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New hope for women with breast cancer

By SHAN JUAN/WANG XIAODONG | China Daily | Updated: 2019-06-21 07:26
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Women in Henan province receive free screening for breast and cervical cancers. [Photo by CHENG ZHUANYI/FOR CHINA DAILY]

She's considering cosmetic procedures later to conceal the scar. "I am still young and the breast is necessary to my body and to my pride as a woman," she said.

Liao, the surgeon, said Chinese women with breast cancer naturally want to know if their breasts can be preserved. For some cancers, the answer is yes.

Breast-conserving surgery aims to remove only the cancer while leaving as much normal breast as possible. How much of the breast is removed depends on factors such as the location and size of the tumor.

But not all patients are right candidates, Liao said. It's usually an option for an early-stage patient.

In most cases the patient will need radiation after the surgery to prevent the cancer's return. Full mastectomies are less likely to require radiation afterward. The decision involves balancing many factors.

"As long as the cancer won't come back and I can keep my breast, I don't mind radiation at all," Dai said. She had been diagnosed with early-stage breast cancer.

To assure the patients of a quality life, Liao has been widely promoting breast-conserving surgery, particularly for younger patients with early stages of breast cancer.

Liao and her colleagues performed about 350 breast-conserving surgeries last year, accounting for 25 percent of all breast cancer surgeries at the center.

"Follow-up radiation therapy is necessary as it helps reduce the chance of relapse by two-thirds," said Chen Mo, a surgeon at the center. More than 95 percent of the recipients there survive for more than five years.

Liao added that with follow-up radiation therapy, "survival chances equal that of a mastectomy".

Other major breast cancer centers in top cities like Beijing and Shanghai have found similar outcomes but nationally it is a different story, with less than 10 percent of breast cancer surgeries performed conserving the breasts, far lower than an average of 63 percent in the United States.

In poor regions, such as the western parts of China, the rate can be as low as 3 percent, Liao said. "A lack of competent breast cancer specialists is mainly to be blamed for the gap," she said.

Wu Jiong, a leading breast cancer surgeon at Fudan University Shanghai Cancer Center, said other factors such as limited access to radiation therapy and a lower detection rate of early breast cancers also play a role.

Currently, no more than 20 percent of breast cancer cases are diagnosed at a very early stage in China, according to the National Cancer Center, which follows the rates of cancer incidence, survival and mortality by collecting and analyzing data from about 370 cancer surveillance centers across the country.

Public awareness needs to be enhanced as well, Liao said.

Dai had no idea breast-conserving surgery was available until she was informed about her options at the hospital.

She discovered her cancer early this year when an ultrasound scan detected a tumor measuring 1.1 centimeters in diameter in her right breast during government-funded free breast cancer screening at a community clinic.

"It was hard to believe at first because I could feel nothing wrong with my breast," she recalled. "But now I kind of feel lucky. I am the only one of the six patients at the hospital ward who is getting the breast-conserving surgery."

Liao said that for younger patients in their 30s: "I strongly recommend breast-conserving surgery if her condition permits. They still have long way to go in their life."

But she also stressed that life and health is the top priority and cannot be compromised. "We follow strict clinical indications in deciding the surgery options."

For instance, an early-stage patient would still receive a mastectomy if she tested positive for breast cancer-causing gene mutations, which indicate a high possibility of relapse.

Moreover, social and economic factors have to be considered before making a treatment decision-for example, whether the patient can afford the extra costs of radiation therapy, usually ranging from 40,000-80,000 yuan ($6,000-$12,000) and whether she can access following-up intervention as needed, Liao added.

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