Guests of this issue: Wu Jiong
Professor Doctoral Supervisor
Fudan University Affiliated Cancer Hospital Vice President
Director of the Clinical Trial Institution of Drugs
Chairman of the Breast Cancer Professional Committee of the Chinese Anti-Cancer Association
Vice Chairman of the Breast Surgeons Branch of the Chinese Medical Association
Vice Chairman of the Oncology Branch of the Chinese Medical Association
October of each year is the month of breast cancer prevention and treatment, and pink ribbon is used as a symbol of breast cancer prevention and treatment activities to remind people to prevent, detect and treat early, and according to data released by the National Cancer Center, breast cancer has become the first of the onset of malignant tumors in women in my country. So why does breast cancer develop so quickly? What treatment methods are there? This issue's big names said that we were fortunate to invite Professor Wu Jing, deputy director of the Affiliated Cancer Institute of Fudan University, to talk with us about the treatment of breast cancer.
[Regular understanding of breast cancer is very important]
Host: When it comes to breast cancer, female friends are actually familiar with it. Many celebrities die of breast cancer at a young age. So can you tell us first how breast cancer is formed and how fast does it grow?
Professor Wu Jiong: Breast cancer is the most common malignant tumor in women. Even in this statistics of our entire population, lung cancer has surpassed lung cancer to become the most common malignant tumor. In the world, there are more than 2.2 million new breast cancer patients every year, and in my country there are more than 400,000 new breast cancer patients, accounting for almost 19% of the new cases in the world. Malignant tumors have a common characteristic, most of which grow into a lump after a single cell mutation, which may spread along the lymphatic tract or blood vessels to the whole body sooner or later. Therefore, malignant tumors are a life-threatening disease and a major killer that endangers the health of the population.
So how fast is it to grow into a lump or multiple lumps from one cell or multiple origins from different parts? Most cells divide into two cancer cells, from two to four. We think it may take two to three months. You can slowly see a tumor that can get a lump in clinical practice. Of course, there are also some tumors. It may grow slowly and can lurk in the body for a long time. So, it may be called inert, but some breast cancers develop very fast. It may be half a month to one month, and it will form very obvious clinically symptomatic breast cancer. Therefore, the growth rate of her tumor in the body is still somewhat different. First, it depends on the patient's systemic function, the biological characteristics of malignant tumors, and some other factors that the patient may have, including psychological factors, will lead to differences in the growth rate of tumors.
Host: In the face of the number one killer of dangerous women's health, have there been some changes in our understanding of breast cancer? Are there any new trends in terms of treatment methods and treatment concepts?
Professor Wu Jing: In the past 20 to 30 years, the development of breast cancer has been very fast, especially in treatment, so our understanding of this disease is getting deeper and deeper. First of all, from the perspective of systemic treatment, since it is a malignant tumor and it may metastasis or recurrence, we must find a way to control its metastasis and recurrence. Drug treatment plays a very important role in it. For breast cancer more than 20 years ago, we realized that it is not a problem. It is a relatively complex disease composed of several different breast cancers. For example, for hormone receptor-positive breast cancer, it accounts for about 60%-70% of the entire breast cancer. When you hear this word, you will know that its incidence and metastasis may still be closely related to the estrogen in the body.So we have developed treatment against estrogen, which we call endocrine therapy; so we also have HER2-positive breast cancer, which accounts for about 15%-20%. It turns out that it is a very dangerous type of breast cancer. It is prone to metastasis of lymph nodes and and internal organs for a long time. It turns out that there are only chemotherapy drugs, but in the past 20 years, we have developed a lot of anti-gene targeted treatments, including this monoclonal antibody and some small molecule drugs to fight against it, and the tumor cells are significantly inhibited and killed, so its efficacy has developed rapidly. We can almost cure this disease, and many patients can survive for a long time. Even if they have distant metastasis, we can control it very well.
So from the perspective of local treatment, I think we have also developed a lot. First of all, breast cancer is a preventable and treatable. The meaning of curable is that if it is discovered early, we can use some surgical techniques to improve the patient to prevent the patient from losing his breasts because of breast , which damages her body. Because everyone knows that if breast cancer has been caused in the past, we all had to undergo radical surgery. One side of the breast may have to be cut off, and even the muscles under her must be cut off, which has a great impact on the patient's mental health. Now we have to have a very early stage. For patients who have no lymph nodes, we can do breast retention surgery. For patients with no lymph nodes, we can see through the detection of sentinel lymph nodes. If the lymph nodes do not metastasize or have very few metastases, we can also not clean the lymph nodes in her armpits, which will greatly reduce the complications after the operation. For patients who may need to remove the breasts, we can still do immediate and on-site breast reconstruction, or delayed breast reconstruction after a period of time, which can give the patient a relatively complete body shape and can greatly improve her quality of life and mental health.
[Breast cancer can be prevented and cured, and enter the era of "chronic diseases"]
Host: Judging from the data of our Affiliated Cancer Hospital of Fudan University, what is the current treatment effect of breast cancer patients? Compared with other tumor breast cancer treatment, what level is currently at the international level?
