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1. Age-Period-Cohort Analysis of Trends of Breast Cancer Incidence and Mortality among Chinese Females from 1990 to 2019
LIU Xuewei, WANG Yuan, WEI Danmei, LU Wenli
Chinese General Practice    2023, 26 (01): 34-41.   DOI: 10.12114/j.issn.1007-9572.2022.0619
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Background

Breast cancer is the leading cause of death among women worldwide, characterized by high incidence and heavy disease burden.

Objective

To assess the secular trend of breast cancer incidence and mortality in Chinese females from 1990 to 2019.

Methods

The data on breast cancer incidence and mortality in Chinese females aged ≥15 years from 1990 to 2019 were extracted from the Global Burden of Disease Study 2019. The Bayesian age-period-cohort (APC) model was used to fit breast cancer incidence and mortality trends during 1990—2019 to assess the effects of age, period and cohort on breast cancer incidence and mortality.

Results

The crude incidence of breast cancer among Chinese females increased from 14.14/100 000 to 52.81/100 000, and the crude mortality increased from 7.22/100 000 to 13.40/100 000 during 1990—2019.The standardized incidence of breast cancer showed an increasing trend in general (17.07/100 000 in 1990, 35.61/100 000 in 2019) , while the standardized breast cancer mortality was basically stable (9.16/100 000 in 1990, 8.98/100 000 in 2019) .The results of the APC model showed that the average net drift value of breast cancer incidence in females of all age groups was 2.58%〔95%CI (2.34%, 2.83%) 〕, and the highest value of local drift was 3.46%〔95%CI (3.11%, 3.80%) 〕 in the 65-69 years old group. The average net drift value of mortality was -0.75%〔95%CI (-1.09%, -0.41%) 〕. The local drift value was stable in 15-44-year-olds, and was above 0 in age groups above 60 years old. The incidence and mortality of breast cancer increased with age. The period effect of incidence showed an increasing trend (RR: 0.79-1.47) , while the period effect of mortality showed a decreasing trend (RR: 1.08-0.90) when the period of 2000—2004 was set as the control group. The cohort effect of breast cancer incidence increased (RR: 0.27-2.48) , and the cohort effect of breast cancer mortality risk increased firstly and decreased after then (RR: 0.78-1.06-0.44) when the cohort of 1955—1959 was set as the control group.

Conclusion

The incidence and mortality of breast cancer in Chinese females increased continuously from 1990 to 2019, which was dominantly influenced by age and cohort.

