Many people believe that since the “culprit” of breast cancer is estrogen, if a woman has gone through menopause, does it mean that she will not develop breast cancer again? Or the earlier menopause, the lower the risk of breast cancer? Do advanced breast cancer patients have to endure the pain of radiotherapy and chemotherapy? Recently, Liao Ning, director and chief physician of the Breast Department of the Cancer Center of Guangdong Provincial People’s Hospital, solved these misunderstandings of breast cancer cognition and treatment for us one by one.
Myth 1: The earlier the menopause, the lower the risk of breast cancer. “It’s not that the earlier the menopause, or the menopause, the lower the risk of breast cancer.” Liao Ning said that in the United States, the peak age of onset of hormone receptor-positive breast cancer patients is 65 years old; in China, the peak age of breast cancer incidence is 65 years old. The stage is 45 to 55 years old. Many women in these two age groups have entered perimenopause or have gone through menopause.
Liao Ning analyzed that the causative factors of breast cancer are related to estrogen levels in women, but the changes of estrogen levels are not only related to menstruation. When a woman is in perimenopause or has gone through menopause, it simply means that estrogen production by the ovaries has decreased, or the ovaries are no longer producing estrogen. However, estrogen is still present in other tissues, such as adipose tissue, in women. Moreover, certain androgens also exist in tissues such as adrenal glands of women, which are also converted into estrogens through the catalysis of aromatase. Therefore, postmenopausal women may also get breast cancer due to other ways of getting too high estrogen.
Myth 2: Endocrine therapy will bring side effects such as bone pain, so it is best not to do it. “Because breast cancer is closely related to hormone levels, endocrine therapy has been increasingly used in breast cancer treatment in recent years.” Liao Ning introduced, but many patients believe that endocrine therapy will cause severe bone pain, so many people All refused to receive this treatment.
Currently, 21.4% of breast cancer patients in China are diagnosed at an advanced stage, and 67.8% of them are estrogen receptor (ER) and/or progesterone receptor (PR) positive. Liao Ning believes that patients with hormone receptor-positive advanced breast cancer should receive endocrine therapy even if there is visceral metastasis.
According to Liao Ning, there are two types of classic endocrine therapy drugs, one is aromatase inhibitors represented by letrozole, anastrozole, etc.; the other is fulvestrant, etc. Representative ER downregulators. ER down-regulators can directly reduce estrogen receptors, and aromatase inhibitors are enzymes that inhibit the conversion of androgens to estrogens. The pathways are different, but they are all designed to block the estrogen receptor signaling pathway.
Liao Ning said that fulvestrant is actually an estrogen receptor downregulator, which reduces estrogen more directly and rapidly than aromatase inhibitors, and has a low incidence of side effects such as bone pain. “The ‘magic weapon’ of many medical oncologists is still chemotherapy, but it is not necessarily necessary.” Liao Ning said, “Many of my patients with advanced breast cancer do not need chemotherapy. They drink tea and exercise every day, and the drug is toxic. Very low.”
Postmenopausal patients with ER-positive advanced stage can be treated with ER down-regulating agents. Liao Ning said that as long as estrogen receptor (ER)-positive and postmenopausal advanced breast cancer patients can use ER down-regulating agents, they do not need to suffer the pain and toxicity of chemotherapy and radiotherapy. “These patients account for 50% to 60% of all breast cancer patients,” she said.
Liao Ning explained that the function of ER down-regulators is mainly to down-regulate estrogen receptors. The ovaries also secrete estrogen, so there will be inaccurate targets. “If there is no menopause to receive ER down-regulating treatment, you need to first ‘castration’, that is, the use of drug injections to reduce ovarian function to the point where estrogen is no longer produced. If there is a fertility requirement, the ‘castration’ can be stopped after the treatment is completed. Ovarian function can be restored with a drug injection.”
Exercise also thwarts cancer cells. Liao Ning pointed out that a recent article published in “CELL” believed that exercise can directly kill cancer cells. At present, her team has developed an “individualized exercise prescription” for breast cancer treatment, and has launched an “individualized exercise prescription plan” to fight cancer through exercise, which is also the first team in the country to launch this project. “For example, once breast cancer patients have undergone surgery, we will have a physical fitness specialist to guide them to exercise, evaluate their exercise ability, formulate individual exercise prescriptions for them, and monitor their exercise level.” Liao Ning Say. (Hu Zhen)
[Editor in charge: Shen Tian]