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lecture Speaker: Beijing Cancer Hospital, prevention and treatment of breast cancer center director, chief physician Ouyang Tao / Radiology Professor Li Jie talks
Time: October 13, 2007
Location: Beijing Cancer Hospital - Academic Hall
Moderator: Distinguished leaders, distinguished guests, distinguished audience, Good morning! Today is October, October is the months, we co-Cancer Hospital and the GE sponsored the clinic and the , the sessions have been held more than a 30. into such a prestigious Peking University and Tsinghua University. Today our The purpose is to raise public awareness of breast cancer in this high incidence of malignant disease of modern women's concern and understanding, while universal health survey of women with breast cancer knowledge.
we have been fortunate to two well-known experts in our hospital, one is the breast Professor Ouyang Tao Centre, another of Professor Li Jie in radiology. Here we have time left to experts, first breast cancer prevention and treatment expert, Professor Tao Ouyang for everyone to do Progress Topic: how to face the and scientific disaster. breast cancer is not a pure killer, it is just a disaster. Since it is a disaster can, through our efforts to disaster reduction. This is my time in every lecture that .
why breast cancer is a disaster it? some patients will die of breast cancer, breast cancer treatment will bring great pain to the patient; and traditional treatment of women's performance will lead to a damaged organ, We all know that the breast may be cut away. such things as closer and closer, the incidence is increasing year by year. It sounds terrible, but it is not. to use the approach to the treatment of breast cancer hazard of this disease , do not take it as a killer, it is not fit to be the killer.
reduction can not? possible. Breast cancer is a chronic disease takes a long time to respond. breast cancer is also the only two approved by WHO in early diagnosis can reduce mortality of the disease. another example, 90 years after Europe and the United States breast cancer mortality has declined, although the incidence is rising, but the level of continuous treatment progress. scientific and technological progress, human benefit in breast cancer therapeutic areas as well. Technology advances also allow a means of breast cancer patients continue to benefit.
we see the case of breast cancer mortality in France, began to decline after 90 years; the United States began to decrease breast cancer mortality; UK mortality rates have been declining after 90 years; Dutch breast cancer mortality is declining. relatively speaking 90 years after breast cancer mortality has declined more obvious. relevant professionals to do a lot of effort and research, the reason is reasonable treatment, and then one that is earlier diagnosis. early detection of breast cancer and appropriate treatment of breast cancer, breast cancer can reduce mortality.
These are the world's researchers involved in breast cancer treatment into a lot of energy spent a lot of money out of the conclusions of research. As the common scientific and technological progress of human property, why can not we enjoy the results of this study give us the benefits of it? so we have to update their knowledge, you know I always wanted to be able to change the use of advanced technology themselves, and benefit from.
What is the early diagnosis of breast cancer?
What is the early diagnosis of breast cancer? doctor referred to the early detection of breast cancer, or in the profession in the current propaganda to the public When talking about early detection of breast cancer, the aim of reducing mortality, followed by improving the quality of life. If a means for early detection of breast cancer, but if this early detection can reduce mortality, the early detection there is no practical meaning. means of early diagnosis of breast cancer actually have two steps, step is to look at the breast, there is no exception, and then one is to clear what is the nature of this anomaly in the end. Because breast cancer is often a matter long, there are benign, there malignant. In addition, through regular self-examination in early detection of breast cancer. and then one is X-ray examination, before we call photographic plate or photographic mammography. Now there is the relative magnetic resonance imaging examination. evaluation of these methods can not be used as breast cancer The discovery means the key indicators are able to reduce mortality. We take a look at the introduction of these methods. mammography camera and its sensitivity is relatively high, there are 100 in 90 breast tumors can be discovered. clinical doctors to do medical examination 95% of the time sensitivity, can be found, or tangible. back I will speak with you, to discover breast cancer is not early breast cancer. Another promotion for a long time regular self-test is sensitive of a 30%.