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2. Constructing a Risk Prediction Model of Breast Cancer-related Lymphedema Based on a Meta-analysis of Prospective Cohort Studies
SHEN Aomei, LU Qian, FU Xin, WEI Xiaoxia, BIAN Jingru, ZHANG Liyuan, QIANG Wanmin, PANG Dong
Chinese General Practice    2023, 26 (17): 2078-2088.   DOI: 10.12114/j.issn.1007-9572.2022.0827
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Background Lymphedema is a common chronic complication bothering breast cancer patients. Early assessment and prediction of the risk for developing breast cancer-related lymphedema (BCRL) is particularly important. However, there is still a lack of an authoritatively recognized and suitably promoted risk prediction model.Objective To construct and validate a risk prediction model for BCRL based on the results of a meta-analysis.Methods Electronic databases including PubMed, Embase, CINAHL, Scopus, Web of Science, Cochrane Library, CNKI, CBM, and Wanfang Data, were searched for prospective cohort studies on risk factors of BCRL from inception to November 2021. Two systematically trained researchers independently screened the literature, extracted data, and assessed the study quality using the Newcastle-Ottawa Scale. Stata 17.0 was used for meta-analysis. The risk factors with significant pooled effect size and their combined risk value were extracted to construct the Logistic risk prediction model. The Logistic and additive risk scoring models were constructed based on regression coefficients and pooled risk values, respectively. The data of 486 breast cancer patients recruited in the breast cancer research center of Peking University People's Hospital, from April 2017 to December 2018, were selected as the validation set. The area under the ROC curve (AUC) and the Hosmer-Lemeshow test were used to evaluate the prediction performance of the risk scoring model. Decision curve analysis was used to evaluate the clinical practicability.Results A total of 49 prospective cohort studies involving 32 543 breast cancer patients were included. Meta-analysis showed that the incidence of BCRL was 20.6%〔95%CI (17.9%, 23.3%) 〕. Among 49 studies, five risk factors with significant pooled effect sizes were reported more than five times, including body mass index (BMI) 〔RR=1.777, 95%CI (1.515, 2.085) 〕, type of breast surgery〔RR=1.320, 95%CI (1.125, 1.549) 〕, type of axillary surgery〔RR=3.058, 95%CI (2.325, 4.020) 〕, radiotherapy〔RR=1.620, 95%CI (1.214, 2.160) 〕, and postoperative complications〔RR=2.373, 95%CI (1.278, 4.405) 〕. The total score for the Logistic risk scoring model ranged from 0 to 34, and that for the additive risk scoring model ranged from 5 to11. The AUCs of Logistic and additive risk scoring models were 0.748〔95%CI (0.701, 0.794) 〕and 0.737〔95%CI (0.691, 0.784) 〕, respectively. The values of Hosmer-Lemeshow test were 0.185 and 0.763, respectively. The optimal cut-off value of the Logistic risk scoring model was 18, with a sensitivity of 81.7%, and a specificity of 43.1%. The optimal cut-off value of the additive risk scoring model was 8.5, the sensitivity was 80.9%, and the specificity was 42.8%. When the probability threshold ranged from 20% to 30%, the model achieved higher net clinical benefit. Conclusion The BCRL risk prediction model based on this meta-analysis has good predictive performance. It can be used as a risk assessment tool for BCRL to guide the hierarchical monitoring and management of BCRL. However, prediction performance and clinical practicability of the model still needs to be validated and optimized in future research.
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3. Mindfulness-based Stress Reduction Can Improve Psychological Condition in Breast Cancer Patients: an Overview of Systematic Reviews
ZHENG Qingyong, ZHAO Liang, WEI Wei, REN Xuejun, WANG Chao, SUN Rui, CONG Minghua, YU Lei, YANG Min
Chinese General Practice    2023, 26 (12): 1503-1512.   DOI: 10.12114/j.issn.1007-9572.2022.0649
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Background

Worldwide, breast cancer has become the most common malignancy, and many breast cancer survivors struggle with psychological problems in treatment and recovery. The efficacy of mindfulness-based stress reduction (MBSR) in the psychological care of breast cancer patients has been confirmed in many systematic reviews (SRs) . However, due to inconsistent outcome measures used in various SRs, the review results cannot be directly applied to clinical practice.

Objective

To perform an overview of the SRs of the efficacy of MBSR in breast cancer patients, providing a reference for the making of psychological care interventions for these patients.

Methods

PubMed, Embase, Cochrane Library, Web of Science, CINAHL, PsycINFO, JBI, CNKI, Wanfang Data, and CBM were searched from inception to July 2022 for SRs of patients with breast cancer treated with MBSR. Literature screening and data extraction were performed by two researchers independently. Methodological quality was assessed using the AMSTAR 2. The standardization of reporting quality was assessed using the PRISMA checklist. Quality of evidence and strength of recommendations were assessed using the GRADE approach. The confidence of evidence from qualitative SRs was assessed using the CERQual.

Results

Fourteen SRs were included. The methodological quality of included SRs was generally low, with only one being of high quality and two fatally missing key items. The defects in reporting quality were mainly in study protocol registration, risk of bias assessment and funding sources. Fifteen outcomes and 73 evidence bodies (0, 31, 28 and 6 were classified as high, moderate, low, and very low quality, respectively, by the GRADE approach, and the other 8 were classified as low quality by the CERQual approach) were identified in the SRs in total. MBSR could relieve anxiety, depression, fatigue, and stress in breast cancer patients to varying degrees, whose efficacy has proven to be significant in a short-term, but is uncertain in a long-term.

Conclusion

Generally, SRs on MBSR improving psychological condition in breast cancer patients contain unsatisfactory quality of evidence, whose methodological quality and standardization level of reporting quality still need to be improved further. Moreover, the shorter-term effect of MBSR has been confirmed, but its long-term effect is uncertain, and requires to be evaluated by more high-quality, large-sample clinical studies.

