1. Does breast cancer affect fertility?
In recent decades, the incidence of breast cancer has been increasing, and it is younger. Research shows that more than half of breast cancer patients in China occur before menopause. Can breast cancer patients with fertility desire become mothers' dreams? Does pregnancy after breast cancer surgery increase the risk of breast cancer recurrence? The reporter interviewed Professor Xie Xiaoming, director of the Breast Department of Cancer Center of Sun Yat-sen University.
In recent years, the incidence of breast cancer is younger.
Breast cancer is the most common malignant tumor in women. According to statistics, the incidence of breast cancer in China has reached 46/65438+ 10,000, and it is increasing by 3% every year.
Professor Xie Xiaoming said that the incidence of breast cancer in China has distinct "China characteristics", one of which is that the onset age is 10-15 years earlier than that of western women. Moreover, the onset age of female breast cancer in China is low, starting from the age of 20 and gradually increasing after the age of 30. The peak age is 40-49 years old, with an average age of 48.7 years.
Why is the number of young women suffering from breast cancer rising gradually in recent years? Xie Xiaoming introduced that the epidemiological survey of breast cancer conducted by seven large hospitals in China, including Cancer Hospital of Peking Union Medical College and Cancer Center of Sun Yat-sen University, showed that 62.9% of patients were diagnosed as premenopausal. In Europe and America, 75% of patients have symptoms after menopause, and most of them are middle-aged and elderly women.
He explained that the known causes of breast cancer are: early menarche, late menopause, short breastfeeding time, unmarried childbearing, family history of breast cancer, oral contraceptives, obesity and high-fat and low-fiber diet, smoking, staying up late and so on. In addition, women's lifestyle has also undergone great changes, mainly westernized diet, high in sugar and high in fat. In addition, the fast-paced life has greatly increased the phenomena of staying up late, marrying late and having children late, infertility and so on, affecting the normal operation of endocrine, which has become a possible reason for modern women, especially young urban women, to induce breast cancer.
The treatment of any disease emphasizes early diagnosis and treatment, and breast cancer is no exception. The results showed that the 10-year survival rate was 90% in patients with stage ⅰ (early stage), 70% in patients with stage ⅱ, and only 10% in patients with stage ⅳ (late stage). Therefore, women should raise their awareness of cancer prevention, do a good job in breast examination, find out early and treat early, and about 90% of breast cancer patients can survive.
Comprehensive treatment based on surgical treatment.
At present, breast cancer is one of the most effective solid tumors. The treatment of breast cancer has developed rapidly and there are many ways, including chemotherapy, surgery, radiotherapy, endocrine therapy, targeted drugs and other treatment methods. According to each patient's condition, stage, molecular biological characteristics and the pathophysiological-psychological-social situation of the patient, it is very important to formulate an individualized treatment plan for breast cancer. For early patients, surgery is needed. Sometimes in the outpatient clinic, we will meet some patients who are unwilling or afraid of surgery, or refuse surgery because they are superstitious about the so-called "secret recipe" in society, which delays the best opportunity for surgery and the opportunity to be cured, leading to incurable.
Choosing appropriate treatment plays a very important role in the prognosis of breast cancer. For breast cancer patients with hormone receptor positive, endocrine therapy must be used as adjuvant therapy. What is endocrine therapy? Xie Xiaoming introduced that 70% of breast cancer is hormone-dependent tumor, and high levels of estrogen and progesterone in the body will stimulate the occurrence and progress of breast cancer cells. Endocrine therapy refers to the method of castration through drugs or ovarian surgery to reduce the stimulation of estrogen on tumor cells and play an anti-tumor role. When either of the two indexes of estrogen receptor (er) and progesterone receptor (PR) is positive (+), the patient is suitable for endocrine therapy. The basic drugs for endocrine therapy of breast cancer include anti-estrogen drugs (such as tamoxifen and toremifene), aromatase inhibitors (such as letrozole and anastrozole) and luteinizing hormone-releasing hormone (LHRHa) analogues (such as goserelin), which can be used selectively.
"Because breast cancer is closely related to estrogen, age and menopause are very important for the choice of endocrine therapy drugs." Xie Xiaoming introduced that premenopausal and postmenopausal women produce estrogen in different ways, so the initial endocrine therapy drugs for patients after breast cancer surgery will be different. Usually, the estrogen of early breast cancer patients with positive premenopausal hormone receptor comes from ovary. When receiving adjuvant endocrine therapy, tamoxifen or tamoxifen combined with ovarian function inhibition is the first choice to inhibit ovarian estrogen production. The secretion of estrogen in postmenopausal women's ovaries basically stops. Estrogen in the body mainly comes from androgen or estrogen precursor secreted by adrenal gland and fat, and is converted into estrogen by aromatase. Therefore, aromatase inhibitors are the first choice for initial treatment of postmenopausal patients.
In addition, in order to achieve the best therapeutic effect and prognosis, endocrine therapy takes a long time, and patients must receive the whole course of treatment according to the doctor's prescription. Xie Xiaoming explained that because 2 ~ 3 years after breast cancer surgery is a recurrence peak, 7 ~ 8 years is another recurrence peak (there is a theory that the appearance of the second peak is related to the withdrawal of endocrine therapy after 5 years), adhering to endocrine therapy 10 year can reduce the recurrence risk of these two peaks.
Worried that breast cancer patients can still have children after treatment?
Among breast cancer patients, some women have no children or even are unmarried. When they learn that they have breast cancer, the most concerned issue is whether it will affect their future sexual life, pregnancy, childbirth, breastfeeding and so on. Some married women of childbearing age also suffer from breast cancer. With the implementation of the comprehensive two-child policy, if they still want to have children, can they have a second child?
