For this type of cancer, Chinese patients may be ten years younger than those in foreign countries?

The latest global cancer burden report shows that there are 2.26 million new cases of breast cancer each year, making it the most common cancer. At the same time, there are different characteristics in urban and rural areas, and at home and abroad >>

Written by reporter Lü Bingxin Edited by Liu Zhao

New Media Editor/Li Yunfeng

Interview experts

Di Lijun (Chief Physician, Department of Breast Oncology, Peking University Cancer Hospital)

The 28th National Cancer Prevention and Control Week, which has just passed, was themed "Early Action for Cancer Prevention and Control". It aims to actively advocate that everyone be the first person responsible for their own health, correctly understand cancer, actively prevent and control cancer, establish the concept of cancer prevention, and take positive actions to achieve early prevention, early detection, early diagnosis, and early treatment, so as to effectively reduce the social harm and disease burden caused by cancer.

The latest global cancer burden report shows that there are 2.26 million new cases of breast cancer each year, exceeding the 2.2 million cases of lung cancer, and has become the most common cancer. In my country, breast cancer also ranks first among female cancers, with more than 420,000 new cases and more than 120,000 deaths each year, seriously threatening the health of women.

What difficulties do breast cancer patients face during the epidemic? Why are cities the hardest hit by breast cancer? Why are there repeated calls for early diagnosis and treatment of breast cancer? The reporter interviewed Di Lijun, chief physician of the Department of Breast Oncology at Peking University Cancer Hospital.

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What difficulties do breast cancer patients face during the COVID-19 epidemic?

"He has superb medical skills, noble medical ethics, uses appropriate medicines, and is a spiritual pillar for patients. I hope the epidemic will pass as soon as possible so that more people can get treatment." A breast cancer patient from Fuzhou, Fujian, commented on Di Lijun's medical skills on a medical platform.

The COVID-19 outbreak is currently spreading frequently in many places, which will have some impact on the treatment of patients with confirmed breast cancer. "Despite this, doctors still try their best to fight for medical treatment opportunities for patients while ensuring epidemic prevention and safety." Di Lijun introduced that online clinics have achieved good results, providing patients with medical services and medication guidance through the Internet. On the other hand, they will also provide patients with suitable treatment plans to minimize the number of visits to the hospital and avoid cross infection.

In addition, the epidemic not only threatens people's physical health, but also impacts their mental health to a certain extent. "And high mental stress is precisely one of the high-risk factors for breast cancer in women," said Di Lijun.

In order to encourage the public to pay attention to their mental state during the quarantine period, the WHO official website specifically mentioned the importance of maintaining mental health in the "Stay Healthy at Home" topic, and also listed a series of ways to relieve stress. For example, while following a trustworthy news channel, try to reduce the number of times you watch, read or listen to news that makes you feel anxious or painful; try to maintain a regular schedule, exercise regularly, and keep in touch with relatives and friends.

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Cities are the hardest hit areas for breast cancer

Breast cancer is a malignant tumor that occurs in the mammary epithelial tissue. In recent years, the number of cases has been ranked first among new malignant tumors in Chinese women. "Breast cancer has a higher incidence in cities," Di Lijun pointed out. "Breast cancer can be called a 'rich disease' to some extent. The more economically developed the region, the higher the incidence. In economically developed countries such as Europe and the United States, the incidence of breast cancer can even reach 100-120 people per 100,000 people. At present, the incidence of breast cancer in my country has reached 60-70 people per 100,000 people, and is still increasing at a rate of 1.5% per year."

Why is the incidence of breast cancer higher in economically developed areas? Di Lijun said that the reason is not very clear at present, and it may be related to factors such as greater employment pressure and late childbearing among urban women. "It is caused by a combination of factors."

(Map/Lancheng)

The "Guidelines for the Diagnosis and Treatment of Breast Cancer (2022 Edition)" issued by the General Office of the National Health Commission pointed out that women aged 35-64 should undergo breast cancer screening at least once every 2-3 years, and high-risk groups should appropriately increase the screening frequency.

In fact, in order to prevent and treat breast cancer, as early as 2009, my country included breast cancer screening for rural women in major public health service projects, and provided free breast cancer screening for rural women aged 35-64 in the project areas, which achieved significant results and also had a wide range of radiation effects. At present, the breast cancer screening project has covered more than 85% of the counties (cities, districts) in the country, and 19 provinces (autonomous regions, municipalities) including Beijing, Heilongjiang, Jiangsu, Zhejiang, Fujian, and Henan have achieved full coverage of counties (cities, districts) in the province.

