Pineapple said
Breast cancer has become the first killer of women's health, and in this issue of the pineapple parlor, Luo Ting, director of West China Hospital of Sichuan University, was invited to talk about what we can do in the face of it. The following is a selection of live Q&A:
Luo Ting
Doctor of Medicine
Deputy Director of the Department of Oncology, West China Hospital, Sichuan University
essentials
1. At present, breast cancer is the first cancer in incidence, but as long as it is diagnosed early and treated early and standardized treatment, the overall mortality rate is not high.
2. Risk factors include both modifiable and immutable factors.
3. Most of the food can be eaten, as long as the food is moderate, diversified intake is good.
4. Not all healthy people need genetic testing.
Pineapple: The recent new Chinese cancer report says that breast cancer is the number one cancer in women, more than lung cancer, so what is the trend of breast cancer in China now, and why is this so?
Director Luo: The latest global cancer burden report in 2020 shows that there are 2.26 million new cases of breast cancer every year, exceeding the 2.2 million of lung cancers, becoming the first cancer in incidence.
Two days ago, the 2016 data released by the National Cancer Center of China, we can see that the incidence of breast cancer in the mainland ranks first, but the mortality rate of breast cancer is not the highest, which indirectly shows that breast cancer currently has a good comprehensive treatment method.
At present, with the continuous improvement of the standardization of breast cancer clinical diagnosis and treatment in recent years, the 5-year survival rate of breast cancer patients in mainland China has reached 83.2%. For a considerable number of very early, less than 2cm stage I breast cancer 5-year survival rate will be higher, of course, all the data must be based on standardized treatment, so we are now pursuing "three early": early detection, early diagnosis, early treatment.
In European and American countries, the proportion of early breast cancer is higher, thanks to its perfect early screening system. Relatively speaking, the staging of the first diagnosis in China will be a little lower, so I hope that everyone can include breast screening in the annual physical examination.
Cancer is not terrible, now cancer has a lot of treatment methods, afraid that you usually do not pay attention to it, once found is advanced. To share with you the self-teasing things between our doctors, if I have no way to escape malignancy in my life, then my first choice is thyroid cancer, and my second choice is breast cancer.
Pineapple: What factors increase the risk of breast cancer?
Director Luo: We generally divide the risk factors into two categories, the first is controllable and changeable factors. The first is diet, followed by exogenous estrogens, including some drugs, or some supplements that you don't know much about the specific ingredients because they may contain estrogen. The other is radiation exposure, such as some people receiving some chest radiation therapy before the age of 30.
It is recommended not to give birth too late, it is advisable to start having children at the age of 25-30, and breastfeeding is recommended, which is important for both the nutritional intake of the child and the mother. The World Health Organization recommends exclusive breastfeeding for at least half a year, and in some European guidelines, it is even recommended that after the addition of complementary foods, breastfeeding can also be continued, up to two years without problems.
Living habits are also controllable, do not develop bad living habits, smoke and drink do not touch. In addition, obesity, bad mood, etc. are also modifiable risk factors.
Since there are factors that can be changed, there must also be factors that cannot be changed. For example, some endogenous estrogens are often reflected in women who have early menarche (less than 13 years old) and late menopause (more than 55 years old). These women are exposed to estrogen for a long time, so there is a certain risk. But this is a risk, not a determining factor, not that menstruation comes at the age of 12, and it seems that you can't run away in this life, absolutely not.
The compactness of the breast glands is also proportional to the risk of breast cancer, many friends will also ask whether there is a relationship with the size of the chest, in fact, the chest not only has glands, but also fat tissue, Women in Europe and the United States do have a larger chest, but the fat is more, and Asian women are more dense.
Some benign diseases of the breast, such as atypical hyperplasia, can also increase the risk.
In addition, if there is a family history, the risk of breast cancer is higher than that of the general population. In particular, risk genes such as BRCA have been clearly found in the family, which may come from the mother or the father.
In short, there are many controllable and uncontrollable factors. We can't change what we are born with, we can do more planning and efforts for ourselves on controllable factors, put down the pressure, and enjoy every day, which I believe is also the most touching point for everyone in recent times.
Pineapple: During menopause, some women will use estrogen replacement therapy, will it increase the risk of breast cancer after using it, and now what is clinically recommended?
Director Luo: It's not that we can't do this at all, but I hope that before doing this, we must first screen the breast itself for problems, and if there is a problem, then we have to solve the problem of the breast first.