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4. Influencing Factors of Benign Breast Nodules Growth in Women 
FAN Na,GAO Ying,WEI Wei,LI Shu,TAO Fengran,JIANG Yunwen,ZHANG Qing
Chinese General Practice    2021, 24 (30): 3799-3805.   DOI: 10.12114/j.issn.1007-9572.2021.02.003
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Background The incidence of benign breast nodules is increasing in recent years,but studies about the factors affecting the growth of benign breast nodules measured by ultrasound(BI-RADS 2 or 3) are very limited. Objective To identify factors associated with the growth of benign breast nodules. Methods A total of 1 399 women with newly detected benign breast nodules by annual ultrasound screening for breast were selected from Health Management Center of Tianjin Medical University General Hospital between January 2013 and January 2019. Basic demographics,blood lipids,blood glucose,tumor markers and routine blood parameters were analyzed. Ultrasonic imaging characteristics such as the location,number,size,echo,composition,margin,morphology,calcification,blood flow,ductal dilatation,and presence of nodules in the contralateral breast were analyzed at baseline and during follow-up. Multivariate Cox proportional hazards model was used to identify the factors associated with the growth of benign breast nodules. Results The mean age of the participants was (45.7±9.3)years,and the median follow-up time was 1.08 years. Up to the study's completion time,654 cases (46.7%) showed an increase in the diameter of the nodules measured by ultrasound. Multivariate Cox proportional hazards regression analysis results revealed that,age <50 years old 〔HR=1.25,95%CI(1.05,1.50)〕,platelet count >252×109/L 〔HR=1.19,95%CI(1.01,1.40)〕,maximum diameter of nodules <8 mm 〔HR=1.62,95%CI(1.35,1.95)〕,and multiple nodules〔HR=1.23,95%CI(1.03,1.47)〕 were all independent risk factors for the growth of benign breast nodules. Conclusion Increased risk of growth of benign breast nodules in women was independently associated with younger age,elevated platelet count,smaller maximum diameter of breast nodules initially measured by ultrasound,and prevalence of multiple nodules. Therefore,clinical priority should be given to the monitoring of breast nodules and shorten the follow-up interval in female individuals with one of the above-mentioned risk factors,to achieve timely control and effective management of nodules.
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5. Risk Factors for Breast Cancer-related Lymphedema in Chinese Women:a Meta-analysis 
ZHANG Hao,LIU Ruirui,ZHU Lin,BO Dingxi,ZHONG Yizhu,LIANG Yun,GAO Jing
Chinese General Practice    2021, 24 (26): 3349-3358.   DOI: 10.12114/j.issn.1007-9572.2021.01.206
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Background Breast cancer-related lymphedema (BCRL)is the most common postoperative complication of breast cancer,which cannot be cured clinically at present. Early identification of the risk factors for BCRL may improve the outcome significantly,yet it is still controversial in existing relevant studies,and there is no relevant systematic review in China. Objective To systematically evaluate the risk factors for BCRL in Chinese women. Methods We searched the databases of CINAHL,PubMed,EMBase,Web of Science,The Cochrane Library,CNKI,CQVIP,Wanfang Data and SinoMed for articles about the risk factors of