Breast cancer is a disease that strikes fear into women's hearts. While many are focusing on prevention, some have fallen into misconceptions without realizing it. Let's explore these together.
Myth 1: Mammograms should start at age 40
Mammography is a widely recognized effective screening tool for breast cancer. In recent years, many doctors have repeatedly emphasized that women should undergo regular mammograms.Based on U.S. experience, many middle-aged women over 40 now undergo annual mammograms and breast ultrasounds as part of their physical exams.
Regarding this, Liao Ning explains that breasts contain different tissue types. Western women tend to have more fatty breast tissue, while Eastern women have less. The latter appears denser, often showing up as a dark shadow on mammograms, which may be misdiagnosed as severe hyperplasia. Especially before menstruation, hormonal stimulation causes breast edema, making misinterpretation more likely.
"Chinese women typically experience gradual breast tissue conversion to fatty tissue after age 50," Liao Ning cautioned. "Dense breast tissue absorbs X-rays, paradoxically increasing the risk of breast cancer or other tumors." Given this reality, she recommends initiating mammograms only after age 50, with color Doppler ultrasound serving as an alternative before that age.
Recent studies also indicate that women aged 40-49 derive minimal benefit from mammograms, while potentially absorbing higher radiation doses that may elevate breast cancer risk. Consequently, the U.S. Preventive Services Task Force has revised its previous recommendation for annual mammograms from age 40+ to age 50+.
Myth 2: Higher Breast Conservation Rates Are Always Better
Breast cancer patients sometimes face a difficult decision: whether to undergo breast-conserving surgery. Regarding breast conservation, patients often fall into two extremes: some strongly insist on preserving the breast, while others, overly fearful of recurrence, demand mastectomy regardless of the doctor's diagnosis.Meanwhile, some doctors overly emphasize breast conservation rates, which is actually a misconception in treatment.
"Determining a patient's eligibility for breast-conserving surgery requires MRI screening for multicentric lesions, followed by comprehensive imaging evaluation and professional consultation," stated Liao Ning. When conditions permit breast conservation, physicians should discuss the patient's psychological state, personality, marital relationship, and social standing to facilitate a shared decision-making process where the patient makes the final choice.
According to the 2011 edition of the Breast Cancer Diagnosis and Treatment Guidelines, breast-conserving surgery is applicable when the patient desires it, the tumor can be completely excised, and negative margins can be achieved. Youth is not a contraindication for breast-conserving surgery. However, patients aged 35 or younger face a relatively higher risk of recurrence and reoccurrence of breast cancer. When considering this option, doctors should fully disclose the potential risks to the patient.
Per these guidelines, breast-conserving therapy is suitable for early-stage breast cancer (clinical stages I and II), particularly for tumors ≤3 cm in maximum diameter with adequate breast volume to maintain satisfactory cosmetic outcomes post-surgery. Stage III patients (excluding inflammatory breast cancer) may also be considered for breast-conserving therapy after preoperative chemotherapy-induced downstaging.
"A high breast-conserving rate does not equate to advanced breast cancer treatment capabilities. Breast-conserving therapy must be strictly applied within its indications,"" Absolute contraindications for breast-conserving surgery include prior radiation therapy to the breast or chest wall, pregnancy requiring radiation therapy, extensive disease precluding complete resection, and ultimately positive surgical margins. Relative contraindications include tumors larger than 5 cm and active connective tissue diseases involving the skin, particularly scleroderma and lupus erythematosus.
Myth 3: Removal Solves Everything
Many believe that removing the tumor resolves all issues. Liao Ning clarifies that breast cancer is a localized manifestation of a systemic disease. Treatment must integrate standard surgery, radiotherapy, chemotherapy, and endocrine therapy throughout the entire process. Endocrine therapy, in particular, plays a crucial role in preventing postoperative recurrence and extending patient survival.
It is understood that hormone-dependent breast cancer accounts for over 50% of cases in China. Approximately one-third of hormone-dependent early-stage breast cancer patients experience recurrence, with peak recurrence rates occurring 1-3 years and 6-7 years post-surgery. The root cause of recurrence lies in estrogen, which promotes tumor cell growth and spread.
Therefore, reducing or blocking estrogen's effects on tumors can effectively shrink tumors and reduce metastasis and recurrence. The fundamental role of endocrine therapy is to target hormone-sensitive breast cancer patients by lowering estrogen levels in the body or preventing estrogen from stimulating tumor cells, thereby preventing tumor recurrence.