we see in Europe and the United States breast cancer mortality has fallen, the mortality reduction and early detection of a great relationship. We look at the case of early detection, 2006 meeting in France When I get some information, one cm below the probability of breast cancer tumor in 1 / 3, but one centimeter below the breast is basically can not touch. two centimeters below the 70% incidence of cancer, and this is imaging findings of breast cancer. only be possible to reduce this level of early mortality.
information in France is like this, one centimeter below is 1 / 3, two centimeters below the more than 70%. also One is in situ, to be a simple operation on the line. early detection is about such a state. only to reach such a state can reduce mortality. regular breast self-test, the latest research results can not reduce breast cancer deaths rate of .05 in the United States some of the relevant guidelines for the early detection of cancer is no longer recommended regular breast self-examination as a means of reducing breast cancer mortality, and have abandoned this method of checking out. If you do regular breast checks no one opposed, but to the regular self-image as an auxiliary means, not as the primary means. This is the 2005 revised U.S. guidelines for the early detection of cancer, which is a card verifiable. now It was talking about regular self to reduce mortality, it is unscientific.
imaging we are now looking at aspects of mammography camera, for example, the GE Medical organizations. formerly known photographic plate is compared density, tumor density, low density of the breast, breast lump is white, and some calcification. next step is to figure out this exception is not a threat to your health, is not required human intervention. Such a breast is less likely to be detected, because it itself is white, you see the contrast between the tumor does not exist. We Chinese race is precisely the people with high breast density, our patients do most of this film mammography situation; Europe and the United States is enough to make a molybdenum target, but in China may not be enough. Why? because China quite early age of onset, young patients with breast more.
another race to take over, and Europe than Our high breast density. The race features not suitable for light to check with the camera. also need to add is that the B-breast, previous results are not too high. We all know that science and technology 90 years ago is not now so well developed, Advanced detection methods do not now, before that B-is not enough; but in Europe and the United States to the breast is divided into four levels, with examination of their B-sensitivity is 40%. So we Chinese X-ray examination alone is not enough the. clinical examination and X-B-ultrasound group and then do or can find a number of early breast cancer patients. So now we Chinese people are not just to do a medical X-ray examination of breast, B-ultrasound is also very important. Because of seeing this trend, foreign investment is also a lot of resources into research and this new device, which is all the B-breast examination. B super machine like a fool as the probe, can cover the entire breast. take great efforts to the development of such equipment, indicating this method, some people are quite useful.
Another way is nuclear magnetic resonance, which is currently checked in the most sensitive imaging method. in a foreign country for the defective gene high-risk breast cancer population. But there is a problem in the country NMR, when you find it difficult to determine after lesion nature, as far as I know there is no such technology internally to achieve this. Therefore, before the lack of positioning means, for normal people to do this Check some problems may exist. now the recommended method for breast cancer is breast X ray; but young people may have to be careful. Although breast X ray now has a relatively low dose, but still not recommended for women under 35 years old to do such checks. At present, for X-ray examination of organic defect is more appropriate, and for other patients is not necessarily the trial.
ultrasound images, especially for those who just finished X-ray examination of patients, followed by breast MRI, in Europe, especially Germany, as the main high-risk groups of organic defect detection method. If you find a problem, it is difficult to take it out. Finally, the attending physician's hand, through the detection of breast cancer in this way will reduce the death rate. but if you go to a place to do breast examination, the doctor attending to you individually by hand, then you should play confirmed a question mark, because the hand of a separate consultation and can not be completely confirmed. another one is the periodic self-test, there is scientific evidence prove that it can not serve as a means of early diagnosis, so there is no harm healthy lifestyle, but do not simply use it as early diagnosis and use. If the method of early diagnosis is not reliable, which will create an illusion, caused by the crisis. early diagnosis If we need to do regular breast X ray, but that there are age restrictions.