BCRL among Chinese women published from inception to June 2020.Two researchers independently screened the studies based on the inclusion and exclusion criteria,extracted data 〔including the first author,time of publication,type of studies,sample size,measurement methods for edema,degree of edema,follow-up time,and BCRL-related factors(age,BMI,hypertension prevalence,lymph node metastasis prevalence,scope of axillary lymph node dissection,having a lymph node dissection,number of lymph nodes dissected,postoperative healing complication,chemotherapy,radiation therapy)〕,and performed risk of bias assessment using the Newcastle-Ottawa Scale. Meta-analysis was performed using RevMan 5.3. Results 31 studies involving 2 618 subjects were included,with moderate or high methodological quality. Meta-analysis showed that older age〔OR=2.59,95%CI(1.95,3.45),P<0.000 01〕,increased BMI〔OR=2.33,95%CI(1.91,2.85),P<0.000 01〕,hypertension〔OR=4.76,95%CI(2.53,8.94),P<0.000 01〕,lymph node metastasis〔OR=1.22,95%CI(1.06,1.39),P=0.005〕,extended axillary lymph node dissection〔OR=2.30,95%CI(1.88,2.81),P<0.000 01〕,having a lymph node dissection〔OR=8.29,95%CI(2.32,29.60),P=0.001〕,number of dissected lymph nodes ≥15〔OR=1.12,95%CI(1.06,1.19),P<0.000 1〕,postoperative healing complication〔OR=4.11,95%CI(3.26,5.17),P<0.000 01〕,chemotherapy〔OR=3.17,95%CI(2.16,4.63),P<0.000 01〕,radiation therapy〔OR=2.69,95%CI(2.32,3.13),P<0.000 01〕were risk factors of BCRL. Conclusion BCRL among Chinese women may be associated with various risk factors,such as age>40,BMI≥24 kg/m2,hypertension,lymph node metastasis,extended axillary lymph node dissection,having a lymph node dissection,number of dissected axillary lymph nodes ≥15,postoperative healing complication,chemotherapy,and radiation therapy. Due to limited quality and quantity of the included studies,more large-sample prospective cohort studies are required to verify the above conclusion.
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6. 替吉奥治疗卡培他滨耐药转移性乳腺癌的疗效分析
王少敏*,叶孟,倪曙民
Chinese General Practice    2017, 20 (20): 2469-2473.   DOI: 10.3969/j.issn.1007-9572.2017.20.009
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目的  分析卡培他滨单药治疗耐药后的转移性乳腺癌患者接受替吉奥单药治疗的疗效及安全性。方法  回顾性分析2011年11月-2015年5月宁波大学医学院附属医院肿瘤内科治疗的22例转移性乳腺癌患者的临床资料。22例患者接受卡培他滨单药治疗,在卡培他滨耐药后接受替吉奥单药治疗,直至疾病进展、不可耐受的毒副作用或患者拒绝治疗。按照实体瘤疗效评价标准(RECIST)进行替吉奥临床疗效评价,观察进展时间(TTP)及总生存期(OS),记录疼痛评分及CA153水平,根据美国国家癌症研究所发布的常见不良反应事件评价标准(CTCAE v4.02)进行毒副作用评价。结果  22例卡培他滨耐药的转移性乳腺癌患者接受替吉奥治疗后5例部分缓解,12例疾病稳定,5例疾病进展,客观有效率(ORR)为22.7%(5/22),临床获益率(CBR)为77.3%(17/22);中位TTP为113 d(22~218 d),中位OS为20.2个月(3.8~38.2个月)。替吉奥治疗前有15例患者有疼痛表现,未经提高止痛药物剂量,治疗后10例患者疼痛减轻。开始替吉奥治疗时CA153水平与治疗过程中最低CA153水平比较,差异有统计学意义〔(174.8±67.4)U/ml与(102.8±69.7)U/ml,t=4.174,P=0.001〕。替吉奥治疗的毒副作用均可耐受,主要毒副作用有厌食〔59.1%(13/22)〕、恶心〔50.0%(11/22)〕、乏力〔45.5%(10/22)〕、中性粒细胞计数减少〔45.5%(10/22)〕、贫血〔40.9%(9/22)〕、腹泻〔36.4%(8/22)〕、手足综合征〔27.3%(6/22)〕、转氨酶升高〔22.7%(5/22)〕及呕吐〔18.2%(4/22)〕等。毒副作用多为Ⅰ~Ⅱ级,仅3例发生Ⅲ级毒副作用。结论  替吉奥单药对于卡培他滨单药耐药的转移性乳腺癌有一定的疗效,而且耐受性良好。因此,对于使用卡培他滨单药治疗后耐药的转移性乳腺癌可考虑选用替吉奥单药治疗。
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7. Breast Cancer Prevention and Treatment Behaviors in Community-living Women: Latent Class Analysis and Influencing Factors
Jiahui MA, Guolian LIU, Lianhua ZHENG, Yaru BAI, Juanjuan MAI, Wenlian YAO
Chinese General Practice    2022, 25 (28): 3515-3522.   DOI: 10.12114/j.issn.1007-9572.2022.0477
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Background

