edges, etc.
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Dynamics: rapid enlargement of nodules or new nodules should be suspected.
"Although there is an association between breast nodules and breast cancer, not all nodules will develop into cancer, and the characteristics, grades, and dynamics of nodules are more indicative of the potential risk of malignancy than the number alone." Regular follow-up, individualized assessment and biopsies if necessary are recommended, while maintaining a positive mindset, Fang said.
Does breast cancer come out of "gas"?
People often say that "breast cancer comes out of gas", is this statement reliable?
"The statement that 'breast cancer comes out of gas' is too simplistic and has no direct scientific basis to support it." However, long-term psychological stress and bad emotions may indeed have a certain impact on the occurrence and development of breast cancer: long-term stress may lead to a decline in immune function, potentially affecting the body's ability to monitor and eliminate cancer cells; Depression, anxiety and other emotions may lead to unhealthy lifestyles, such as alcoholism, smoking, lack of exercise, etc., which indirectly increase the risk of breast cancer; Psychological stress can affect the neuroendocrine system, potentially affecting hormone levels, especially estrogen levels.
"It is important to emphasize that psychological factors are not the direct cause of breast cancer, but one of many risk factors." Fang Yi said that maintaining a positive and optimistic mindset is indeed good for overall health, but it is not a substitute for scientific prevention and treatment.
How to Prevent Breast Cancer?
Fang Yi reminds that in daily life, women should avoid exposure to chemicals such as polycyclic aromatic hydrocarbons and bisphenol A, which may affect breast health by interfering with the endocrine system. At the same time, do not misuse or abuse hormone beauty products and health care products, although most of the beauty products and health care products sold through formal channels are safe, it is still necessary to pay attention to the hormone ingredients, heavy metals and other chemical additives contained in some products may have potential health risks, when purchasing beauty products or health care products, you should try to choose products that have passed strict quality certification, and avoid long-term use of health care products containing estrogen.
How do I know if my breasts are healthy? What are some common forms of breast cancer screening?
"At present, it mainly includes mammography, i.e. mammography, ultrasonography and magnetic resonance imaging (MRI)." According to Fang Yi, it is generally recommended that women over the age of 40 undergo breast ultrasound or mammography screening every 1-2 years, while high-risk groups should be screened once a year from the age of 35. In addition, breast self-examination is also a simple and effective method to help women detect breast abnormalities early, it is recommended to check once a month, the best time is 7-10 days after the end of menstruation, the specific steps are as follows-
Inspection: Stand in front of the mirror with your hands hanging down naturally, observe whether the size and shape of the breasts are symmetrical, check whether the skin is sunken, wrinkled or discolored, and whether the nipples are inverted or discharged. Repeat the above steps by raising your hands high above your head or crossing your hips to squeeze the pectoralis major muscles.
Palpation (standing or sitting): Elevate the arm and touch the entire breast with the other hand in small circles from the outside to the inside, using light, medium, and heavy force, paying special attention to the outer upper quadrant close to the armpit. Gently press on the nipple to check for discharge.
"It is important to note that breast self-examination is not a substitute for professional examination." Fang Yi said that it is recommended that women conduct regular self-examinations, familiarize themselves with the state of their breasts, and seek medical attention in time if they find abnormalities.
Can Chest Massage Reduce Breast Cancer Risk?
Breast massage can eliminate lumps and reduce the risk of breast cancer, and folk remedies can treat breast cancer...... These rumors about breast cancer have been circulating for some time now, are these claims true?
"These claims lack scientific basis, breast massage cannot treat breast tumors, folk remedies are not only ineffective, but may also delay treatment, standardized medical methods are still the key to breast cancer treatment." Fang Yi said that for healthy breasts, moderate breast massage can improve local circulation, increase comfort, from the perspective of traditional Chinese medicine, dredging the meridians, is beneficial to breast health, but breast massage will not improve women's genetics, nor does it change the hormone level in women's bodies, all the claims that "breast massage can reduce the risk of breast cancer" propaganda is exaggerated, excessive massage, improper massage may also damage breast tissue. In addition, there are also biased beliefs among some people, such as "men don't get breast cancer", "wearing a bra increases the risk of breast cancer", "breast cancer always has obvious symptoms such as pain", etc., which are not true.
