I don't have to worry about breast cancer because no one in my family has had it? Is breast cancer a terminal illness? The truth is...

With the improvement of living standards and health awareness, people are paying more and more attention to breast cancer. There is no doubt that breast cancer poses a great threat to women's health and life. The cancer data report released by the International Agency for Research on Cancer of the World Health Organization (WHO) shows that in 2022, there will be 19.96 million new cancer cases worldwide, among which female patients have the highest incidence of breast cancer. Breast cancer is also the most common malignant tumor in women in China, and its incidence ranks first among malignant tumors in women in China. October of each year is designated as "World Breast Cancer Prevention and Treatment Month" to promote knowledge related to breast cancer.

Copyrighted stock images, no reproduction is authorized

It is a good thing that everyone pays more attention to breast cancer, but there are also many rumors about breast cancer circulating on the Internet. If you believe in these rumors, it may have an adverse effect on the prevention and treatment of breast cancer. So, are these rumors true? What are the high-risk factors related to breast cancer, and how to correctly prevent and treat breast cancer? Let's take a look!

No family history, no need to worry about breast cancer?

This statement is not comprehensive. Although heredity is indeed a high-risk factor, it is not comprehensive to only look at heredity. The "Guidelines for Screening, Early Diagnosis and Early Treatment of Breast Cancer in Chinese Women (2021, Beijing)" points out that people at high risk of breast cancer include:

1. Have a family history of hereditary diseases, that is, those who have any of the following

① A first-degree relative has a history of breast cancer or ovarian cancer; ② Two or more second-degree relatives have breast cancer before the age of 50; ③ Two or more second-degree relatives have ovarian cancer before the age of 50; ④ At least one first-degree relative carries a known BRCA1/2 gene pathogenic genetic mutation; or the person carries a BRCA1/2 gene pathogenic genetic mutation. Note: First-degree relatives refer to mothers, daughters, and sisters; second-degree relatives refer to aunts, aunts, grandmothers, and grandmothers.

2. Those who have any of the following

① Age of menarche ≤ 12 years old; ② Age of menopause ≥ 55 years old; ③ History of breast biopsy or surgery for benign breast disease, or history of atypical hyperplasia of the breast (lobule or duct) confirmed by pathology; ④ Use of "combined estrogen and progesterone" hormone replacement therapy for at least half a year; ⑤ Mammographic X-ray examination after the age of 45 indicates that the breast parenchyma (or breast density) type is unevenly dense or dense.

3. Those who possess any two of the following

① No history of breastfeeding or breastfeeding time <4 months; ② No history of live birth (including never giving birth, miscarriage, stillbirth) or age of first live birth ≥30 years old; ③ Use only "estrogen" hormone replacement therapy for at least half a year; ④ Miscarriage (including spontaneous abortion and artificial abortion) ≥2 times. From these descriptions, we can see that in addition to genetic factors, the causes of breast cancer include age of menarche, age of menopause, whether giving birth and breastfeeding, whether receiving estrogen replacement therapy, and exposure of the chest to ionizing radiation at a young age, which are closely related to the incidence of breast cancer. In addition, diet and lifestyle should not be ignored. For example, obese people, those who lack exercise, those who like to eat fried, pan-fried, smoked or high-fat foods, those who often smoke, drink alcohol, stay up late, and those who are under great psychological pressure should also be careful. Therefore, even if no one in your family has had breast cancer, you should not take it lightly.

Regular breast self-examination is sufficient, no physical examination is necessary

This statement is not correct.

Although breast self-examination may reveal some breast cancer lesions, it is unreliable and cannot effectively improve the early detection rate of breast cancer. Therefore, women of appropriate age and at high risk must undergo regular standardized medical screening examinations. For the general risk population, it is recommended to use breast ultrasound alone for screening from the age of 45, or consider using mammography (molybdenum target), with a frequency of 1 to 2 years. For the general risk population with dense breasts, a mammogram combined with breast ultrasound should be performed once a year. For the high-risk population, it is recommended to start screening with a mammogram combined with breast ultrasound once a year from the age of 40, and if necessary, with a breast MRI once a year. For high-risk women with a family history of breast cancer, the age of starting screening should be 10 years younger than the youngest person in the family diagnosed with breast cancer, but should be ≥25 years old. In summary, breast self-examination is a good habit, but it cannot replace regular physical examinations. Although breast self-examination may accidentally discover some breast cancer lesions, it cannot effectively improve the early detection rate of breast cancer. Therefore, women of appropriate age and at high risk must take the initiative to undergo standardized screening examinations instead of relying on self-examination.

Copyrighted stock images, no reproduction is authorized

The main value of breast self-examination is to help raise women's awareness of cancer prevention. In addition to breast self-examination, women should go to the hospital for regular breast examinations. During clinical breast examinations, doctors can find breast lumps and other abnormal signs through breast examinations. Medical examinations are an important step in diagnosing breast cancer, including B-ultrasound examinations, mammography, MRI examinations, pathological examinations, etc.

If you have breast cancer, you will definitely feel a lump in your breast. Does a lump in the breast mean it is breast cancer?

