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首页> 外文期刊>The Internet Journal of Academic Physician Assistants >Recent advances in management of breast cancer
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Recent advances in management of breast cancer

机译：乳腺癌管理的最新进展

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Sir,In past decades, tremendous advances have been made in detection and management of breast cancer management. Conventional mammography cannot detect 10 to 15% of palpable breast tumors. Moreover, there are difficulties in imaging of dense breast. Digital mammography is an advanced form of screening that offers electronic archiving of breast studies, with improved contrast resolution over a larger dynamic range. These advantages may obviate the need for many call-backs and eliminate the film storage problem. Other methods like whole breast ultrasound, magnetic resonance imaging (MRI) and positron emission tomography are also investigated for screening of breast cancer. Ductal lavage is a recently used minimally invasive method that can be used to collect cellular material for cytomorphology and biomarker studies. In ductal lavage, cellular material is retrieved by inserting a 1.5-cm flexible microcatheter through through the nipple surface orifices under local anesthesia and infusing the same with saline. Potential uses of ductal lavage include selection of women for risk-reduction therapy, monitoring response to a risk reduction intervention, diagnostic workup of a nipple discharge, and early diagnosis of an occult cancer. Ductal lavage can be used to study genetic alterations associated with breast cancer. In conjunction with the newly identified genetic markers, ductal lavage has the potential to identify early breast cancers before any mammography changes occur. It can be used to study breast epithelial cells at the molecular level. Limitations of ductal lavage are its time-consuming nature, inability to detect extra-ductal carcinoma, and uncertainty about its sensitivity and specificity.Now genetic testing is available to detect mutations in the tumor suppressor genes BRCA1 and BRCA2. These mutations are responsible for 70-80% of hereditary breast cancer. The American Society of Clinical Oncology recommends that genetic testing be offered to individuals with a strong family history or early age at diagnosis of cancer. For adult women with a known BRCA mutation, risk of breast cancer can be minimized by various strategies like increased surveillance, prophylactic surgery, and chemoprevention. However, these strategies do no apply to adolescent women and hence, genetic testing is of limited benefit in them. Genetic testing in adolescents may cause adverse psychological impact also.Traditional procedure for documenting axillary lymph node, level 1 and 2 axillary lymph node dissection is associated with a lifetime risk of ipsilateral upper extremity lymphedema. To prevent this, of radioactive label technetium sulfur colloid or a vital blue dye can be injected into the breast before surgery to identify sentinel nodes which are most likely to harbor metastatic disease. However, there is a learning curve associated with the technique. National Surgical Adjunct Breast and Bowel Project (Breast Cancer Prevention Trial BCPT; P-1) showed that administration of tamoxifen reduced the risk for invasive and noninvasive breast cancer by almost 50% in all age groups and also in patients with a history of lobular carcinoma in situ (56%) or atypical hyperplasia (86%). However, tamoxifen was associated with significantly increased risk of pulmonary embolism and endometrial cancer, and stroke. Preliminary evidence from Study of Tamoxifen and Raloxifen trial indicates that raloxifene has similar breast cancer risk reduction activity compared with tamoxifen, but with a lower incidence of uterine neoplasia. Long-term results from various phase 3 trials conducted in United States and Europe demonstrated that breast cancer survival is equal in early stage breast cancer patients, regardless of whether they are treated with breast-sparing procedures or mastectomy. Despite this, only a minority of eligible patients have been treated with lumpectomy and breast radiation therapy in the United States. Most breast cancer treatment guidelines state that
机译：主席先生，在过去的几十年中，在乳腺癌管理的检测和管理方面已取得了巨大的进步。常规的乳房X线照相术无法检测到10％至15％的可触知乳腺肿瘤。而且，在致密的乳房成像中存在困难。数字化乳腺X射线摄影是一种先进的筛查形式，可对乳房研究进行电子存档，并在较大的动态范围内提高对比度分辨率。这些优点可以消除对许多回叫的需要，并消除了胶卷的存放问题。还研究了其他方法，如全乳超声，磁共振成像（MRI）和正电子发射断层扫描，以筛查乳腺癌。灌洗导管是最近使用的微创方法，可用于收集细胞材料以进行细胞形态学和生物标记研究。在导管灌洗中，通过在局部麻醉下将1.5厘米的柔性微导管穿过乳头表面孔口插入，然后将其注入盐水中，即可回收细胞材料。导管灌洗的潜在用途包括选择女性进行降低风险的治疗，监测对降低风险的干预措施的反应，对乳头溢液的诊断检查以及对隐匿性癌症的早期诊断。导管灌洗可用于研究与乳腺癌相关的基因改变。与新近确定的遗传标记结合，导管灌洗有可能在任何X线摄影术发生变化之前就识别早期乳腺癌。它可以用于在分子水平上研究乳腺上皮细胞。导管灌洗的局限性在于其耗时的特性，无法检测导管外癌以及对其敏感性和特异性的不确定性。现在可以进行基因检测来检测抑癌基因BRCA1和BRCA2中的突变。这些突变导致了70-80％的遗传性乳腺癌。美国临床肿瘤学会建议向有很强家族史或诊断癌症的较早个体提供基因检测。对于具有已知BRCA突变的成年女性，可以通过各种策略（例如加强监视，预防性手术和化学预防）将乳腺癌的风险降至最低。但是，这些策略不适用于青春期妇女，因此，基因检测对她们的益处有限。青少年的基因检测也可能造成不良的心理影响。传统的记录腋窝淋巴结，1级和2级腋窝淋巴结清扫的程序与同侧上肢淋巴水肿的终生风险有关。为了防止这种情况，可以在手术前将放射性标记tech硫胶体或重要的蓝色染料注射到乳房中，以确定最有可能带有转移性疾病的前哨淋巴结。但是，该技术存在学习曲线。美国国家外科辅助性乳腺癌和肠道项目（乳腺癌预防试验BCPT; P-1）表明，他莫昔芬的使用在所有年龄段以及有小叶癌病史的患者中将浸润性和非浸润性乳腺癌的风险降低了近50％原位（56％）或非典型增生（86％）。但是，他莫昔芬与肺栓塞，子宫内膜癌和中风的风险显着增加有关。他莫昔芬和拉洛昔芬研究的初步证据表明，雷洛昔芬与他莫昔芬相比具有相似的降低乳腺癌风险的活性，但子宫瘤的发生率较低。在美国和欧洲进行的各种3期试验的长期结果表明，早期乳腺癌患者的乳腺癌生存率是相同的，无论他们是否接受了保乳手术或乳房切除术。尽管如此，在美国只有少数合格的患者接受了肿块切除术和乳腺放射治疗。大多数乳腺癌治疗指南都指出

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