some observations of our own to discover the symptoms, such as the nipple skin erosion, and if this is the case to go to hospital for examination, this can be found in their own The. The other is some yellow or white nipple foreign body, these symptoms are likely and early breast cancer. nipple is abnormal before surgery, can now make further checks to determine whether abnormal nipple a tumor. papilla 50% of foreign bodies because of the secretion of a tumor, there are also half of the tumor factor, half the length of the tumor in this man there is also 30-50% may be breast cancer, the ratio is very low, but passed in such a way that is good , and most do not need systemic treatment. If such signs to the hospital to be checked in time. This is the only two can be found through their own eyes, symptoms of early breast cancer. In addition to the professional bodies should be through the imaging method to check.
who should have regular breast exams?
we talk about for a long time whether early detection of everyone to do regular checks? If we have a way to find out who is a high chance to get breast cancer , which may be above the problem relatively simple. But now more difficult, and why? what would cause a higher breast cancer risk factors? I have not had a baby, not breastfeeding, I got married relatively late, and I work pressure, etc., These risk factors can not be. what are the risk factors? history of breast cancer, the side had breast cancer, the other side the possibility of disease is much higher than normal. Another is that some genetic defects. another one is in the past did breast surgery or pathological examination did and found that this change is called atypical pathological factors. The other is a very significant family history of breast cancer, or have more family history of ovarian cancer, such Some people can be seen as high risk of breast cancer, except for outside factors and age and so not necessarily related. Finally there is a reason why non-pathological breast hyperplasia, breast hyperplasia general we say, this is not the concept of pathology, this breast hyperplasia and breast cancer is not necessarily related to the concept of clinical and pathological concepts should not be confused, confusing the two concepts are plenty of ignorance, some because of the lack of pathological concept.
stress again that the proliferation of breast cancer and biopsy must be the results of pathological examination if not done, puncture, and surgery, can not diagnose the problem if the pathological category.
done an inspection did not find any problems in this round is over, no problem. but a do find a problem with B-how to do? to clear the nature of the abnormal, the nature of the film do not look at a B-will be able to identify it? can make a guess, but can not make the final judgments, and if not through pathology to determine the clear, even according to the film, people may tell you it is not breast cancer, this film is not for the treatment of the premise. From a medical point of view, if not from the perspective of treatment of breast cancer pathology is illegal.
must be clear what is the nature of a two-step disease. One is to get suspected that part of the organization, to see some take a little lump or calcification of a check in the past we touch to the hospital cut off a tumor Besides, this is before the traditional approach, this approach is considered to be very stupid, gradually being replaced. Now is not the diagnosis of breast cancer in Europe through the removal of mass-based. put a lot of opportunity is an operation removed, many opportunity to have this. In addition, there are many benign lesions, surgery is not necessary, it is very clear. to tell you a phenomenon, touch the removal of a tumor to do it in Europe and the United States has basically been eliminated in our hospital have also been eliminated. now the preferred way is to do a biopsy. Some people doubt whether it would puncture the transfer done, we should believe in science, I believe that the doctors treating you. This method can be popular in the world is justified. Also for small mass (1 cm or less) the use of puncture is not accurate, you can use the minimally invasive approach. we are now using this approach has done more than 100 cases, more than 90 cases are below 1 cm.
early the significance of detection of breast cancer is very important. can be reduced to the health effects of disease to a minimum: first, to retain the chance of sexuality we improve organ; second, upper limb function of reservations; the third, lower treatment costs; fourth, reduce the risk of death. We have an evaluation of their system, divided into two parts, one is the size of the tumor as small as 1 cm to be conservative treatment, and other tumor metastasis is also a very important factor, both factors can be prevented by early detection.
to maintain a good attitude, can not ignore, nor fear, the key is participation. Now the subject is no longer medical doctors, but patients; health conscious people who are not strong, the hospital will provide help. in the United States and Europe, community activities, all free to participate, so as to profit, not actions speak more to no avail. I began to also say, and willing to tell you some useful knowledge to change behavior we . so early detection is the key to a good state of mind; not scared to death, can not but seriously. Although the chances of becoming sick is not high, but if it is found, then treatment must be positive.
adhere to regular inspection, 35 to 40 years old, every 1 to 1.5 years time. professional organizations is an effective and reliable means of protection.
