Milestone! The treatment of breast cancer with high recurrence risk also has a “treasure book”

The evening of August 2, “Dr. Ye Songqing Talks About Breasts”The fourth phase of the series of live broadcasts was successfully concluded. Professor Liu Qiang of Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Breast Cancer Hospital Affiliated to Fudan University Professor Li Junjie of Surgery and Professor Ye Songqing of Department of Oncology of Fujian Provincial Hospital introduced the first “Expert Consensus on Diagnosis and Treatment of Young Breast Cancer in China” online, and discussed the hot clinical issues of young breast cancer.

oneWhy consensus?

Recently, Professor Liu Qiang from Sun Yat-sen Memorial Hospital of Sun Yat-sen University, a Chinese member of the International Breast Cancer Consensus for Young Breast Cancer (BCY5) expert group, led the first “China Young Breast Cancer Consensus”. (YBCC) Diagnosis and Treatment Expert Consensus”, and is responsible for the main writing of the consensus. Why write this consensus, and what does its birth mean?

Professor Liu Qiang

Sun Yat-sen Memorial Hospital of Sun Yat-sen University

There are more young breast cancer patients in China, and the younger the patients, the higher the malignant degree of the tumor and the recurrence The risk is also greater. This is one of the reasons why young breast cancer has received much attention. However, at present, the European expert group is discussing the needs of young breast cancer patients in their 30s and 40s, and lacks attention to the needs of younger breast cancer patients.

In addition to the age of onset, there are also differences in the needs and pathogenic factors of young Chinese breast cancer patients and European and American patients.


Different BRCA mutations

The age distribution of young breast cancer between China and the United States is not only different, but also the pathogenicity rate of BRCA gene mutation is different, that is, It is said that Chinese and Americans who also carry BRCA gene mutations have a higher probability of breast cancer in Americans, and a lower probability of breast cancer in Chinese. Moreover, Chinese people who carry BRCA gene mutations do not necessarily have a family history. The NCCN Guidelines for Reducing Breast Cancer Risk in the United States recommend that people with BRCA gene mutations should have preventive ovary/breast removal at the age of 35-40. And we Chinese have a lower morbidity rate, so we need a guideline for young breast cancer that is more suitable for Chinese to guide our clinical practice.

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Different social environment

Professor Liu Qiang

Sun Yat-sen Memorial Hospital of Sun Yat-sen University

Chinese women are actually very good and not easy. In the United States, about 50% of women are housewives at home, while in China, most women shoulder the burden of Responsibilities and obligations in many aspects such as work, family and society.

Therefore, the consensus also needs to take care of all aspects of the needs of young Chinese women after rehabilitation.


Different milk retention rates

In China, breast cancer patients who choose breast conservation are often lower than those in Europe and the United States. One of the reasons is that when the tumor is discovered, the tumor stage is usually late, and the opportunity for breast conservation has been missed. The second is because many patients’ attitudes will also change as the situation changes. When facing the threat of cancer, they do not consider breast conservation at all. I will regret not choosing to preserve breast milk.


Focus on the mental health of young breast cancer patients

During the live broadcast, Professor Liu Qiang mentioned another patient of his own. She was diagnosed with breast cancer at the age of 25. It has been 5 years since then. She has fully recovered, and the fear of tumors has been eliminated, but she said that there is still a psychological shadow, and she always feels that she is a patient, because she is afraid that the genes will be passed on to children, and she does not want to get married again. Some feelings of inferiority.Professor Liu Qiang told her that there is no need to think so, because she has already done the test, and there is no mutation in BRCA1/2, even if there is a mutation, we now have this advanced reproductive system Use technology to choose a healthy child, she has fully recovered, and she should not have any wounds in body or mind.You should treat yourself as a normal healthy person, go to Live normally and healthy, and enjoy the next few decades of life.For this reason, Professor Liu Qiang proposed the consensus of the next session, and also pay more attention to young people Psychological problems of breast cancer patients.

The “2022 White Paper on the Quality of Life of Breast Cancer Patients in China” is in progress. How is your psychological situation? Come along with your friends and sisters Fill it out and let us contribute to the treatment and survival of breast cancer patients!