Fang Yi reminds that the early signs and symptoms of breast cancer may not be obvious, and some patients may even have no symptoms at all, but it is still very important to understand the following possible early symptoms -
Breast lumps: the most common early symptom, usually painless, firm in texture with irregular borders, which may be fixed in the surrounding tissues and do not change with menstruation.
Breast skin changes: dimpling, wrinkling, orange peel changes, or local skin redness, warmth, edema, etc.
Nipple changes: Sudden inversion of the nipple, or scaling, crusting, or ulceration of the nipple or areolar skin.
Nipple discharge: unilateral, spontaneous, bloody discharge should be suspected.
Changes in breast size or shape: Significant asymmetry in the breasts.
Axillary or supraclavicular mass: may be a sign of lymph node metastasis.
Breast pain: Although most breast cancers are painless in the early stages, persistent local pain is a cause for concern.
Breast skin color change: Localized redness, purple, or abnormal color of the skin.
"After finding suspicious symptoms, you should go to a professional hospital for imaging and biopsy in time, avoid self-diagnosis, and pay attention to maintaining a healthy lifestyle." Fang Yi reminds that the cureability of breast cancer depends on a variety of factors such as the stage, type and molecular subtype of the cancer, and breast cancer detected early and treated in time usually has a higher cure rate. In some developed countries, the five-year relative survival rate for breast cancer has reached around 90%, meaning that many patients can survive for a long time or even be completely cured. Of course, even early-stage breast cancer requires long-term follow-up to confirm whether it is completely cured.
According to Fang Yi, the main treatment methods for breast cancer include surgical treatment, radiotherapy, chemotherapy, endocrine therapy, targeted therapy, immunotherapy, etc., and the treatment plan usually combines a variety of methods and is individualized according to the specific situation of the patient.
Does having breast cancer mean having the entire breast removed?
"No, breast-conserving surgery has become a common option for many patients, and comprehensive treatments such as postoperative radiotherapy can achieve better treatment results while preserving the shape of the breast." According to Fang, breast-conserving surgery plus radiotherapy is comparable to the long-term survival rate of total mastectomy in many cases. Therefore, in the case of meeting the indications, breast-conserving surgery is an excellent option. Even if a total mastectomy is required, modern breast reconstruction techniques can help patients maintain their body image by reconstructing the breast at the same time or after the excision. "It is important to weigh multiple factors such as the curability of the surgery, the cosmetic effect, and the psychological acceptance of the patient, and formulate the most suitable individualized treatment plan for the patient."
In addition to medical treatment, comprehensive psychological and social support is essential for breast cancer patients to recover and improve their quality of life. For example, psychological counseling can help patients cope with emotional stress, and cognitive behavioral therapy can adjust negative thoughts. Family support and partner relationship counseling are also important for the patient's day-to-day care and intimacy.
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People at high risk of breast cancer
Women with a family history of breast cancer: if a first-degree relative (mother, sister or daughter) has a breast cancer patient, the risk is increased by 1.5-2 times; People who have more than one relative with cancer or a family history of male breast cancer are at higher risk.
Women with high-risk gene mutations: BRCA1/2 gene mutation carriers, as well as those with mutations in other high-risk genes (such as TP53, PTEN, CDH1, STK11, PALB2, etc.), have a significantly increased risk of breast cancer.
Women with a history of breast cancer have a 3- to 4-fold increased risk of cancer in the contralateral breast and a higher risk of recurrence in the ipsilateral breast.
Women with high-risk breast cancer lesions: for example, the risk of atypical ductal hyperplasia is increased by 4-5 times, and the risk of lobular carcinoma in situ is increased by 8-10 times.
Women with long-term estrogen exposure: women younger than 12 years of menarche, older than 55 years of menopause, nulliparous or older than 30 years of age at first delivery, and those who have been on hormone replacement therapy for a long time (>5 years) are at higher risk.
Women with dense breasts: People with high density of breast tissue are associated with an increased risk of breast cancer.
Women who have previously received radiation therapy to the chest: For example, people with Hodgkin lymphoma have an increased risk of breast cancer after receiving radiation therapy to the chest.
Obese women: especially postmenopausal obesity (BMI >30kg/m2), the risk of breast cancer is increased.
Women who drink alcohol for a long time: Women who drink more than 1 standard drink per day have an increased risk of breast cancer.
Women who have been using oral contraceptives for a long time: the risk increases with longer use, but the risk gradually decreases after discontinuation.