mastectomy breast cancer patients
not all, then a brief treatment of the following circumstances. As science continues to progress in treatment of breast cancer models have been the innovation and development. You may think that breast cancer had to be dropped across the board, is not the case. Now there are many new methods, such as breast-conserving treatment, after treatment you go swimming, washing Sauna is not a problem, to achieve this goal is not to the cost of survival. abroad for breast-conserving therapy has now been for 30 years, according to the rules of medical research to find disease and the most rigorous medical evidence to support the use of this treatment. with this treatment of patients will not have any effect on the life and health, and no one will feel the breast is not important to retain the breast is possible, we have to do with the idea that breast cancer treatment. in accordance with strict standard to do so, or cut on the survival of breast conservation is no different, the only difference is that for patients with left breast is a big psychological impact.
especially to those who left breast, but because of late treatment or other factors can not meet the strict conditions to retain the breast, the breast can also take down the sick, with their own organization or external organizations to restore parts of the breast removed. Now we are the belly bulge most respected organizations to use them on this one can solve the problem of breast-conserving shape.
breast-conserving our hospital from 2001 to now has been studying, and now the proportion of relapse is about 1.1%, very low. with the same period to do a breast full cut more than 1300 cases of phase no different than our own information back to the same. and then there is this technology as far as I know only Beijing Cancer Hospital in Beijing can do. go to the body to determine axillary lymph node in patients with no transfer, so if there is no transfer would not have to do another surgery. Last year we achieved 51% cure rate. a very large tumor on the breast, the patient has a strong desire to want the breast to stay, made a preoperative treatment of patients reached the final wishes, new methods of treatment by 30% of patients the tumor completely disappeared. Is there anything good? way breast cancer is now more appropriate to choose which of the patients which were previously optional, is generally small, ineffective treatment of money is very stupid. This is our current standard treatment.
talk so much, simple and effective way to early diagnosis and treatment of the rationalization of the other early involvement is very important, decisions are patients do, the doctor is only the implementation of this decision, be sure to early diagnosis, Thank you!
breast X photography and the early prevention of early diagnosis of breast
Professor Li Jie Li Jie
: Good morning. very glad Love in October to participate in monthly milk GE medical care for our breasts for this organization's activities, and we talk about breast X photography and the early prevention of early diagnosis of breast. breast early prevention and early treatment, although a small part, but it is also important part. following the discovery of the treatment and diagnosis to tell you about this. Let us look at the knowledge of breast cancer and X-ray of knowledge. to tell you where the problems encountered. I introduced the content of what is breast self-examination ? The second is the X-ray photography of the value? X-third what is the significance of breast self-examination?
What is the X-ray photography? it differs from traditional X-ray, it belongs to mammography technology . The new technology also rhodium palladium technology. Another is the common X-ray photography, the other is specifically designed for breast examination of the machine, which main purpose is to detect early breast cancer. When talking about breast X-ray photography , we bound to traditional film X-ray projection and limited the issue of digital projection. I will give you that.
incidence of breast cancer increasing. just mentioned detection of breast cancer method of early diagnosis so few, first, X-projective, and breast self-examination; The other is the professional clinicians check the clinical visits, along with ultrasound. just mentioned Professor Ouyang and clinical examination for the newly diagnosed The value of early breast cancer found that there is evidence to prove that it can reduce breast cancer mortality. and breast ultrasound in healing also has its advantages, it is the value of screening for breast cancer clinical trials is being applied research among the broader market . breast X-ray photography is used and is now the only proven method of reducing breast cancer mortality in the examination, a mammogram is now an important method of choice. Here to tell you a few of breast cancer have been carried out and the X-ray confirmed clinical studies.
in the United States, Sweden and the Netherlands, they conducted clinical trials on people's results show that the breast X ray projection can make breast cancer mortality reduction. is the biggest two-Sweden County experiment, it is more than 70,000 people carried out the checks every two breast cancer patients showed that in 8 years, 11 years and 14 years later, breast cancer mortality decreased by 30% of the phenomenon, which is very optimistic. breast X ray projection is the only proven way to reduce mortality.