In order to protect the breast health of urban women, on January 18 this year, the National Health Commission also issued a new "Breast Cancer Screening Work Plan", expanding the scope of screening services from rural women of appropriate age to urban and rural women of appropriate age (35-64 years old). Screening services give priority to rural women and urban low-income women.

Di Lijun also pointed out another trend in the incidence of breast cancer in my country. The peak age of breast cancer in European and American women is 60 years old, while the peak age of breast cancer in Chinese women is about 50 years old, which is ten years younger than that in foreign countries.

Does that mean breast cancer is becoming younger? Di Lijun explained that the peak age for Chinese women is 50, and the average menopause age for Chinese women is around 49. Compared with European and American countries, the proportion of premenopausal breast cancer in my country's breast cancer patient population is comparable to or even slightly higher than that of postmenopausal breast cancer, while breast cancer patients in European and American countries are mainly postmenopausal breast cancer. Therefore, we see more young people suffering from the disease, "but it's not that they are getting younger, but that the total number has increased." In addition, according to existing data statistics and observations, the peak age of Chinese women's disease is also moving backward, and the average age of onset is tending to be higher and higher.

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5% to 10% of people are diagnosed with the disease at an advanced stage

Many people probably know that painless lumps in the breast area, nipple discharge, skin changes, nipple and areola changes, and enlarged axillary lymph nodes are typical symptoms and manifestations of breast cancer. But in fact, these symptoms mostly appear in the middle and late stages of cancer. Early breast cancer has no obvious typical symptoms and signs, and it is not easy to attract the attention of patients.

"Only by conducting regular breast cancer screening can we detect it early and improve the cure rate and quality of life of breast cancer patients," said Di Lijun.

"Unfortunately, about 5% to 10% of patients are already in the late stage of breast cancer once it is discovered," said Di Lijun. The idea of ​​"not wanting to see a doctor" is very popular in some rural areas. Some women do not actively seek medical treatment after becoming ill, and only choose to seek medical treatment when their breasts become red, swollen or even ulcerated. By this time, the cancer cells have often already metastasized.

"Among the patients who come to our Department of Breast Oncology, 70% are in the late stage." Having been engaged in clinical work on breast cancer for decades, Di Lijun feels very sad about this phenomenon. Therefore, in addition to his daily medical, scientific research and teaching work, he also actively conducts grassroots education and strengthens cancer prevention education in rural areas where health science knowledge is relatively lacking, "instilling in the people the health awareness of physical examination even if they are not sick, advocating the concept of early diagnosis and early treatment, and strangling the disease in the cradle."

In fact, it is necessary to promote the concept of "early diagnosis and early treatment". According to the data of the seventh census of my country, the proportion of people aged 65 and above is 13.50%. The aging population has brought new challenges to "Healthy China". The disease burden caused by breast cancer will also be greatly increased. Therefore, breast health issues urgently need the attention and participation of the whole society.

At the same time, it is also recommended that women do a self-examination in the mirror one week after the end of each menstrual cycle to observe the symmetry of the breasts, whether the skin has changed, whether the nipples are sunken, whether there are nodules when touched, and other abnormalities, so as to achieve a simple breast examination.

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The level of primary care needs to be standardized

For breast cancer patients, time is life. The patient's survival rate is determined by the stage and type of the disease, but generally speaking, the 5-year survival rate of early-stage breast cancer patients can reach more than 90%.

"Therefore, there is no need to be afraid of cancer." Di Lijun said that breast cancer is a common disease that can be cured if it is discovered, diagnosed and treated early. In addition, with the continuous development of medicine, the treatment of breast cancer has become more diverse. In addition to traditional surgery, radiotherapy and chemotherapy, endocrine therapy, targeted therapy and immunotherapy can all achieve good results, and the side effects have been significantly reduced.

Di Lijun introduced that the current treatment level and cure rate in China's first-tier cities are basically the same as those in Europe and the United States, but there is still much room for improvement in the diagnosis and treatment level at the grassroots level. In some rural areas, due to the limitations of the diagnosis and treatment level, the treatment plans provided by doctors are not effective, and sometimes patients are over-treated. "But what is more regrettable is that some necessary treatments that should have been done were not done at the time."

In order to avoid and reduce the occurrence of such problems, Di Lijun actively participates in the standardized training for oncologists in grassroots hospitals every year. He improves the diagnosis and treatment level of local doctors by discussing cases with grassroots doctors, analyzing treatment deficiencies, and standardizing breast cancer treatment plans.

"Cancer cells are very cunning, and medical workers need to keep learning and conducting research," said Di Lijun.

Produced by: Science Central Kitchen

Produced by: Beijing Science and Technology News | Beijing Science and Technology Media

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