Professor Wu Jing: In the past 20 or 30 years of breast cancer, we have become more and more specialized in breast cancer. The ability and concept of multidisciplinary comprehensive diagnosis and treatment have been continuously improved. For the Affiliated Cancer Hospital of Fudan University, a multidisciplinary comprehensive diagnosis and treatment team has been established in China for a long time. With everyone's efforts, our five-year survival rate has increased to 93.6%, and the ten-year survival rate has also increased to 82.6%. This data is still the same as the most advanced level in the world. Of course, from the overall level of our country, the five-year survival rate may be slightly lower, so we still need to work harder. We say that since there is a five-year survival rate and a ten-year survival rate, there are still some patients who may die due to tumor recurrence and metastasis. In addition, more than 30% of patients will still experience metastasis and recurrence after getting sick. I mentioned earlier that many of our patients have metastasis and recurrence after metastasis and recurrence, there are many drugs to control the disease so that she can survive for a longer period of time. There are also some patients who may be avoiding medical treatment or do not have the concept of screening or census in the early stages. When they see the doctor, they have already moved from a distance. The proportion is about 3%-6%. Therefore, we may need to use more active systemic treatment to see if it can help her survive for a longer period of time, so there are still many challenges.
["Two-Environment" concept for treating breast cancer]
Host: In fact, if breast cancer patients can receive standardized treatment, the survival rate is already very high, or we can say it is a chronic disease. So, for breast cancer gradually becomes a chronic disease, what new concerns and research directions do you and your team have in the diagnosis and treatment work?
Professor Wu Jiong: I think it is indeed a kind of chronic disease that we call many tumors a chronic disease. Just like the diabetes and hypertension we are facing now, malignant tumors have become a fatal disease. Now we have a lot of treatment concepts and methods, and its long-term survival rate has been greatly improved. For us from the perspective of controlling chronic diseases, we have a concept of both worlds and become a comprehensive and full-process management, which is for a breast cancer patient. We can start from screening to early diagnosis to treatment to rehabilitation. Even if she has a distant metastasis, we can still do some long-term treatments. Sometimes it is a maintenance treatment that allows her to survive for a relatively long time. Therefore, in these tasks, we do a lot of work. First of all, in addition to paying attention to the treatment of the tumor itself, we also need to pay attention to the mental health of the patients. Therefore, this psychological medicine department has also been established in the Oncology Hospital to pay attention to some psychological rehabilitation, including patients and family members. Then in the process of facing the disease, we have a good mentality. I think confrontation and confrontation Only when the disease process is concerned, she is more confident to cooperate with the treatment. At the same time, I think that some of our anti-tumor treatments
will still bring some adverse reactions to the patient. Some of her may feel nausea and vomiting during chemotherapy. After the operation, there may be some functional disorders and edema in the upper limbs. Therefore, we have also established a treatment team for lymphedema . We can do some rehabilitation and physiotherapy in the early stage. In addition, we can relieve these symptoms after some long-term rehabilitation and treatment of this patient. In terms of persistence, we have also made some innovations. For example, through this Internet hospital, we provide more guidance to patients online. Our recent Internet hospital has also launched some means including early screening for breast cancer, so that patients can learn about this knowledge online and make appointments for relevant screening examinations, so that patients can seek medical treatment more conveniently. If patients need long-term medication, they can also use this mobile phone online and click a click to dispense medicine. We have some services for dispense medicine to deliver medicine to the door.
[Hospitals at all levels develop breast specialties. Scientific management of breast diseases]
Host: Then we also know that you are the chairman of the Breast Cancer Committee of the Chinese Anti-Cancer Association. So what work have we done to promote the improvement of the national breast cancer diagnosis and treatment level? How are the results?
Professor Wu Jing: Breast cancer is indeed a very representative professional committee of our Chinese Anti-Cancer Association . It is a very representative and a very long history of a single disease professional committee. With the efforts of many experts in the early stage, we have indeed done a lot of work.
First of all, it is to formulate and promote guidelines and standards, because we have many hospitals at different levels in China, and have established breast specialties. Professional practitioners need to receive good continuing education and also need to use standardized diagnosis and treatment concepts to improve the treatment level of the entire disease.
Second, we have done some specialties empowerment, that is, these specialties, which require the construction of
capabilities in all aspects to make their treatment methods richer and make their entire treatment team stronger.
Third, we have also done some domestic multi-center database construction in terms of a lot of this data, so that our data can be more detailed and dynamically updated to evaluate what we are doing.
[Change lifestyle habits and pay attention to female breast health as soon as possible]
Host: Although the treatment effect of early breast cancer is already very good, as the saying goes, don’t get sick if you don’t have any disease, so what should female friends do to stay away from breast cancer?
Professor Wu Jing: We believe that breast cancer is a preventable and curable disease, so if it can prevent it from getting sick, then we think this is the best way to prevent and treat tumors. Then we call it a treatment before the disease. From the prevention perspective, we should advocate the concept of a healthy life, exercise more, improve some of our dietary structure, and have a relatively healthy and positive attitude to face many setbacks and difficulties in life, and have better social and communication. These are very important. At the same time, I think we should also strengthen health screening and census. If we have the opportunity and ability, we should do some examinations regularly. Moreover, these examinations should be selected as a better specialty, a good specialty physical examination, and at the same time we should also learn to have a self-examination, and cooperate with regular basic census methods such as ultrasound. Even if we get sick, we can detect it early and obtain better treatment results.