Why? We know that breast cancer occurred from the cellular to the local occurrence of a small mass to be our perceived by humans, symptoms usually give us a warning signal had a year to several years. Once there if we can find the symptoms, this is not an early out. The greatest value of X-projective appears that in our symptoms before the disease can be found through the following methods to find it, this is the period in sub-clinical breast cancer can be detected.
look at this case, it is a physical examination of a woman to participate. We in the film on and found a small piece of calcification, we know that calcium is important in early breast cancer, resulting in a significant performance of breast cancer is to have this tiny calcification. probably a total of 10% of breast cancer is due to calcification was found. The calcification is a very small and very irregular calcification., is the kind of very irregular size and shape, density is not even a small calcification, according to our knowledge of radiology, it is this still the possibility of breast cancer .
In this case, we would recommend to her biopsy, biopsy is an end of the screening method. We instruments to guide the surgeon to the location of calcification, and calcification of successfully cut this down, this is a specimen photography. We see this calcification cut down, we found it by checking a carcinoma in situ, carcinoma in situ breast cancer before the development is in the fat of the breast, the prognosis is very effective.
patient is a 55-year-old woman, she is the side of the breast cancer has been won, and the removal of the conventional review. in the sixth side we have discovered that side of her left breast has a large density of small things , about 5 mm or so. but it looks like is not particularly good, is a very vague form of non-uniform, we think this is a suspicious lesion, it may be a small lesion. After a year the patient more before receiving confirmation of oncology, it really is breast cancer. When clinical palpable breast mass have been camera and then later, the mass has reached 2 cm in size of such an obvious, in fact, touched the lump has been more than two centimeters , and reached a three or four centimeters. This is the second phase of breast cancer, is not an early out. the treatment effect is more obvious than after the two were just good.
another patient, she had the nipple depression, we can see in the picture, see the nipple area, see the nipple has a dense band behind the tumor. the patient to seek treatment only after the inverted nipple, X-ray film, we see In fact she has not had an early cancer. In fact X-projective for this is not the detection of breast cancer patients, because she has obvious clinical symptoms to seek treatment only.
this time the skin is watching that there is thickening, patients find themselves in clinical skin mass to come to such a treatment, and this is the third of the breast, the more after she's even worse than just five years, chances of survival only about 11%, 12% or less.
and this has occurred in patients with large axillary lymph nodes. is not particularly a big lump, axillary lymphatic metastasis has been, and this is not an early. Of course Finally, she must depend on the diagnostic biopsy confirmed. so a census of breast X ray can make women over the age of 50 diagnosed about 4 years ahead of schedule, so that the young women's breast cancer about 2 years ahead of schedule. Indeed X-projective is very credible, so that we can breast cancer be found early, patients have an early opportunity for treatment.
This is a European data, as in Europe and the United States since the mid 80's large-scale The X-ray surveys. in overall mortality after 89 years has been showing a downward trend was. in the United States in the late 80's mortality rate is declining. gradually increased in breast cancer incidence of breast cancer under the present conditions in reducing mortality. It has two main elements of which one is more of breast cancer is found early, early breast cancer found in the U.S. and Europe accounted for 30% of the proportion of breast cancer. then one is breast cancer treatment technology continues to development and progress, there are more treatment to decrease breast cancer mortality that two factors.
cases we have seen from the front, breast X-ray examination there are two types of people to adapt. One is not any symptoms healthy people, this is what we call the census of breast X ray examination. The other is the emergence of symptoms of breast cancer checks, that is, when a patient known that breast lumps, or nipple discharge, or pain, or like orange peel or other depression symptoms, can diagnose breast cancer checks. Just now we talked about a few examples of X ray examination of the breast the most value in those asymptomatic population to detect early breast cancer, If the event of a symptom, not the earlier a breast cancer.
breast X-ray examination then is how to conduct it? This is what we are using a breast X ray camera, which is a vertical of machine, a rotating rack, a presentation board and a compression plate. during the inspection, our technician will conduct a breast compression. This compression may cause some discomfort, some people would appear in the feel pain, can not stand. The pain of oppression is very important, it will make the image clearer we can make the radiation dose decreases. because the reduced thickness of the breast glands receive radiation will be reduced. This pain is the X-ray examination of patients before the test must have a mental preparation. because of the pain, some people would refuse such inspection or fear, in fact, it is not necessary.
