Follow-up and health management of "Pink Ribbon"

With the combined influence of various factors such as the accelerated pace of life, the aging of society, and environmental pollution, the incidence and mortality of malignant tumors have also shown an upward trend, and have become the world's major disease deaths and public health issues. The World Health Organization's International Agency for Research on Cancer (IARC) released global cancer burden data in 2020, showing that there are 2.3 million new cases of breast cancer each year, which has become the number one killer threatening women's health. Since 2003, October of each year has been the Pink Ribbon Breast Cancer Prevention and Awareness Month, October 18 is the Pink Ribbon Breast Cancer Prevention and Awareness Day , and the third Friday of October is Pink Ribbon Care Day .

With the emphasis on breast cancer screening and the improvement of standardized diagnosis and treatment technologies, the cure rate of breast cancer patients in China is gradually increasing. With the extension of the follow-up period of breast cancer patients, the tumors and related health problems that patients need to face are also gradually increasing, and more accurate and long-term plans need to be formulated. The 2022 edition of the "Guidelines for Follow-up and Health Management of Breast Cancer in China" (hereinafter referred to as the "Guidelines") includes four parts: follow-up path map, follow-up management, comprehensive health management and patient-reported outcomes. It aims to standardize the long-term follow-up of breast cancer patients and guide clinical physicians to actively carry out comprehensive interdisciplinary health management of breast cancer patients, thereby further improving the prognosis and quality of life of Chinese breast cancer patients.

The guidelines suggest that once breast cancer is diagnosed, patients should avoid a sedentary lifestyle and resume their daily physical activities before the disease as soon as possible. After the end of phased anti-tumor treatment, consult a rehabilitation physician every 3 to 6 months to assess the current physical activity and obtain exercise advice. Moderate-intensity activities include: cycling (speed <16km/h), walking (speed ≤6.4km/h), dancing (social dance, square dance, etc.), household activities (such as making beds, moving tables and chairs, mopping the floor, hand washing clothes, sweeping carpets, etc.). High-intensity activities include: race walking or running (speed ≥8km/h), cycling (speed ≥16km/h), skipping rope, swimming, basketball, football, weighted mountain climbing (weight ≥7.5kg). Adult breast cancer patients aged 18 to 64 should adhere to at least 150 minutes of moderate-intensity activities (roughly 5 times a week, 30 minutes each time) or 75 minutes of high-intensity aerobic exercise per week, and strength training (large muscle group resistance exercise) at least 2 times a week. Exercise in groups of 10 minutes, and it is best to ensure that you exercise every day. Elderly breast cancer patients aged 65 and above should try to exercise according to the above recommendations. If they have chronic diseases that limit their movement, they should adjust the exercise time and intensity appropriately according to the doctor's instructions and avoid being in a state of inactivity for a long time.

Lifestyle intervention is recommended for all patients: A. Moderate-intensity exercise of ≥30 minutes per day, such as walking, running, etc., is recommended, and weight-bearing exercise is encouraged

B. Promote outdoor activities and increase sunlight exposure

C. Adjust your diet, increase your intake of a variety of fruits and vegetables, choose whole grains or high-fiber foods, eat fish at least twice a week, and choose foods rich in calcium.

D. Quit smoking and drinking, and avoid secondhand smoke

E. Be careful to prevent falls and physical impacts, and have your bone density (BMD) tested every year and assess your fracture risk

The upper limb lymphedema is assessed by asking the patient about his/her subjective feelings and objectively measuring the arm circumference of the affected upper limb. Generally, if the circumference of the affected upper limb is <3 cm longer than that of the contralateral upper limb, it is considered mild edema; 3 to 5 cm is considered moderate edema; and >5 cm is considered severe edema.

The treatment of common upper limb lymphedema problems during follow-up requires the participation of multiple disciplines, among which conservative treatment includes artificial lymphatic drainage, skin care, multi-layer bandage compression, massage therapy, functional exercise , etc.

Educate patients on the prevention of upper limb lymphedema (1) Keep the affected upper limb away from high temperature environments

(2) Avoid weight bearing

(3) Avoid compression of the proximal upper limb

(4) Keep the affected upper limb above the level of the heart during sleep

(5) Avoid invasive procedures and infections on the affected limb

(6) Restore arm function as soon as possible

(7) Wear elastic sleeves when flying or traveling long distances

(8) Do appropriate physical exercise

Breast cancer has entered the era of chronic disease management. As the life span of breast cancer patients increases, in addition to paying attention to the disease itself, more attention should be paid to the management of concomitant diseases and treatment-related adverse reactions during follow-up. For example, regular follow-up tests should be conducted on the respiratory system, circulatory system, digestive system, reproductive system, nervous system, and psychological aspects to further improve the prognosis of breast cancer patients and improve their survival and quality of life.

The American Cancer Society (ACS) points out that in addition to smoking, the most important and modifiable determinants that can affect cancer risk are weight, eating patterns, drinking, and physical activity, of which 3% of cancer cases are caused by lack of exercise. The editor hereby calls on everyone to pay attention to choosing healthy living habits, and at the same time give more care to people in need.