Jeannie Shen, M.D. Clinical assistant professor, UCLA Dept of Surgical Oncology Surgical director, UCLA Pasadena Oncology Medical director of Breast Surgery, Huntington Hospital
誤解 #1 假如我有乳腺癌家族史, 我 患乳腺癌的風險自然會較高 *Because breast cancer is so prevalent, having a family history doesn t always mean you are at higher risk * 因為乳腺癌是如此普遍, 有家族史並不一定表示你的風險會較高 *Most women with a BRCA gene mutation who get breast cancer are younger (<50 yo) or premenopausal * 大多數有 BRCA 基因突變, 得乳腺癌的婦女是年輕的 (<50 歲 ) 或停經前
*Rule of 2 s: 二的定则 *Two 1 st degree relatives with early-onset breast cancer * 有兩個第一親屬有早發性乳腺癌 *One woman with early-onset breast cancer twice * 一個女人有早發性乳腺癌兩次 *Early-onset breast cancer and ovarian cancer * 早發性乳腺癌和卵巢癌 *Early-onset breast cancer and male breast cancer * 早發性乳腺癌和男性乳腺癌 If this fits you, you should talk to your primary care doctor about your family history 如果這是你的情況, 你應跟你主診醫生談談您的家族史
*There is no direct link between food groups and breast cancer * 任何食物類別跟乳腺癌沒有直接的關係 *Studies show that a high soy intake does not increase the risk of breast cancer. Therefore, tofu and soy milk is safe. * 研究表明, 吃黃豆類不會增加患乳腺癌的風險 因此, 豆腐和豆漿是安全的 *Post-menopausal obesity and weight gain is associated with increased risk of breast cancer. * 停經後肥胖和體重的增加與增加患乳腺癌的風險有關 *Post-menopausal weight loss is associated with a lower risk of breast cancer * 停經後的重量降低與減低乳腺癌的風險有關
*A healthy diet is important to help maintain a healthy weight, which will help lower the risk of breast cancer * 健康的飲食是很重要的, 可以幫助維持健康的體重, 這有助於降低患乳腺癌的風險. *Low in saturated fat 減低飽和脂肪 Red meat 3 times a week 红肉每週吃 3 次 Green leafy vegetables 多吃綠葉蔬菜 Limit sweets (to help maintain healthy weight), not because sugar is dangerous 少吃甜食 ( 有助於保持健康的體重 ), 而不是因為糖是危險的 Limit alcohol consumption 限制飲酒
*Early detection saves lives 早期發現可拯救生命 - * Mammograms detect 70-80% of breast cancers * 乳房 X 光檢查發現 70% 至 80% 的乳腺癌患者 - Mammogram is the best tool for detecting the earliest stage 0 breast cancer - 乳房 X 光檢查, 是檢測到早期 (0 期 ) 乳腺癌的最佳工具 - Mammograms can detect cancer before you feel it - 乳房 X 光檢查可以在你還不能摸到以前發現癌症 - Mammograms are safe 乳房 X 光檢查是安全的 - Minimal radiation 最低的輻射 *Continue to get annual mammogram * 應繼續每年乳房 X 光檢查
* Mammograms are less sensitive with dense breast tissue * 乳房 X 光檢查對組織緻密的乳房比較不敏感 - May detect up to 50% of breast cancers 可能會檢測到 50% 的乳腺癌患者 - Can be harder to see small invasive cancers 可能很難看到小的侵犯性的癌 * Ultrasounds can see small invasive cancers 超聲波檢查可檢測到小的侵犯性的癌 * ACRIN 6666 study 2800 women 醫學研究報告,2800 女性 - 42 cancers detected, 12 cancers seen only on US 檢測到 42 宗乳腺癌,12 宗癌症只有在超聲波檢查時才發現 - But <10% of abnormal US-biopsies showed cancer - 但只有 <10% 不正常的超聲波檢查經活檢後發現有癌症 - Routine breast Ultrasound should not be performed in the absence of symptoms or abnormal mammogram - 没有症狀或異常的乳房 X 光檢查的話, 不必做常規的乳房超聲波檢查
*Surgery is the mainstay of treatment for breast cancer * 手術是治療乳腺癌的主要治療 *Surgery does not cause the cancer to spread * 手術不會導致癌擴散 *Surgery is important to get rid of the cancer in the breast and hopefully prevent the future spread of the cancer * 手術治療是很重要的, 除掉乳房上的癌, 能防止癌未來的擴散
*Studies show that the overall survival rates between lumpectomy and mastectomy are the same * 研究表明, 乳房腫瘤切除術和乳房切除術的整體存活率是相同的 *Remember: women don t die from breast cancer cells in their breast, they die when the cancer cells spread to other organs * 請記住 : 女人不會死於自己乳房中的癌細胞, 而是死於癌細胞擴散到其他器官 *Lumpectomy and radiation is a safe alternative to mastectomy * 乳房腫瘤切除術加乳房輻射治療是乳房切除術的安全代替