Although there is a certain connection between breast cancer and breast lumps, there is not a strict correspondence as the rumors say. Although most clinical manifestations of breast cancer are accompanied by breast lumps, about 10% of patients diagnosed with breast cancer will not have lumps, pain, or other abnormal symptoms in their breasts. The lumps found in women of childbearing age are mostly benign lesions, such as breast fibroadenomas, breast lobular hyperplasia, breast cysts, etc. Therefore, the diagnosis of breast cancer requires professional examination and judgment, and cannot rely solely on one's own guesses. The doctor will conduct a detailed examination of the breast, such as palpation, to understand the size of the nodule, hardness, mobility, whether there is redness and swelling on the skin surface, etc., and make a comprehensive preliminary judgment. According to the actual situation, apply for breast ultrasound and X-ray mammography and other related examinations.

Here are some situations where there is no lump but breast cancer is suspected:

1. Nipple changes

The nipple may appear flat, retracted, or sunken. Some special types of breast cancer, such as eczematoid nipple cancer, may also present with nipple itching, thickening of the nipple epithelium, desquamation, and exudation. If nipple eczema does not improve with topical medications, then you may have a special type of breast cancer - Paget's disease of the breast.

2. Nipple discharge

Some breast cancer patients may experience nipple discharge, which may be colorless, milky white, light yellow, brown, or bloody.

3. Inflammatory breast cancer

The type of breast cancer with the worst prognosis has similar symptoms and signs to mastitis. Symptoms include: rapid breast enlargement, redness, persistent itching, and increased skin temperature. When you find breast redness and swelling, especially in non-breastfeeding women, you must be vigilant and not easily think of breast redness and swelling as mastitis, which will delay diagnosis and treatment. Therefore, in summary, breast cancer does not necessarily have lumps, and breast lumps are not necessarily breast cancer. If you find abnormalities in your breasts, you should go to the hospital for examination and diagnosis in time.

Breast cancer = terminal illness

Although there are a lot of popular science content about cancer and breast cancer, many friends are still prone to "talking about cancer". Next, let's comfort these friends. Among all cancers, breast cancer is one of the cancers with the highest cure rate. According to the "China Cancer Survival Statistics 2019-2021" released by the National Cancer Center, the 5-year survival rate of breast cancer patients in my country is as high as 80.9%. Some female friends may worry that breast cancer surgery will damage their body beauty. In fact, breast cancer can be treated in a variety of ways, including surgery, chemotherapy, radiotherapy, endocrine therapy, targeted therapy, immunotherapy, etc. According to the patient's pathological type, molecular typing and disease stage, a targeted treatment plan is formulated, that is, standardized, individualized and precise treatment, which can greatly improve the patient's treatment efficacy and reduce the impact. Therefore, breast cancer is not a terminal illness. The cure rate of breast cancer depends on many factors, including the type, size, grade, stage of the tumor and the patient's overall health status. When formulating a treatment plan, specialists will follow professional guidelines. Standardized treatment is to choose the treatment plan that is most likely to be effective for the tumor based on our current understanding of tumors and evidence-based medicine.

How to prevent breast cancer?

In addition to checking the breasts during physical examinations, developing a good habit of self-examination can also help detect problems earlier. The best time to self-examine the breasts is generally 9 to 11 days after the onset of menstruation. At this time, the effect of estrogen on the breast is minimal, and breast lumps are easy to find. Postmenopausal women can perform self-examinations at a fixed time every month. When self-examining, you should use the correct touch method, press the breasts lightly with your fingertips, check for lumps or abnormal sensations, squeeze the areola and nipples, and observe whether the nipples have discharge. Be careful not to pinch or pull the breast tissue with your fingers (reminder: it is recommended to learn the correct self-examination method from a doctor in person). If you find abnormal conditions such as breast lumps, nipple secretions, nipple erosion, skin depression or redness, and lumps under the armpits during self-examination, you need to go to a breast specialist for further examination immediately! It needs to be emphasized again that breast self-examination is very unreliable and cannot effectively increase the early detection rate of breast cancer. The main value of self-examination is to help improve women's awareness of cancer prevention. Therefore, grassroots medical workers are still encouraged to teach women how to perform breast self-examination once a month (the self-examination method must be correct).

Copyrighted stock images, no reproduction is authorized

In addition to self-examination and regular medical examinations, people should maintain a healthy lifestyle, eat a balanced diet, exercise regularly, and maintain a healthy weight in their daily lives. They should also develop good eating habits, quit smoking and limit alcohol intake, avoid consuming too much high-fat, high-sugar, and high-salt foods, and eat more fresh vegetables, fruits, whole grains, and other foods. In addition, avoiding ionizing radiation as much as possible, reducing the effects of estrogen, giving priority to breastfeeding for lactating women, and refusing to abuse cosmetics containing estrogen, etc., all contribute to the prevention of breast cancer.

Author: Hu Zhongdong, Healthy China Action Spokesperson, Associate Chief Physician, Registered Nutritionist, Health Manager

Review | Pan Zhanhe, Chief Physician, Master Supervisor, Department of Oncology, Zhongshan Hospital, Xiamen University