每年，超過25萬美國人被診斷出乳腺癌。
2019年1月22日，《美國醫(yī)學會雜志》正刊發(fā)表哈佛大學醫(yī)學院、達納法伯癌癥研究所的患者教育，描述了乳腺癌不同類型和分期的診斷與治療。
達納法伯癌癥研究所：哈佛大學醫(yī)學院、哈佛大學公共衛(wèi)生學院的教學醫(yī)院之一，1947年由西德尼·法伯（現(xiàn)代化療之父、兒童白血病醫(yī)生）創(chuàng)建，1974年被命名為西德尼·法伯癌癥研究所，1983年由查爾斯·安德森·達納（美國記者、作家、官員，先后擔任紐約論壇報和紐約太陽報總編、美國陸軍助理部長）基金會提供支持，更名為達納法伯癌癥研究所。
乳腺癌的診斷與分期
當乳腺細胞開始失控時，發(fā)生乳腺癌。許多乳腺癌在乳腺鉬靶（專門用于仔細觀察乳腺組織的X線掃描）檢查時被診斷，部分乳腺癌在女性自己或其醫(yī)生發(fā)現(xiàn)乳房異常腫塊時被診斷，少數(shù)乳腺癌最初表現(xiàn)為乳房皮膚或乳頭的變化。
在診斷時，乳腺癌細胞可能被發(fā)現(xiàn)于乳腺組織、手臂下方腋窩淋巴結(jié)、或者體內(nèi)更遠部位。根據(jù)癌癥被發(fā)現(xiàn)的部位，乳腺癌被分為Ⅰ～Ⅳ期。Ⅳ期乳腺癌又稱轉(zhuǎn)移性乳腺癌，乳腺癌已經(jīng)擴散至體內(nèi)遠離乳房和腋窩淋巴結(jié)的部位。
乳腺癌的類型
根據(jù)乳腺癌細胞不同蛋白質(zhì)的存在與否，乳腺癌被分為三種類型：
激素受體陽性乳腺癌：約占乳腺癌病例的70%，癌細胞存在雌激素受體或孕激素受體的蛋白質(zhì)；
HER2陽性乳腺癌：約占乳腺癌病例的15%～20%，癌細胞存在高水平的HER2蛋白質(zhì)；
三陰性乳腺癌：約占乳腺癌病例的15%，癌細胞無雌激素受體、孕激素受體或HER2的蛋白質(zhì)。
乳腺癌的預后與治療
大多數(shù)美國乳腺癌患者并未死于乳腺癌。與每年新診斷的25萬例病例相比，每年死于乳腺癌4.1萬例。乳腺癌的預后和治療取決于乳腺癌的分期和類型。
每個治療計劃都是個體化的，應該由患者和癌癥醫(yī)生共同制定。
對于Ⅰ～Ⅲ期乳腺癌患者，治療的目標是治愈乳腺癌。通常治療包括手術(shù)切除乳房腫瘤、藥物、以及可能的乳房放療。
對于已經(jīng)擴散至身體遠處部位的Ⅳ期乳腺癌患者，治療的目標是盡可能長期控制乳腺癌。Ⅳ期乳腺癌治療以藥物為主。
不同類型的乳腺癌對不同的藥物有效。
激素受體陽性乳腺癌首選抗雌激素藥物治療，一些患者也需要靜脈化療。
HER2陽性乳腺癌需要靜脈注射專門攻擊異常HER2蛋白藥物以及靜脈化療。
三陰性乳腺癌目前主要依靠靜脈化療。
JAMA. 2019 Jan 22;321(3):316-316.
Breast Cancer Treatment.
Adrienne G. Waks; Eric P. Winer.
Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
This JAMA Patient Page describes the diagnosis and treatment of different types and stages of breast cancer.
Breast cancer is diagnosed in more than 250000 people in the United States each year.
Diagnosis and Stages of Breast Cancer
Breast cancer occurs when cells in the breast begin to grow out of control. Many breast cancers are diagnosed based on a mammogram, a specialized x-ray scan designed to look closely at breast tissue. Some breast cancers are diagnosed when a woman or her doctor finds an abnormal lump in her breast. Rarely, changes in the skin or nipple of the breast can be the first sign of a breast cancer.
At diagnosis, breast cancer cells may be found in the breast tissue only, in the axillary lymph nodes under the arm, or in more distant sites in the body. Based on where the cancer is found, breast cancer is assigned a stage, from I to IV. Stage IV breast cancer, also called metastatic breast cancer, is breast cancer that has spread to a place in the body distant from the breast and axillary lymph nodes.
Types of Breast Cancer
Breast cancer is divided into 3 types based on the presence or absence of different proteins in the breast cancer cells. Hormone receptor-positive breast cancer makes up 70% of breast cancer cases and has either estrogen receptor (ER) or progesterone receptor (PR) protein in the cancer cells; ERBB2-positive (formerly known as HER2-positive) breast cancer makes up 15% to 20% of breast cancer cases and has high levels of ERBB2 protein on the cancer cells; and triple-negative breast cancer makes up 15% of breast cancer cases and does not have ER, PR, or ERBB2 protein in the cancer cells.
Prognosis and Treatment of Breast Cancer
Most people in the United States who have breast cancer diagnosed do not die of their breast cancer. Compared with the 250000 cases diagnosed annually, 41000 deaths due to breast cancer occur each year. The prognosis and treatment of breast cancer depend on the stage and the type of breast cancer.
Each treatment plan is individualized and should be made together by a patient and a cancer doctor. For patients with stage I to III breast cancer, the goal of treatment is to cure the breast cancer. Usual treatment consists of surgery to remove the breast tumor, medicines, and possibly radiation therapy to the breast. For patients with stage IV breast cancer, which has spread to a distant part of the body, the goal of treatment is to control the breast cancer for as long as possible. Treatment for stage IV breast cancer consists mainly of medicines.
Different types of breast cancer respond to different medicines. Hormone receptor-positive breast cancer is best treated with anti-estrogen pills. Some patients need intravenous chemotherapy infusions as well. ERBB2-positive breast cancer is treated with intravenous medicines that specifically attack the abnormal ERBB2 protein along with intravenous chemotherapy. Triple-negative breast cancer is treated with intravenous chemotherapy.
DOI: 10.1001/jama.2018.20751
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