*Sometimes, after lymph node surgery, lymphedema can develop * 有時淋巴結手術後, 淋巴水腫可能發生 - Occurs in 10-20% of patients who have an axillary node dissection - 發生在 10% 至 20% 腋窩淋巴結切除者 - Occurs in 3% of patients who only have a sentinel node biopsy - 發生在 3% 前哨淋巴結活檢者 *Historical guidelines recommend no IV, blood pressure measurements, or blood draws * 傳統的指引建議避免靜脈輸液, 血壓測量, 抽血
*Avoid blood draws, blood pressure measurements, or IVs when possible (but within reason) * 避免抽血, 測量血壓, 或靜脈輸液 ( 在合理的範圍內 ) *After recovery, progressive light weight exercises (ask your doctor) * 恢復後, 漸進式地去做輕重量運動 ( 請詢問您的醫生 ) *Early identification of lymphedema and institution of treatment can treat and reduce lymphedema * 早期確定淋巴水腫並進行治療, 可以治療和減少淋巴水腫 - Manual lymphatic drainage (massage) 手動淋巴引流 ( 按摩 ) - Compression bandages 壓縮繃帶
*Radiation is important after lumpectomy to reduce the risk of the cancer coming back in the same breast * 放射治療在腫瘤切除術後是重要的, 可減少癌症在同一乳房發生的風險 *Radiation is a local therapy directed at the breast itself and does not cause hair loss * 放射治療是一種針對乳房的局部治療, 不會導致脫髮 *Standard radiation is given Mon-Fri for 6 weeks * 標準的放射治療是週一至週五連續 6 個星期, -Side effects: skin erythema, breast tenderness, fatigue - 副作用 : 皮膚出現紅斑, 乳房脹痛, 疲勞
*Breast reconstruction is safe 乳房重建是安全的 *Breast reconstruction does not increase the risk of cancer recurrence after mastectomy * 乳房切除後乳房重建不會增加癌症復發的風險 *Breast reconstruction does not make it harder to detect cancer recurrence after mastectomy * 乳房重建, 不會導致難以檢測乳房切除術後的癌症復發 *It is a longer surgery and recovery, because you are combining two procedures into one * 因這是兩個手術合併為一, 所以手術時間較長, 恢復期也較長
*Medications 药物 - Tamoxifen, Arimidex, Femara, Aromasin - 他莫昔芬, 瑞寧得,Femara, Aromasin - Reduce your risk of getting breast cancer again by up to 50%. It is important to take the medications regularly. - 減少高達 50% 再患乳腺癌的風險 重要的是要定期服藥 *Diet 飲食 - A healthy diet which maintains a healthy weight, avoids weight gain, helps weight loss will lower the risk of breast cancer recurrence - 健康的飲食習慣, 可以保持健康的體重, 避免體重增加, 有助於減肥並會降低乳腺癌復發風險
*Exercise 運動 Regular exercise has been consistently shown to lower the risk of breast cancer recurrence 常規的運動, 已被證明可以降低乳腺癌復發風險 *30-50% risk reduction 降低風險 30-50% *Related to weight loss, but also other biological mechanisms * 與降低體種有關, 但也與其他生物機制有關 *Moderate exercise 30 minutes 5 days a week is strongly encouraged * 強烈建議 : 適度運動 30 分鐘, 每週 5 天,
*
*You will need to see your doctor to review your medical history and get a physical exam periodically after you complete your cancer treatment 完成癌症治療後應定期見你的的醫生, 審查病歷, 作身體檢查 - This is generally with the medical oncologist, although you may continue to follow-up with your surgeon and radiation oncologist as well 一般情况下, 你應見你的腫瘤醫生, 但你也可以繼續與你外科醫生和放射腫瘤醫生作後續檢查 *Years 1-3: every 3-6 mo *Years 4-5: every 6-12 mo *After year 5: once a year 第 1-3 年 : 每 3-6 个月 第 4-5 年 : 每 6-12 个月 5 年以後 : 每年
New lumps in the breast or underarm 在乳房或腋下有新的腫塊 Rash on the breast 乳房上有紅疹 Nipple discharge 乳頭溢液 Bone pain 骨頭疼痛 Chest pain 胸部疼痛 Abdominal pain 腹部疼痛 Shortness of breath or difficulty breathing 呼吸短促或困難 Persistent headaches 持續性頭痛 Persistent coughing 持續咳嗽
If you have a lumpectomy, 如果你做了乳房腫瘤切除術 : *You may need a repeat mammogram after surgery to ensure all calcifications were removed * 你可能需要在手術後, 再作乳房 X 光檢查, 以確保所有的鈣化點已被割除 *You will need a mammogram on the cancer side 4-6 months after you complete radiation * 完成輻射治療 4-6 個月後, 對另一側乳房做 X 光檢查 *Afterwards, you should continue to have a bilateral mammogram annually * 之後, 應該繼續每年對兩個乳房作 X 光檢查