Professor Xie Xiaoming's answer is: "Yes, patients can resume moderate sexual life after wound healing, and they can get pregnant under the guidance of doctors after treatment!" It is generally recommended to stop endocrine therapy and consider pregnancy after 3-6 months. According to the current research, for breast cancer patients, pregnancy in recovery period after chemotherapy does not increase the risk of recurrence and metastasis. Although chemotherapy has certain damage to women's ovarian function, some studies show that women under 35 still have 56% fertility after chemotherapy; However, the fertility of women over 40 years old after chemotherapy is very low. But endocrine therapy has little effect on ovarian function. If the patient has fertility requirements, ovarian protection or cryopreservation of ovarian tissue, eggs and fertilized eggs can be carried out before chemotherapy.
It is understood that more than 10 patients treated by Professor Xie have successfully given birth to their first or second children, realizing their nanny dreams. For example, Miss Chen, a 30-year-old Shantou native, has never had children because of her busy work after marriage. Just when she was going to get pregnant, she found out breast cancer. This is a bolt from the blue for Chaoshan people. Fortunately, she was in the early stage of the disease, and after the operation, she learned that "the side effects produced during the treatment of breast cancer will have a negative impact on her reproductive function." Determined to have children, I was introduced to Professor Xie Xiaoming. After treatment, Miss Chen was successfully upgraded to a mother and gave birth to a second child two years later.
For breast cancer patients who really need to have children, how to assess whether they have the conditions for pregnancy and how to choose the timing of pregnancy? Xie Xiaoming believes that for patients with advanced or high-risk breast cancer, fertility is generally not recommended in the near future. For patients with low-risk breast cancer, it is more reliable to get pregnant after 3 or even 5 years of treatment without recurrence and metastasis. However, for breast cancer patients who are in the early stage of the disease and have very low risk of recurrence, it is relatively safe to consider pregnancy after 2 years of treatment. After receiving endocrine therapy, you should continue to complete the unfinished treatment before pregnancy after giving birth. In addition, if you plan to have children, you should stop endocrine therapy for 3-6 months before you start preparing for pregnancy.
Finally, he reminded that these women should resume taking endocrine drugs as soon as possible after delivery, so breastfeeding is not recommended, because breastfeeding means stopping taking endocrine drugs for a long time.
Self-examination and physical examination can not be less.
If young women want to find breast cancer early, they must first learn the method of breast self-examination and see a doctor in time if they find any abnormality. People with a family history of breast cancer should go to the hospital regularly for breast examination.
● Self-check
It is recommended to have a self-examination every time after menstruation 1 week. Postmenopausal elderly women can choose the examination and treatment time at will.
Look for changes in appearance, pain, lumps, pus, etc. Mammary. It should be noted that fingertips should be used instead of fingertips during palpation, and breasts should not be grasped by hand.
During self-examination, it is recommended to face the mirror, put your hands on your hips, and observe whether the appearance and contour of the breast are abnormal. Then, raise your arms and observe whether the appearance, skin, nipple and contour of the breast are abnormal. Generally, the order of touching the breast with fingertips is up, inside, down and outside, then lying on your back and lifting your shoulders slightly. Raise your right arm and touch the breast, the tail lobe of the breast and the right armpit with your left hand.
● Physical examination
Xie Xiaoming emphasized that self-examination alone is far from enough. It is recommended to go to the breast department of the hospital regularly every year for relevant examinations. Women over the age of 30 have specialist physical examination and breast B-ultrasound examination every year; For women over 40 years old, in addition to specialist physical examination and breast B-ultrasound, molybdenum target examination should be done once a year to find early breast cancer. (Reporter Yu)
2. How to prevent breast cancer?
Controlling fat and losing weight: it is found that cancer cells are in the initial state, and only when they are "stimulated" can they proliferate rapidly, thus becoming ill. High-fat diet is a "stimulant" of breast cancer. Long-term intake of fat can make the body produce a large number of estrogen-like and prostaglandin-like substances, which can stimulate the growth of cancer excessively. A large amount of fat intake will also make the body fat and reduce immune function, which gives opportunities. Therefore, controlling fat intake, reducing and improving the immune mechanism and disease resistance of the body can effectively prevent and reduce the occurrence of breast cancer.
Avoid drinking: For women, the harm of drinking is far greater than that of men. Women who drink alcohol have a higher risk of breast cancer than those who rarely drink alcohol. People who drink 1 cup or more every day have a higher risk of breast cancer than those who rarely drink, which is most significant among former women. At present, alcohol can stimulate the secretion of prolactin in the anterior pituitary gland, which is related to the occurrence of breast cancer. Therefore, women, especially those before and after menopause, should give up drinking and drink less.
Drink less coffee: coffee, cocoa, chocolate, these foods contain a lot of xanthine, which can promote benign, and benign breast hyperplasia is related to breast cancer. If women, especially premenopausal women, eat too much of this kind of food, with the intake of xanthine, the risk of breast cancer will greatly increase. Therefore, women, especially those over middle age, should drink less coffee and eat less chocolate.
Eat more fruits and vegetables: Studies have found that coarse grains, vegetables and fruits not only contain a lot of plant cellulose, vitamins and trace elements with anticancer effects, but also contain a variety of bioactive substances that can prevent and slow down the development of cancer at all stages, among which soybeans, corn, edible fungi, seaweed, garlic, tomatoes, oranges and berries have the most significant effects. Therefore, eating more of these foods in daily diet is not only beneficial to health, but also helpful to the prevention of breast cancer.