The launch of the first “Expert Consensus on Diagnosis and Treatment of Young Breast Cancer in China” is a good start for the diagnosis and treatment of young breast cancer patients. This consensus has gathered the wisdom of hundreds of experts, and made a professional clinical guide in the aspects of reproduction, gynecology, rehabilitation, chemotherapy, and endocrine therapy for young breast cancer.

Professor Liu Qiang

Sun Yat-sen Memorial Hospital of Sun Yat-sen University

I hope this consensus can also arouse the attention of all sectors of society to young breast cancer. In fact, during breastfeeding or giving birth 1 Women under the age of 35 have a higher incidence of breast cancer than non-pregnant women of the same age, especially those over the age of 35.

However, during this period, women’s breasts are often in a swollen state, and it is easy to ignore lumps or be mistaken for breast accumulation. More attention should be paid to their breast health at this stage. I also hope that such a consensus can help our patients go better and go further on the road to long-term recovery.

Two Young breast cancer clinical hotspots

Afterwards, Professor Ye Songqing and Li Junjie initiated a discussion on young breast cancer clinical hotspots.

Who needs BRCA genetic testing?

Professor Li Junjie

>Fudan University Affiliated Cancer Hospital

Nowadays, clinicians are becoming more and more open to this issue, but at the same time they are becoming more and more cautious. As genetic mutation testing becomes more feasible, we will also recommend more patients for such testing.

But I don’t think it’s necessary to enforce which groups of people must do it. In the general population, the BRCA gene The mutation rate accounts for 2%, 5% in breast cancer, 10% in patients with BRCA mutation, and its mutation rate or penetrance in patients with family history and young triple-negative breast cancer may be rate will be higher. If the patient does not reject it, it is also possible to draw a blood to observe the state.

And more and more caution means that we don’t need to see a BRCA mutation, or even a disease-causing mutation, immediately. An ultimatum.

Such a discovery was made in the United States, due toConcerns about mutated genes have led to very high rates of overtreatment in some states. In 2019, literature suggested that in some states in the United States, the rate of opting for contralateral resection of young patients with cancer on one side of the breast can reach 49%. Such a rate is too high, so our clinicians will be very cautious. Talk to the patient about whether there is a mutation, whether it is likely to cause disease or definitely disease-causing.

What is the rate of subsequent possible new breast cancers from our own model, contralateral The incidence of breast cancer. Then comprehensively judge whether it is necessary to accept a more traumatic surgery.

Professor Ye Songqing span>

Surgery of Oncology, Fujian Provincial Hospital

Conditional breast cancer patients can do it anyway Genetic testing to find out whether there is a mutation in your own BRCA gene also has a reference role for subsequent treatment.

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The breast conservation rate of domestic breast cancer patients is generally low, but the Fudan University Cancer Hospital The milk conservation rate is relatively high, how is this achieved?

strongProfessor Li Junjie

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Fudan University Cancer Hospital

In our center, the breast conservation rate has been consistently remained at around 28%. Now we also put forward that for women before the age of 40, we hope to come to our Fudan Cancer Hospital, with breasts coming in and breasts going out.

is the first choice for patients who are suitable for breast conservation Breast conservation, if it is not suitable for breast conservation, we will perform plastic surgery on the basis of total mastectomy, so as to achieve 25%-27% of breast reconstruction patients. We hope that more than 50% of women will be able to maintain her shape after surgery.

Professor Ye Songqing

span>Surgery of Oncology, Fujian Provincial Hospital

Young breast cancer patients have a relatively high demand for breast conservation, and It is hoped that the milk retention rate can be improved on the premise of ensuring safety. We can also use breast-conserving plastic surgery and reconstruction techniques to create a better shape for a better quality of life.

for Is tamoxifen and toremifene equivalent in premenopausal breast cancer patients?

Professor Li Junjie

< p>Fudan University Affiliated Cancer Hospital

Currently, the indications of toremifene only include postmenopausal breast cancer patients. But in fact, in terms of its mechanism of action, it is just as effective before and after menopause.