The overall incidence of breast cancer in Chinese women is on the rise, seriously threatening their physical and mental health. Breast cancer prevention and treatment behaviors are critical to the outcomes of affected women in the community. However, these behaviors vary across individuals. And measures should be explored to improve the efficacy of such behaviors.

Objective

To perform a latent class analysis of breast cancer prevention and treatment behaviors among community-living women, and to explore the associated factors, providing evidence for individualized prevention and management of female breast cancer in the community.

Methods

A total of 1 355 community-living women were selected from in 15 towns/subdistricts of 5 counties/districts in Yinchuan and Zhongwei cities of Ningxia, China by use of convenience sampling method from November 2019 to August 2020. They were surveyed using a questionnaire consisting of baseline characteristics, and breast cancer prevention and treatment behaviors (relevant questions used are belonging to the part of breast cancer prevention and treatment in the Knowledge, Attitude and Practice of Breast and Cervical Cancer Prevention and Treatment Among Women in Ningxia) . The latent classes of breast cancer prevention and treatment behaviors were presented, and their influencing factors were identified by multivariable logistic regression analysis.

Results

The survey achieved a response rate of 97.93% (1 327/1 355) .By use of latent class analysis, breast cancer prevention and treatment behaviors of the respondents were classified into four latent classes, including positive prevention and treatment (n=522, 39.34%) , high-risk behaviors plus positive treatment (n=449, 33.83%) , high-risk behaviors plus negative treatment (n=229, 17.26%) , and general prevention and treatment (n=127, 9.57%) . The overall median score of breast cancer prevention and treatment behaviors was 9.00 (7.00, 11.00) points for all respondents. The median score of breast cancer prevention and treatment behaviors was 11.00 (11.00, 12.00) points for respondents with positive prevention and treatment behaviors, 9.00 (8.00, 10.00) points for those with high-risk behaviors plus positive treatment behaviors, 6.00 (5.00, 6.00) points for those with high-risk behaviors plus negative treatment behaviors, and 8.00 (6.00, 9.00) points for those with general prevention and treatment behaviors, with significant difference across the groups (H=1 008.493, P<0.001) . Multivariable Logistic regression analysis showed that, compared with general prevention and treatment behaviors, living in Zhongwei and having a history of childbirth were associated with increased possibility of being classified into positive prevention and treatment behaviors, having health insurance〔urban resident basic medical insurance (URBMI) , commercial health insurance, or other types〕, self-pay treatment, and a history of hormone replacement therapy were associated with increased possibility of being classified into general prevention and treatment behaviors (P<0.05) , having a history of childbirth were associated with increased possibility of being classified into high-risk behaviors plus positive treatment behaviors, having health insurance (URBMI or commercial health insurance) , as well as a history of hormone replacement therapy were associated with increased possibility of being classified into general prevention and treatment behaviors (P<0.05) , and primary education or below, household monthly income per person of 1 000-2 999 yuan were associated with increased possibility of being classified into high-risk behaviors plus negative treatment behaviors, and having URBMI were associated with increased possibility of being classified into general prevention and treatment behaviors (P<0.05) .

Conclusion

In general, breast cancer prevention and treatment behaviors in this group could be definitely classified, all being performed at a moderate level. To improve the level of breast cancer prevention and treatment behaviors of Ningxia's community-living women, focus should be on those who have high-risk behaviors and negatively seek for treatment. Moreover, the problems in positive breast cancer prevention and treatment behaviors in women with other three classes of behaviors should also be intervened and corrected to improve the outcomes of them.

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8. Potential Effect of Walking on Emotional Health among Breast Cancer Survivors: the Mediating Effects of Different Dimensions of Posttraumatic Growth
FU Shi, CHEN Chen, YU Mengzhu, JIN Changqin, HE Gan, CHU Qiao, HE Yaping
Chinese General Practice    2023, 26 (17): 2089-2094.   DOI: 10.12114/j.issn.1007-9572.2022.0797
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Background

Breast cancer has become the most prevalent cancer worldwide, which leads to both physical symptom burden and psychological distress among patients. Although available literature has demonstrated the effect of physical activity in improving psychological health among breast cancer survivors, the underlying psychosocial mechanism is relatively understudied.

Objective

To investigate the association of walking with positive and negative affect among breast cancer patients, and examine the potential mediating effects of different dimensions of posttraumatic growth between them.

Methods

From April to July, 2019, 256 breast cancer patients receiving community-based management were recruited using convenience sampling from Shanghai Pengpuxincun Community Health Center to attend a household survey. Two hundred and thirty-five of them who completed the survey were included as final participants (achieving a response rate of 91.8%) . Levels of walking were measured using International Physical Activity Questionnaire-Long Form (IPAQ-long) , posttraumatic growth was assessed using Posttraumatic Growth Inventory-Short Form (PTGI-SF) , emotional health was assessed using the 20-item Positive and Negative Affect Scale (PANAS) . Structural equation modeling was conducted to test the parallel mediating effects of different dimensions of posttraumatic growth between walking and positive and negative affect.