If you have a mastectomy, 如果你做了乳房切除手術 *You do not need any more breast imaging on the cancer side * 你不需要對有癌症的乳房做 X 光檢查 *You should schedule a mammogram on the non-cancer side one year after your first mammogram that led to the diagnosis, and then annually * 你應安排於被診斷癌症的乳房 X 光檢查後一年, 對非癌側的乳房做 X 光檢查, 然後每年做 X 光檢查
* Women with a BRCA gene deleterious mutation have an increased risk of breast and ovarian cancer. * 有 BRCA 基因有害突變的婦女, 乳腺癌和卵巢癌的風險增加 - Only 5-10% of all breast cancer patients have the BRCA gene mutation - 但所有的乳腺癌患者中, 只有 5-10% 有 BRCA 基因突變 * Most women with breast cancer do not have a BRCA gene mutation and therefore are not at increased risk of ovarian cancer * 大多數患乳腺癌的婦女, 没有 BRCA 基因突變, 因此, 卵巢癌的風險不会增加 * You should continue to see your gynecologist regularly for a Pap smear (cervical cancer screening) * 你應該繼續見你的婦科醫生, 定期作子宮頸抹片檢查 ( 子宮頸癌篩檢 ) *Tamoxifen increases the risk of endometrial cancer * 他莫昔芬會增加子宮內膜癌的風險 *You should report any vaginal bleeding to your doctor * 如果有任何陰道出血, 你應該告訴你的醫生
*Aromatase inhibitors (AI) lead to decreased bone density and increased risk for osteoporosis 芳香化酶抑製劑 (AI) 導致骨密度降低, 骨質疏鬆症的風險增加 - Anastrazole (Arimidex), Letrozole (Femara), Exemestane (Aromasin) *All patients on an AI should take calcium/vitamin D 所有服 (AI) 者应服鈣 / 維生素 D *Bisphosphonates may help stabilize bone density 雙磷酸鹽類藥物可能有助於穩定骨密度 - Ongoing studies are evaluating role of bisphosphonates at initiation of AI 正在進行的研究在評估雙磷酸鹽類藥物对 AI 開始的作用 *You should have a DEXA scan within 3 months of starting an AI, and then as needed 在開始 AI 3 個月內, 應做一次 DEXA 掃描, 隨後根據需要 - If baseline DEXA normal, then have a DEXA every year or every 2 years - 如果基線骨密度正常, 每年或每 2 年做一次 DEXA 掃描 - If baseline DEXA shows osteopenia, then have a DEXA scan every year - 如果基線 DEXA 顯示骨質疏鬆, 每年做一次 DEXA 掃描 - If baseline DEXA shows osteoporosis, then have a DEXA scan every year or consider Tamoxifen 如果基線 DEXA 顯示骨質疏鬆, 每年做一次 DEXA 掃描, 或考慮改服他莫昔芬
* Routine blood tests (CBC, liver, kidney function) 常規血液檢查 (CBC, 肝, 腎功能 ) * Chest X-ray 胸部透視 * Bone scan 骨掃描 * Liver ultrasound 肝臟超聲波檢查 * CT scan 電腦斷層掃描 * Breast MRI 乳腺 MRI * PET scanpet 掃描 * Breast cancer tumor markers, such as CA 15-3, CA 27.29, and CEA 乳腺癌腫瘤標誌如 CA 15-3, CA 27.29,CEA 等
Recommended follow-up Frequency Doctor s visit Every 3-6 months for 1 st three years Every 6-12 months for 4 th and 5 th year After 5 th year, annually Mammogram If lumpectomy, then new baseline MMG 4-6 months after you finish radiation on cancer side, then annual bilateral MMG. If mastectomy, MMG on opposite breast one year after your diagnosis, then annually. Screening ultrasound Not recommended at this time Self breast examination Pelvic exam Bone density (DEXA) scan Once a month - Report new lumps, skin changes, nipple discharge Annually - If you re taking Tamoxifen, report vaginal spotting/ bleeding/discharge Annually or every other year - If you re taking Aromtase Inhibitor (Arimidex, Femara, Aromasin)
後續檢查建議 見你的的醫生 Mammogram 乳房 X 光檢查 Screening ultrasound 乳房超聲波檢查 Self breast examination 自我檢查乳房 Pelvic exam 骨盆檢查 Bone density (DEXA) scan 骨骼密度 DEXA 掃描檢查 第 1-3 年 : 每 3-6 个月一次 第 4-5 年 : 每 6-12 个月一次 5 年以後 : 每年一次 Frequency 頻率 乳房腫瘤切除術 完成對癌症側乳房電療後 4-6 個月, 作新的基準 X 光檢查, 然後每年對雙側乳房 X 光檢查 乳房切除 診斷後一年對另側乳房 X 光檢查, 然後每年一次 据现在的醫學研究, 没有推薦 每月一次 - 告訴醫生 : 新的腫塊, 皮膚改變, 乳頭溢液 每年一次 - 如果你正在服用他莫昔芬, 告訴醫生陰道點滴出血 / 出血 / 排液 每年, 或两年一次 - 服芳香化酶抑製劑 (AI) 者 (Arimidex, Femara, Aromasin)