*For medical professionals only
For patients with advanced breast cancer, Professor Ma Fei has something to say!
"According to the data released by the research institute, there were 2.26 million new cases of breast cancer in the world in 2020, surpassing lung cancer for the first time and becoming the world's number one cancer. What is even more shocking is that the improvement in efficacy in the field of advanced breast cancer in the past decade has not been significant. On March 28, Professor Ma Fei of the National Cancer Center and the Cancer Hospital of the Chinese Academy of Medical Sciences said at the "2021 China Cancer Health Management Conference and the Fifth Breast Cancer Management Chief Expert Forum".
The "2021 China Cancer Health Management Conference and the Fifth Chief Expert Forum on Breast Cancer Management" focused on the standardized diagnosis and treatment of common malignant tumors, quality control, all-round interdisciplinary management and other topics. At the meeting, Professor Ma Fei introduced the "China Advanced Breast Cancer Diagnosis and Treatment Capacity Promotion Project", and the Medical Oncology Channel exchanged views with Professor Ma Fei on this topic.
Leap to the top of the malignant tumor,
Where should Chinese breast cancer patients go?
▌Medical community: At present, the incidence of breast cancer has jumped to the first place in malignant tumors, please talk about the current diagnosis and treatment status of breast cancer in China?
Professor Ma Fei: At present, the level of breast cancer diagnosis and treatment in China has been greatly improved, and the areas with better medical conditions have reached the level of Western developed countries, but China is vast, there are certain regional differences, and on the whole, the central and western regions are lower than the 5-year survival rate of breast cancer patients in the eastern coastal areas, and the 5-year survival rate of rural patients is lower than that of urban patients. Second, the early diagnosis rate of breast cancer patients in China is low. Most of the patients diagnosed for the first time are in stage II and III, while most of the patients in western developed countries are stage I or even stage 0. Third, the public does not know enough about breast cancer, and many people talk about cancer discoloration, or avoid medical treatment. This situation is mainly due to the long-term accumulation of regional medical differences, the homogenization of medical care in various regions is not done well, and many patients do not trust doctors in primary hospitals. In addition, national screening is crucial, the current breast cancer screening rate in China is not high, the early diagnosis rate of patients is low, and it is difficult to improve survival. The patient's low awareness of the disease means that we need to strengthen science publicity. Healthy China, science first, only the health awareness of the whole people has improved, it is possible to improve these situations.
▌Medical community: Can you tell us about what is included in the "China Advanced Breast Cancer Diagnosis and Treatment Capacity Promotion Project"? And what is the original intention and significance of the project?
Professor Ma Fei: The proportion of patients with advanced breast cancer in the overall breast cancer patients is large, 3% to 8% of the patients with initial diagnosis are advanced, and 30% to 40% of patients with early breast cancer still progress to advanced after treatment. The survival of advanced patients is not optimistic, and the 5-year survival rate is only 20%, while the 5-year survival rate of stage I patients can reach more than 95%. If you want to conquer breast cancer, the focus is on advanced breast cancer. Compared with early breast cancer, there are more treatment options for advanced breast cancer, the diagnosis and treatment process is more complicated, and the individual differences are greater, which makes the treatment of advanced breast cancer particularly difficult. Therefore, it is of great significance for the capacity building of advanced breast cancer diagnosis and treatment.
The "China Advanced Breast Cancer Diagnosis and Treatment Capacity Promotion Project" contains several aspects, first, the standard is the first. In 2020, we formulated the Guidelines for the Standardized Diagnosis and Treatment of Advanced Breast Cancer in China, which was jointly formulated and promoted by the Breast Cancer Expert Committee of the National Center for Oncology Quality Control and industry associations. Second, it is necessary to implement the standard into clinical practice. Some doctors may not have a thorough understanding of the guidelines, so we use actual case consultation to improve the level of diagnosis and treatment and build practical experience. Third, we will select classic cases, make them into case collections for publication, and promote them nationwide. These three aspects will form a "closed loop" to improve the overall diagnosis and treatment level of advanced breast cancer.
Standard first, China wisdom synchronization international
▌Medical community: You just mentioned that the standard comes first, so what are the key points for updating the Guidelines for the Standardized Diagnosis and Treatment of Advanced Breast Cancer in China? What is the significance of the update?
