How to screen breast cancer？ The screening standard suitable for Chinese is coming.
Recently, the China Breast Cancer Screening Standard (T/CPMA 014-2020) proposed by China National Cancer Center was published online in chinese journal of cancer prevention and treatment. The correspondent is Professor He Jie, director of National Cancer Center and academician of China Academy of Sciences.
As a common cancer, according to the latest global cancer burden data released by the International Agency for Research on Cancer (IARC) of the World Health Organization in 2020, there were 2.26 million new breast cancer cases in the world in 2020, surpassing lung cancer (2.21 million cases) for the first time, becoming the largest cancer in the world, accounting for 11.7% of new cancer cases. Among the newly diagnosed cancer patients, one in every eight is a breast cancer patient. China is a big country with breast cancer. In 2020, there will be about 420,000 new cases of breast cancer and nearly 120,000 deaths.
Screening, improving the detection rate of early breast cancer and precancerous lesions, and timely and effective treatment are important measures to improve the prognosis of breast cancer and reduce the risk of death. The standards put forward suggestions on the population, measures, results and management of breast cancer screening in China. We have sorted out the relevant contents, hoping to help you better understand the knowledge of breast cancer screening.
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Who should have breast cancer screening?
The standard suggests that people at high risk of breast cancer should be screened from the age of 40; The general risk population (all school-age women except the high-risk population) should be screened for breast cancer between 45 and 70 years old.
High-risk population
Women who meet any of the following conditions 1, 2 and 3 are at high risk of breast cancer.
1. Women with genetic family history, that is, women with any of the following: 1) First-degree relatives (mothers, daughters and sisters) have a history of breast cancer or ovarian cancer; 2) Among the second-degree relatives (aunts, grandmothers and grandmothers), two or more people suffered from breast cancer before the age of 50; 3) Among the second-degree relatives, 2 or more have ovarian cancer before the age of 50; 4) At least one first-degree relative carries a known pathogenic genetic mutation of BRCA1/2 gene, or carries a pathogenic genetic mutation of BRCA1/2 gene himself.
2. Have any of the following: 1) Age of menarche ≤12 years old; 2) menopausal age ≥55 years old; 3) Have a history of breast biopsy or surgery for benign breast diseases, or a history of atypical hyperplasia of breast (lobules or ducts) confirmed by pathology; 4) Use hormone replacement therapy of "estrogen and progesterone combination" for not less than half a year; 5) X-ray examination of breast after 45 years old suggests that the type of breast parenchyma (or breast density) is uneven compactness or compactness.
Note: Breast parenchyma types can be divided into fat type, scattered fibrous gland type, heterogeneous dense type (which may cover small masses) and dense type (which reduces the sensitivity of breast cancer detection).
3. Those who have any of the following two items: 1) No breast-feeding history or breast-feeding time less than 4 months; 2) No history of live birth (including never giving birth, abortion or stillbirth) or the age of first live birth ≥30 years old; 3) hormone replacement therapy using only "estrogen" for not less than half a year; 4) Abortion (including natural abortion and induced abortion) shall not be less than 2 times.
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How to screen?
General risk population: breast ultrasound examination should be performed every 1-2 years; If you do not have the conditions for breast ultrasound examination, you should use mammography.
High-risk population: breast ultrasound combined with mammography is performed once a year.
How to understand the screening results?
Classification of diagnostic results of mammography
The diagnostic results of mammography are usually classified by the Breast Imaging Reporting and Data System (BI-RADS), which is formulated by American Radiological Society (ACR) and widely used internationally.
