Breast cancer is the most common malignant tumor in Chinese women, and the current prevalence of breast cancer in China is 59/100,000, and the peak age of the disease is 40 to 50 years old. Compared with Western countries, Chinese women's breast cancer presents three major characteristics: first, the prevalence rate is growing rapidly, in the past three decades, the prevalence of breast cancer in Chinese women has increased significantly at a rate of 3% to 5%; second, the incidence is younger, on average, more than 10 years younger than Western women; third, the prevalence and mortality rates vary greatly between different regions, and the early diagnosis rate and survival rate are relatively low.
Left: Breast cancer ultrasound image; Right: Breast cancer X-ray (molybdenum target) image
Active and effective breast cancer screening can improve the rate of early diagnosis and reduce the case fatality rate, but it lacks norms and guidelines for adapting to the Chinese people. The main point of contention is whether to recommend breast ultrasound or mammography (x-ray) as the main means. X-rays are generally accepted for breast cancer screening in Europe and the United States, and european and American national guidelines also mainly recommend X-rays as a screening method.
Mainland doctors have observed in long-term clinical practice that the characteristics of breast cancer in Chinese women are very different from those of European and American women: the physiological characteristics of the breast glands are higher density and smaller volume; the peak age of the disease is smaller, and the proportion of dense breasts is higher. These factors lead to poor sensitivity to X-rays, which are not suitable for breast cancer screening in Chinese women. In recent years, more and more multidisciplinary clinical expert opinions such as breast surgery, internal medicine, ultrasound and imaging have tended to support the application of breast ultrasound in screening.
▲The picture shows the X-ray (molybdenum target) image of a healthy dense breast. Left: CC bit, right: MLO bit. Because the X-ray images of breast cancer lesions are also white, it can lead to a decrease in sensitivity
Peking Union Medical College Hospital insists on using Chinese evidence-based medical research to solve Diseases and Health Problems in China. A nationwide prospective, multi-center randomized controlled study of 13,000 high-risk women led by Sun Qiang's team with the support of the "Eleventh Five-Year Plan" national support plan was randomized with X-ray examination, breast ultrasound, and X-ray combined ultrasound, and the results found that the sensitivity and accuracy of ultrasound were significantly better than X-ray examination. For Chinese women, breast ultrasound has obvious advantages in breast cancer screening from the perspective of breast cancer age, breast density, health economics, radiation and comfort of examination.
Director Sun Qiang introduced: "Mainland women have entered the peak age of illness since the age of 40, and it is recommended that mainland women begin to receive breast cancer prevention and control knowledge education from adulthood, conduct breast self-examination and clinical breast examination regularly, and start with an annual breast ultrasound examination from the age of 40. For women at high risk of breast cancer, regular breast ultrasounds can be advanced to the age of 30. ”
▲The concord breast surgery, ultrasound medicine and radiology teams participated in the formulation of the "Guidelines for Breast Cancer Screening for Chinese Women"
Corresponding author: Sun Qiang
Sun Qiang, Director of Breast Surgery, Peking Union Medical College Hospital, Chief Physician, Doctoral Supervisor. He is also the vice chairman of the Beijing Society for the Prevention and Treatment of Breast Diseases, the chairman of the Academic Work Committee and the former chairman of the Surgical Professional Committee, the chairman of the Breast Disease Expert Committee of the Beijing Medical Doctor Association, the chairman of the Breast Disease Branch of the Chinese Research Hospital Association, the chairman of the Breast Cancer Committee of the Chinese Geriatric Oncology Society, and the national expert of the two cancer monitoring pilot project in rural areas. He has undertaken many national breast cancer screening and early diagnosis projects such as the "Eleventh Five-Year Plan" and "Twelfth Five-Year Plan", and has won many national or provincial and ministerial awards such as the National Science and Technology Progress Award.
Corresponding author: Shen Songjie
Shen Songjie, Assistant Director of Breast Surgery Department, Peking Union Medical College Hospital, Deputy Chief Physician, Master Supervisor. He graduated from Peking Union Medical University in 2005 with a Ph.D. degree in eight years, and was sent by Peking Union Medical College Hospital to study at the Dana-Farber Cancer Center of Harvard Medical School and the Harvard School of Public Health in 2013. He specializes in breast conserving, radical treatment and immediate reconstruction of breast cancer. He also serves as the honorary chairman of the Youth Committee of the Beijing Breast Disease Prevention and Control Society and other academic part-time positions. He has undertaken a number of national, provincial and ministerial projects related to breast cancer diagnosis and treatment, and his clinical diagnosis and treatment achievements have won awards such as the Chinese Medical Science and Technology Award and the Beijing Science and Technology Progress Award.
Text/Shen Songjie Fu Tan lou
Photo / Sun Liang Courtesy of Breast Surgery
Editor/Xiao Xiong Chen
Editor-in-Chief/Chen Mingyan
Producer/Wu Peixin