Professor Ma Fei: Previously it was called "Consensus", this time it was called "Guide". The change of these two words shows that it has a certain degree of administrative binding force and is more authoritative. In addition, the order of first- and second-line priority schemes and the specific recommended levels are clarified, so that doctors can choose suitable schemes according to the recommended level and research progress. At the same time, this update also adds Innovative Drugs in China, fully reflecting the contribution of Chinese wisdom to the progress of breast cancer.
For example, in the treatment of HR-positive HER2-negative advanced breast cancer, first-line therapy recommends a treatment regimen (IA) for targeted CDK4/6 inhibitors combined with endocrine drugs. Second-line and post-line therapy recommendations, for patients who have progressed after first-line endocrine therapy, according to the progress of targeted therapy for advanced breast cancer in recent years and the availability of drugs in China, corresponding recommendations and other treatment options are recommended based on previous treatment plans. This is compared with the 2018 consensus: the order of first- and second-line priority options and the specific recommended levels are clarified, so that doctors can choose a more suitable program for patients according to the recommended level and the description of research progress. In the treatment of HER2-positive advanced breast cancer, it differs from international guidelines: the addition of innovative drugs in China. Compared with the 2018 consensus, the update is that the first line emphasizes dual targets, and the second line adds new drugs for anti-HER2 treatment in the past 2 years, including innovative drugs in China.
In addition, it is worth mentioning that the "Guidelines for the Standardized Diagnosis and Treatment of Advanced Breast Cancer in China" also contain some drugs that are not listed in China, but have been listed in other countries around the world, because in some parts of China, through the "first to try" policy, patients can use these drugs legally and compliantly. For example, in the Hainan Boao Medical Pilot Zone, there is such a policy.
Guidelines for the Standardized Diagnosis and Treatment of Advanced Breast Cancer in China
Clinical landing, build a consultation platform for difficult cases of advanced breast
▌Medical community: Regarding the construction of a consultation platform for difficult cases of advanced breast, can you please introduce what phased achievements have been achieved by the Cancer Hospital of the Chinese Academy of Medical Sciences and share relevant experience?
Professor Ma Fei: Our hospital has been exploring the case consultation system, which has begun to bear fruit. Through consultation, we gather experts to provide better treatment plans for difficult patients. At the same time, on this basis, a case upload system is established, a case display platform is formed, and the database is displayed to doctors across the country for common exchange and learning. At present, the case system has been set up and communicated with the publishing institutions, and in the future, we will select some excellent cases for publication.
Now, we have consulted with hospitals in many areas for difficult cases and given corresponding guidance. In the future, we will focus on uniting with consultation centers in some regions to form an academic exchange platform for the consultation of difficult cases in the whole country.
From the update of guidelines to the practical promotion of difficult case consultation, to the case set to show individualized treatment plans and clinical outcomes, this closed-loop round of updates every 2-3 years will allow us to see the progress of China's advanced breast cancer diagnosis and treatment level and the final achievement of the 2030 healthy China goal. We also call on more relevant people to participate and work together to break the disciplinary boundaries, break the geographical boundaries, and ultimately, help the regulation and innovation of advanced breast cancer, and help the length of life and quality of life of patients.
Expert Profiles
Professor Ma Fei
Chief physician, professor, doctoral supervisor. Director of the Department of Internal Medicine Treatment, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences.
Concurrently served as secretary general of the National Anti-tumor Drug Clinical Application Monitoring Committee, vice chairman of the Breast Cancer Committee of the National Cancer Quality Control Center, secretary general of the Breast Cancer Screening and Early Diagnosis and Early Treatment Specification Committee of the National Cancer Center, expert of the Healthy China Action Promotion Committee, vice chairman of the Oncology Pharmacist Branch of the Chinese Pharmacist Association, vice chairman of the Integrated Tumor Heart Disease Branch of the China Anti-Cancer Association, vice chairman of the Multiple Primary and Unknown Primary Tumors Committee of the Chinese Anti-Cancer Association, secretary general of the Clinical Research Committee of Oncology Drugs of the Chinese Anti-Cancer Association, Vice Chairman of the National Female Ovarian Protection and Anti-Aging Promotion Engineering Committee, Director General of the Geriatric Tumor Branch of the Chinese Society of Gerontology and Geriatrics, Vice Chairman of the Beijing Society for the Prevention and Treatment of Breast Diseases, Chairman of the Quality Control Committee of Tumor Chemotherapy of Beijing Cancer Treatment Quality Control and Improvement Center. He won the second prize of the National Science and Technology Progress Award, and the honorary titles of "Top Ten Outstanding Young Doctors in the Capital" and "China Young Oncology Scientist Award".