Including authoritative journals like The Lancet, relevant research data have also been published, and perimenopause hormone replacement therapy does increase the risk of some breast cancers. But we must not be killed with a stick, it is two-sided, for example, it can indeed improve the quality of life, and even for bones, cardiovascular health is also beneficial.
When we want to supplement estrogen for a long time, we must fully weigh the pros and cons, consider clearly at this stage, pay more attention to which piece of demand, try to make it balanced, this actually needs a professional doctor to provide advice for everyone, breast screening should also keep up.
Pineapple: How old is the youngest breast cancer patient you've ever met?
Director Luo: The youngest I've ever met is 18 years old. When it comes to the age of illness, China is still a little different from Europe and the United States, Europe and the United States are relatively more postmenopausal patients, and China's various data show that the age of onset is 10 years younger than europe and the United States, and there are more premenopausal or perimenopausal patients.
This involves epidemiology, domestic and foreign patients in some diseases in the performance of the disease is different, now in the domestic oncology field, there are also very good and suitable for Chinese diagnosis and treatment guidelines and programs introduced.
So we don't have to blindly advocate foreign countries. When encountering some patients must choose imported drugs, I often say that There are many good drugs in China that are exported, and they are also called imported drugs in the hands of foreigners, so they are not simply distinguished by foreign and domestic, and those that are suitable for your condition are the best. Trust the doctor and use the doctor's expertise to make the most optimal recommendation for you.
Pineapple: 26 years old with breast cancer, can you have children after treatment?
Director Luo: There are still quite a lot of breast cancer in young people, and it is recommended to go to the corresponding reproductive genetics specialist to do some consultation before treatment. Chemotherapy and targeted therapy do have an impact on ovarian function, but there are also many protective means, such as freezing eggs, ovarian tissue, embryos, etc. Even if these do not work, there are some drugs that can also protect ovarian function.
It is generally recommended that patients can consider pregnancy and childbirth after chemotherapy, radiation therapy, and follow-up endocrine therapy have been completed and the drug has been stopped for three months.
I did a survey in my own patient base two days ago, and among more than 100 patients, I have now received more than 10 patient friends who said that they have completed the follow-up pregnancy and childbirth very smoothly.
So at present, it is not said that pregnancy will definitely increase the risk of breast cancer recurrence, but when it is more suitable to do this, you must communicate with the doctor, because after all, there are still some peak periods for recurrence, try to smoothly pass the peak period, and then do this again.
These things require better communication between doctors and patients, so that patients can leave no regrets in their entire lives.
Images are from the public image gallery
Pineapple: I ask some dietary issues that everyone is more concerned about, whether it is to prevent breast cancer or target breast cancer patients, can soy milk be drunk?
Director Luo: You can drink it, and you can eat beans and tofu.
Pineapple: Can I drink milk?
Director Luo: Milk can be drunk, but you must find a good source of milk.
Pineapple: Can bird's nest be eaten?
Director Luo: Bird's nest is something that we are not very good at fully evaluating the ingredients in it, and at present, it does not say that it cannot be eaten.
Pineapple: Donkey milk and camel milk are ok?
Director Luo: Donkey milk and camel milk have actually not been drunk myself, mainly to see whether it has passed the normal way of national approval.
Pineapple: Can honey be eaten?
Director Luo: Natural honey does not contain estrogen, and royal jelly may have some trace amounts of estrogen. Honey can be eaten, but there is also a problem: fructose glucose content is high, eat more fat, and obesity is a risk factor.
Pineapple: Can peppers be eaten?
Director Luo: It's no problem to eat chili peppers, we are already eating in these areas of Sichuan and Hunan. But sometimes because patients have gastrointestinal reactions when they carry out some treatments, some are prone to nausea and vomiting, some will have diarrhea, try to eat some mild, gastrointestinal relatively adaptable food.
Pineapple: Can sea cucumbers be eaten?
Director Luo: Many patients will also ask me if I can eat seafood, in fact, if you think about it, those who are in coastal cities, they will also get this disease, people's diet structure is originally like this, don't they eat it?
Pineapple: Can I drink coffee?
Director Luo: Two days ago, at the outpatient clinic, a patient said after seeing the patient: "Teacher Luo, every time I come to your clinic, you are not drinking coffee, you are drinking milk tea." ”
Current studies have not confirmed that coffee has a significant relationship with the onset of breast cancer, but it should be appropriate, and try not to drink it at night, affecting sleep.
I think that anything you eat involves the problem of quantity, and it is good to eat it in a measured and diversified way.