1. BI-RADS 0: The existing image failed to complete the evaluation, and other image examinations need to be added.
2. BI-RADS 1: normal, no abnormality was found in mammography. The possibility of malignancy is 0%.
3. BI-RADS 2: Benign findings, with definite benign changes and no malignant signs. The possibility of malignancy is 0%.
4. BI-RADS 3: Benign lesions that may be large. 0% < malignant possibility ≤2%.
5. BI-RADS 4: Suspected malignant lesions, but without typical malignant signs. 2% < malignant possibility < 95%.
6. BI-RADS 4A: low-grade suspected malignancy. 2% < malignant possibility ≤10%.
7. BI-RADS 4B: moderately suspected malignant. 10% < malignant possibility ≤50%.
8. BI-RADS 4C: highly suspected malignant. 50% < malignant possibility < 95%.
9. BI-RADS 5: Highly suggestive of malignant lesions with typical imaging features of breast cancer. Malignant possibility ≥95%.
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Classification of ultrasonic diagnosis results of breast
The classification of ultrasound evaluation refers to the screening of National Comprehensive Cancer Network (NCCN) and the BI-RADS classification standard proposed by American Radiological Society.
1. BI-RADS 0: The diagnostic information obtained by ultrasound is incomplete and cannot be evaluated, and it needs to be evaluated after other imaging examinations.
2. BI-RADS 1: negative, no abnormality was found by ultrasound. The possibility of malignancy is 0%.
3. BI-RADS 2: Benign lesions, with definite benign changes and no malignant signs. The possibility of malignancy is 0%.
4. BI-RADS 3: Benign lesions that may be large. 0% < malignant possibility ≤2%.
5. BI-RADS 4: Suspected malignant lesions, but without typical malignant signs. 2% < malignant possibility < 95%.
6. BI-RADS 4A: low-grade suspected malignancy. 2% < malignant possibility ≤10%.
7. BI-RADS 4B: moderately suspected malignant. 10% < malignant possibility ≤50%.
8. BI-RADS 4C: highly suspected malignant. 50% < malignant possibility < 95%.
9. BI-RADS 5: Highly suggestive of malignant lesions with typical imaging features of breast cancer. Malignant possibility ≥95%.
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Screening result management
1. BI-RADS 1 and BI-RADS 2 need no special treatment.
2. BI-RADS 3：
The evaluation of mammography is BI-RADS 3, so it is advisable to reexamine the breast on the lesion side at the next 6 months, and reexamine the breast on both sides at the 12th and 24th months.
If the lesion remains stable, it can continue to be reexamined, and if it has not changed for 2-3 years, it can be reduced to BI-RADS 2. If the lesion disappears or shrinks during the reexamination, it can be directly evaluated as BI-RADS 2 or BI-RADS 1. Biopsy should be considered if suspicious findings are found in the lesions during the reexamination.
The breast ultrasound evaluation is BI-RADS 3, so it is advisable to have breast ultrasound reexamination in 3-6 months, and it can be reduced to BI-RADS 2 if there is no change after 2 years of follow-up.
3. BI-RADS 4A: Further imaging examination and biopsy are needed.
4. BI-RADS 4B: Further imaging examination is needed, and biopsy is appropriate.
5. BI-RADS 4C and BI-RADS 5: Biopsy should be performed.
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tag
According to the standard, the breast physiological characteristics and breast cancer epidemic characteristics of women in China are quite different from those in western countries, so we can’t copy foreign experience. Establishing breast cancer screening standards suitable for women in China will play an important role in improving the scientificity, feasibility and practicability of breast cancer screening and reducing the incidence and mortality of breast cancer.
reference data
[1] He Jie, et al.,(2021). China female breast cancer screening standard (T/CPMA 014-2020). chinese journal of cancer prevention and treatment, DOI: 10.16073/J.CNKI.CJCPT.2021.01.02.
[2] Latest global cancer data: Cancer burden rises to 19.3 million new cases and 10.0 million cancer deaths in 2020. Retrieved Nov 16 ,2020, from https://www.iarc.fr/fr/news-events/latest-global-cancer-data-cancer-burden-rises-to-19-3-million-new-cases-and-10-0-million-cancer-deaths-in-2020/
Note: The purpose of this article is to introduce the progress of medical health research, not to recommend treatment schemes. For guidance on treatment plan, please go to a regular hospital.