(Health Times reporter Zhao Weide)
"In the case of comparable efficacy, let doctors and patients choose the best and most reasonable treatment method, we need to continue to do a good job of science publicity, do a good job of early diagnosis and early screening, and improve the quality of life of breast cancer patients." Professor Jiang Zefei, vice chairman and secretary general of the Chinese Society of Clinical Oncology (CSCO), told the People's Daily health client reporter.
Jiang Zefei, Vice Chairman and Secretary-General of the Chinese Society of Clinical Oncology (CSCO). Courtesy of respondents
Can you combine your clinical experience to talk about the overall diagnosis and treatment of breast cancer in China 20 years ago and the main changes that have occurred now?
Jiang Zefei: 20 years ago, I just returned to China to join the work, then there were more terminal patients, and now there are more early patients, overall the number of patients is increasing, but the proportion of terminal patients is decreasing, the proportion of early patients is increasing, and the cure rate is significantly improved. Another change is that 20 years ago, the treatment was mainly surgery and radiotherapy and chemotherapy, and now the proportion of surgery is getting smaller and smaller, that is to say, the proportion of breast conservation is increasing, while radiotherapy is becoming more and more refined, drug treatment is more precise, and the treatment concept and ideas have changed greatly.
I have been an intern doctor since 1986, and now I have been treating more than 100,000 patients, and my greatest happiness is to grow up with patients and grow older. I was in my 20s when I was a breast cancer patient, she was in her 50s at the time, and now she is in her 80s, and she is still calling me "Xiao Jiang", which is a very happy feeling. There are also patients, who were only eighteen or nineteen years old when they were sick, who were still in college, and now graduated, who came to counsel when they could get married and when they could have children, and I said that when you got married, you should send me joy candy, not for me, but to encourage other young patients, doctors and students to share the joy of their patients after they were cured.
What are the characteristics of the age of onset of breast cancer patients?
Jiang Zefei: Strictly speaking, breast cancer is an accumulative middle-aged and elderly disease, and the older you get, the more likely you are to get sick, so the peak age of the disease in the mainland is around 50 years old. However, recently, there have also been some young women with diseases, especially those living in large cities, which are related to genetic factors on the one hand, and on the other hand, the tension and anxiety caused by the pressure of life and work are also susceptible factors to the disease. Early prevention is therefore key.
Early screening and early diagnosis should give a relatively individualized screening program for people with different risk levels, if there is a known genetic mutation, a known family history, or a known history of breast atypical hyperplasia, it should be checked regularly, and the frequency of examination may be twice a year; and for many healthy women, it can be once a year. At the same time, it is recommended to conduct examinations in relatively fixed medical institutions as much as possible to achieve dynamic and continuous monitoring. In addition, the examination methods of women of different ages are also different, young women can pass the physical examination and B ultrasound examination of professional doctors, and the molybdenum target is suitable for women over 40 years old.
What are the main treatments for breast cancer at present? What is the status of endocrine therapy?
Jiang Zefei: At present, the treatment methods of breast cancer include surgical treatment, chemotherapy, endocrine therapy, targeted therapy, immunotherapy, etc. Endocrine therapy is the preferred treatment plan for neoadjuvant therapy for early HR+ patients and treatment for patients with advanced postmenopause. In the 1990s, the advent of the third-generation aromatase inhibitor ushered in a new era of endocrine therapy for breast cancer. From 20 years ago to today, endocrine therapy has played an important role in reducing the risk of breast cancer recurrence and death. Especially during the two-year epidemic, endocrine therapy can allow patients to get long-term safe treatment while also protecting patients from the threat of covid-19. Now many patients after surgery, with aromatase inhibitors such as endocrine treatment drugs, oral convenience, high compliance, long-term application, patients can get good clinical benefits.
How can I improve the "net benefit" of my patients?
Jiang Zefei: The diagnosis and treatment of breast cancer in mainland China has entered the era of chronic disease management, but there are still patients who still suffer from the long-term adverse effects of treatment decades after the end of treatment, such as the damage of mastectomy to appearance, etc. The concept of "net benefit" came into being in this context, not simply focusing on the disease itself, but also caring for the diseased individual. "Net benefit" is an important indicator of the effectiveness of breast cancer diagnosis and treatment. Taking endocrine therapy for breast cancer as an example, in order to increase the "net benefit" after the efficacy and side effects are offset, the balance of efficacy and side effects is key, clinicians should identify high-risk groups to give extended endocrine programs, take interventions for drug side effects, and select steroid aromatase inhibitors with less effect on bone and blood lipids for patients, which reduces long-term toxicity as a whole and allows patients to obtain better quality of life.
At present, the diagnosis and treatment of breast cancer in the mainland has been more standardized and standardized, but the health knowledge of different regions should be continuous, taking milk conservation as an example, some doctors do not like breast protection, may be cut off directly, the quality of life of patients can not be guaranteed, so in the case of equal efficacy, let doctors and patients choose the best and most reasonable treatment method, need to continue to do a good job of science publicity.