Many patients hope to block the risk of disease by eating or not eating something. But we know that the pathogenesis of the disease is complex, and no one or several factors can completely determine whether the disease is obtained or not.
We can only say that as far as possible in the known information, through the adjustment of the dietary structure, correspondingly reduce some risks. To put it mildly, I dare not say that I will not have breast cancer in my own life.
Pineapple: Can ejiao be eaten, is it necessary?
Director Luo: When you choose what to eat, you should think about the purpose and first determine what kind of state you are in.
We understand that ejiao has the effect of tonifying blood, for example, some patients are indeed anemia, proper consumption is still no problem, we must choose products from regular sources. However, if the anemia is already very serious, it is not enough to rely on ejiao, and there are corresponding drugs to help everyone correct the anemia. Food supplementation is an adjunctive, but not a therapeutic modality.
Pineapple: Can breast cancer patients get the COVID-19 vaccine?
Director Luo: Can you fight, in different treatment stages of the strategy is different, some time ago, the Chinese Clinical Oncology Society Breast Cancer Committee specially out of the breast cancer patients new crown vaccination expert consensus ("CSCO BC breast cancer patients new crown vaccination expert consensus"), everyone can search on the Internet, in addition to our public number [Milk Words] also have sharing, if you are interested, you can go to see. (Directions: Click here to view)
Pineapple: Can I use skin care products or cosmetics during treatment? Is there any type that needs to be circumvented?
Director Luo: Of course, it is possible, women love beauty, and it is good to make up their own mood. Of course, when choosing, try to choose ingredients that do not contain hormones, mineral oils, formaldehyde, and even heavy metals.
I often tell patient friends that moisturizing and applying a mask is nothing wrong, because some treatments will indeed make the patient's skin state is not too good, but buy regular products from formal channels, do not try to buy three no products cheaply.
Young people like to wear makeup and apply nails, but doctors need to pay attention to the condition of the patient's skin and whether it is anemia, sometimes by looking at lip color and nails. You can't deprive everyone of the right to love beauty, but it is also recommended that you do not make it too complicated and do not affect the doctor's judgment.
Patient friends in the treatment period is actually quite hard, there is some psychological support, there is a kind of beauty-loving emotions, the pursuit of quality of life mentality in the words, I personally support, moderate is good.
Pineapple: Is it okay to dye my hair? What do I need to be aware of?
Director Luo: Patients who have entered the recovery period can dye their hair, and it is important to control the frequency. For breast cancer patients, I think it is best not to do more than twice a year, and try to choose some natural hair dyes, and do a skin allergy test first.
Pineapple: Breast fibromas have been repeated or frequent, what should I do?
Director Luo: Fibroids are actually very common in the clinic. When it comes to fibroids, it should have been diagnosed by pathology, because the usual B ultrasound or molybdenum target examination can only see that the breast has a nodule, and this nodule is actually a description of the form.
If it is finally judged by pathology that it is indeed a fibroma, you don't have to worry too much, because it is benign, and it is currently believed that if it is a simple fibroma, it does not increase the risk of breast cancer.
But fibroids also have some complexity, or there are some easily proliferative lesions around it, or the patient has a family history, and the risk of subsequent breast cancer will increase slightly.
At present, it is impossible to eliminate it through drugs or massage or some folk remedies, and it can be removed through some minimally invasive surgeries now.
Every day in the outpatient clinic can meet a lot of benign patients, when they go the most favorite question is that I can eliminate it by eating what, I will play with them, like having 5 fingers, I now ask you, what do you eat can give him fingers to eat, no matter what method you use, you can only take a knife to kill it.
Most fibroids don't actually have to be treated, unless they are more than two centimeters or other surgical indications, they can be removed.
For patients with multiple occurrences, if you want to remove it through minimally invasive rotary incision means, you need to dig out one by one like digging potatoes under the guidance of color ultrasound, but sometimes it is too small to dig, and when you go to review later, you may not see the largest one, but the small one is still in that place.
But in general, everyone still does not have to worry too much, do our regular physical examination and screening.
Pineapple: If the mother is a breast cancer patient, how should a daughter do screenings? Or what should you do if you're worried you're at higher risk?
Director Luo: Regarding the health screening of breasts, first of all, monthly self-examination is needed, for example, after bathing, to see if it looks, whether it is symmetrical, the color of the skin, whether there is a depression, whether the nipple has secretions.
You can raise one hand, the other hand with the fingers of the 4 fingers except the thumb, in a circle way in the breast quadrant to touch, if you feel a lump induration, you can not judge, you can go to the hospital for further examination.