Normally, we want to decomposition of two-way location of the breast projection. This is a piece of breast examination, left internal mammary and right breast pieces shine out of the way ordinary. We see both sides of the breast, we called oblique, which is axial, and in both directions, left right as such. normally breast is symmetrical, then these white areas is our mammary glands. we call breast essence, it is a mixture of glandular and fibrous tissue of this image . normally is bilateral symmetry. We radiologist is from these films may be found in some breast abnormalities, including just saw some of the masses and calcification.
these circumstances, we do a breast diagnosis, is nothing less than that of several results, one is the adaptability of the healthy that is a negative result, this situation requires two years of regular checks on the line. In addition, we found some benign lesions, X line can be of a some characteristic performance of a specific benign diagnosis is also not very worried about this situation, to regularly review it. then one is likely to be benign, it is probably benign 98% chance that this situation with short-term patient enough. which is the middle of a suspicious nature we call X-positive results, we see from the symptoms of breast cancer may be found, this situation needs to be considered for biopsy, clinicians need to take a look the most appropriate way. This is also not particularly worried, because there are some cases using this after the final biopsy result is benign, but this does have the potential opportunities. So we can not rule out the need for biopsy.
another one is very typical of the malignant behavior, in which case you need to take measures, and we have these different types to make a diagnostic classification, this classification is also globally. no matter where the check Radiology Doctors will know, are recognized. This is the assessment of ACR, a system diagnostic report.
So to sum up the value of X-ray photography is, to the clinical detection of breast cancer before symptoms appear. by the early detection and early diagnosis received early treatment, so patients can prolong survival after diagnosis to reduce mortality rates. The breast X-ray photography is indeed an effective method, but it is also an economical screening method.
that breast What are the limitations of X-ray photography? First, it is not possible to find all of the breast cancer. There are two cases, one is by common clinical, the patient has an obvious palpable mass, but in the X line We can not see this mass of forms. there is a way to have some special growth of breast cancer, which itself does not form a definite mass and no calcification, X ray did not form density for comparison. We found that by comparing the density lesions, and therefore can not be found.
about it, 9% -10% of breast X-ray can not be displayed, so this case we were going to do the exchange of patients, combined with ultrasound. So Our understanding is important, we do X-ray examination, if it is a first line of the check can not rule out breast cancer. Another limitation is in relatively dense glands of young women, we often go out film difficult, sometimes X-overlap in the truth, we can not accurately to judge it certainly is benign, is definitely vicious, or some other tests to further clear.
we look normal the performance of different human breast. These white areas in different age groups there is a difference. a woman in her lifetime increased with age, hormone levels decreased gradually shrink the gland is to present a law of fats More and more ingredients. This means that with age the variation of the gland. into old age this gland will almost, but mostly young dense breast. this useful? We say that The density of the breast is the most important thing will affect the sensitivity of our detection of breast cancer. For there is a high density of small breast lesions found it very difficult for us because it was hidden to the high density of the glands inside. and low density We found that the breast is relatively easy. So the higher the density of the breast on the X-ray photography is weak, the lower its sensitivity. In this case, we will recommend the patient to do B-inspection, X line and B- The check is breast examination two most important method of mapping study, their role is complementary. dense breast is the advantage of ultrasound, and fatty breast is X-advantage.
we look like translucent breast, later found a lump, and we can see at a glance, without professional knowledge, ordinary people will be able to find abnormalities. and as such a high density of the breast, this is a 50-year-old woman, her left has been able to touch the side of an obvious mass, breast cancer is already a. and X ray can not detect any abnormalities, which is the density would affect the discovery of breast cancer.
and as such a density of slightly more than just also a low point density of the ...
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