Although for a long time, we all believed that the efficacy of toremifene was greater than or equal to that of tamoxifen, especially in patients with cypd2D6 gene mutation, but in the clinical diagnosis and treatment of breast cancer, he The data volume of moxifen is at the level of evidence-based medicine, and the data volume is the largest.

So in clinical practice, we do not need to distinguish who is superior and who is inferior, and now there are more and more A lot of data suggest that the two drugs themselves are equivalent.

How to consider dose-dense therapy in younger patients?

Professor Li Junjie >

Fudan University Cancer Hospital

For young breast cancer patients, three Dose-dense chemotherapy regimens are more recommended for patients with negative breast cancer. Mainly because triple-negative breast cancer, its own tumor cells are more active, it takes a shorter time, through the action of different chemotherapy drugs, intensive use of chemotherapy drugs, can better kill these more active tumor cells .

Young patients have better tolerance to chemotherapy, so it is easier to use such a dose-dense treatment regimen. But don’t think that you are more sensitive to this kind of program at a young age, I don’t think this is relevant.

Professor Ye Songqing

p>Surgery of Oncology, Fujian Provincial Hospital

Dose-dense regimens are not specific to young breast cancer, but Because younger patients may be better tolerated, more specialists will choose this more intensive treatment regimen.

One answer per issue


This year, 32 years old, on May 9, 2022, was diagnosed with invasive breast cancer in the left breast. On May 17 at Sun Yat-sen Memorial Hospital of Sun Yat-sen University in Guangzhou, she underwent nipple-sparing subareolar excision of left breast, and left breast prosthesis reconstruction at the same time. On May 24, he returned to Sun Yat-sen Memorial Hospital in Guangzhou to get the pathological results and decide on the treatment plan. Pathological results ER (95%), PR (95%), Her-2 (1+), Ki6720%. At the suggestion of the professor, the EP Clinic genetic test was done, and the test result was 3.0, which is a low risk value. At the same time, the BRAC1/2 gene test was done, and the test result was that no clear pathogenic mutation was detected. After an interview with the professor, it was decided not to undergo chemotherapy, but to choose endocrine therapy for 5 years. The medication regimen is exemestane tablets + goserelin implants.

Patient questions

1, EP Clinic is now the authoritative authority in China How is sex, can it be used as an important basis for judging the condition? 2. Some doctors believe that the age of 32 is a high-risk age and should not be tested. Instead, chemotherapy should be performed directly, followed by endocrine therapy. So, using the EP Clinic test results as a standard, is it appropriate to give up chemotherapy? 3. Are there any treatment recommendations for this type of patient?

Expert Answers

For Clinicians In other words, our treatment strategy is determined after a combination of all factors, rather than a single factor that necessarily determines what treatment plan you want to choose. Age, tumor size, lymph node status, ER, PR, HER2, Ki67 are all factors that need to be considered, and if in this case, we are still worried or unsure whether to proceed with chemotherapy, we can choose multi-gene testing, This patient’s results suggest a low risk, which means she does not need chemotherapy.

EP Clinic is an international indicator. And EP Clinic, we can comprehensively judge the risk of recurrence through our series of genes plus our clinical score. Therefore, for a patient with strong positive ER and PR, and low Ki67 level, we can choose not to do chemotherapy, and use endocrine therapy well for 5 years, which is the most appropriate treatment plan.

Review Expert p>

Qiang Liu

Director of Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University

Executive Vice President and Director of Breast Surgery, Yat Sen Breast Cancer Hospital

Outpatient hours:< /p>

Sun Yat-sen Memorial Hospital Week of Sun Yat-sen UniversityFour all-day clinics

Review expert

Li Junjie

Deputy Chief Physician of Breast Surgery, Fudan University Cancer Hospital

Outpatient clinic hours during the epidemic:

Tuesday morning Pudong Campus – Expert Clinic

Wednesday Morning Xuhui Campus – Expert Clinic

Saturday morning Xuhui Hospital District – Special Needs Clinic

=”600> strong>Review expert

Ye Songqing

Fujian Provincial Hospital Cancer Executive Deputy Chief of Surgery

outpatient Room:

every Tuesday and Friday morning (outpatient clinic on the fourth floor)

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