In addition to the breasts, we also recommend touching your armpits again, after touching, you can also gently, do not squeeze the nipples very hard, to see if there are some secretions, if the secretions are bloody, you hurry to the hospital.
We recommend self-testing after 5-7 days of clean menstruation, as there are some interfering factors during menstruation. Again, self-examination is not a substitute for other screening methods, and it must be remembered.
For the general population, it is recommended to do breast ultrasound every year at least 40 years old, and if the doctor recommends that a molybdenum target be done, it also needs to be done.
Ultrasound and molybdenum targets are the golden companion for dense mammary glands. In foreign countries to promote molybdenum targets, that is because European and American people have more breast fat, glands are not so dense, so more need for molybdenum target detection. For Asian women, ultrasound and molybdenum targets are like black cats and white cats, and it is good cats that catch mice.
I also mentioned earlier that there are some high-risk groups, such as those with family history, who can advance the screening to 20 years old, and need to go to ultrasound in half a year, and molybdenum targets are recommended to be done once a year. If you have done a B ultrasound and a molybdenum target, there is a time when the diagnosis is unclear, you can do another breast enhancement MRI.
The image comes from the internet
Pineapple: Are tumor markers useful for breast cancer screening?
Director Luo: Breast cancer screening mainly relies on imaging examination for the time being, but for patients who have been diagnosed, we will pay attention to the markers of CEA and CA153 as a means of indirectly judging the condition, but we will not change the program simply because of the change of indicators, or we will combine the imaging examination to make a comprehensive judgment.
Pineapple: Clinically, what kind of person would you recommend to do genetic testing, and how is it generally measured?
Director Luo: I believe that the reason why everyone pays attention to BRCA is more from Julie, but in fact, not all healthy people have to do genetic testing, if someone in your family has breast cancer or ovarian cancer, then it is recommended that people who are sick do it first. If it is clear that there are pathogenic variants such as BRCA1 and BRCA2 in the family, family members who have not yet been diseased should go to some genetic counseling.
There are corresponding guidelines in clinical work, such as women less than 40 years old with breast cancer, men with breast cancer, you need to go to test.
There are also triple-negative breast cancer, HER2 hormone receptor positive, second primary breast cancer, and patients with a history of breast and prostate cancer that are close relatives, and we recommend testing because it may be associated with medication.
At present, there are more detection methods, West China Hospital is a blood test, may not only measure BRCA1, BRCA2, may also test other genes associated with breast cancer risk, a total of 21.
When associated with medication, it is mainly for BRCA1 and BRCA2 to choose drugs with PARP inhibitors, but it does not mean that with this gene, you must use this drug. Because the corresponding clinical studies of these drugs are required for enrolling patients, many times choose some high-risk lymph node metastases very much, or very advanced patients are so.
Pineapple: How should women usually pay attention to breast health?
Director Luo: Breasts accompany women for life, and we do pay more attention to it a lot of times. But it is not to say that spending a lot of money is to pay attention to it, or it is necessary to go to a regular medical institution for screening, if there is really no problem, do not toss it blindly. It only takes you to come to the hospital every three months or six months to do a color ultrasound.
About breast hyperplasia I would like to remind everyone that some patients say that breast pain, especially this pain related to menstruation, feel very anxious, do not have to, this is a physiological process of hyperplasia, do not be afraid.
What we are most afraid of is this type of patient: can eat and sleep, nothing, that is, a lump on the breast, very hard, no care, slowly grow bigger and bigger. The earliest manifestation of most breast cancers is the painless mass of the breast.
I have an elderly patient whose breast lumps are so big that they have formed a rupture, and she changes her medicine at home.
One day when I finally came to the clinic, I asked what drove you to sit here with me today, and the old man said that it was because the little grandson did not want to be close to her recently, and he thought that she had a smell on her.
This makes people feel very emotional, the elderly are willing to take this step for the sake of their grandchildren, in fact, if they take this step earlier, she can better nurture her life and enjoy the joy of heaven better.
Pineapple: If the mother has cancer, at what age should the daughter be genetically tested?
Director Luo: Usually after adulthood, specific suggestions can be to go to genetic counseling.
Pay attention to director Luo's team public number "milk words"
Learn more about breast health
*Due to space limitations, only a selection of Q&A has been selected. This article aims to popularize the science behind cancer, not drug promotional materials, let alone treatment options recommendation. For guidance on treatment options, visit a regular hospital.
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