Results

The result of intermediary effect analysis show that, walking was associated with greater positive affect through facilitating the personal strength dimension of posttraumatic growth among breast cancer patients, with an indirect effect of 0.07〔95%CI (0.02, 0.13) 〕. Moreover, walking was associated with lower level of negative affect through facilitating the appreciation for life dimension of posttraumatic growth, with an effect size of -0.13〔95%CI (-0.21, -0.05) 〕. The result of the intermediary model show that, the level of walking activity promoted positive emotions (β=0.34, P<0.01) by promoting the personal strength dimension of post-traumatic growth (β=0.21, P<0.01) . In addition, walking activity decreased negative mood (β=-0.37, P<0.01) by promoting the life appreciation dimension of post-traumatic growth (β=0.35, P<0.01) .

Conclusion

Posttraumatic growth plays an important role as a mediator between walking and emotional health in breast cancer patients. In view of this, physicians from community health centers, the institutions responsible for long-term health management of cancer patients, should value walking as a potential intervention for improving psychological health of breast cancer patients in the future community health management. In addition, it is recommended to use both physical activity and psychological interventions to improve posttraumatic growth, in order to further enhance the intervention efficacy.

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9. Impact of Shared Decision Making on Quality of Life in Breast Cancer Patients Partially Mediated by Functional Exercise Adherence 
ZENG Jie,JIN Lei,LI Qian,WU Wenjing,SHI Baoxin
Chinese General Practice    2021, 24 (7): 847-854.   DOI: 10.12114/j.issn.1007-9572.2021.00.095
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Background Shared decision making(SDM) can improve the quality of life and treatment compliance of breast cancer patients,but there is no study on whether functional exercise compliance as a mediator variable between SDM and quality of life. Objective To investigate the perceived level of involvement in SDM of breast cancer patients with modified radical mastectomy,and discussed the correlation of SDM,exercise adherence and life of quality. Methods During the period from January to April 2019,277 breast cancer patients who accepted modified radical mastectomy in Tianjin Medical University Cancer Institute & Hospital were enrolled by means of convenience sampling. A set of questionnaires including socio-demographic questionnaire,the Chinese version of the 9-item Shared Decision Making Questionnaire(SDM-Q-9),the Postoperative Functional Exercise Compliance Scale-Breast Cancer(PFECS-B),and the Chinese version of Functional Assessment of Cancer Therapy-Breast(FACT-B) were used to collect data in a survey. Spearman correlation analysis was used to explore the relationships between SDM,functional exercise adherence and quality of life. AMOS 25.0 was applied to analyze the mediating effect of functional exercise adherence between SDM and quality of life,and to establish a structural equation model containing these three indicators. Results The median scores of SDM-Q-9 and PFECS-B,and average score of FACT-B for these breast cancer patients were 27(18,34),49(46,53),and (89.38±9.073),respectively. The score of SDM-Q-9 showed a statistically significant positive correlation with that of PFECS-B and FACT-B(P<0.05). The partial mediating effect of functional exercise compliance between SDM and quality of life was significant(P<0.05). The direct effect of SDM on quality of life was 0.391 and the mediating effect was 0.299(accounting for 43.3% of the total effect),the total effect was 0.690. Conclusion Breast cancer patients with modified radical mastectomy may have a low perceived level of involvement in SDM. SDM may directly affect their quality of life,and also may affect it indirectly through the mediating effect of functional exercise adherence.
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10. Invasive Lobular Carcinoma of Breast:Clinicopathological Features,Current and Prospective Diagnosis and Treatment 
FAN Ziyu,FANG Xuan,ZHANG Sheng
Chinese General Practice    2021, 24 (30): 3806-3813.   DOI: 10.12114/j.issn.1007-9572.2021.00.596
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Breast cancer is the highest prevalent malignant tumor worldwide,with a variety of histological types,among which invasive lobular carcinoma(ILC)of breast is the second most common histologic type,accounting for about 5%-15% of invasive tumors,showing an increased prevalence in the past 30 years. The major characteristic of ILC of breast is the loss of E-cadherin,which leads to the absence of adhesion between cells. The special diffuse infiltration and growth of ILC of breast pose some challenges to clinical physical and imaging examinations. Even if most patients with ILC of breast are hormone-receptor positive and sensitive to endocrine therapy,the problem of treatment resistance is inevitable in clinical applications. In addition,recent studies have found that the prognosis of ILC of breast is not as good as previously reported,and the principle of treatment based only on tumor stage and molecular typing does not seem to be fully applicable. It is possibly necessary to study ILC of breast as an independent clinical entity. In this paper,we reviewed the epidemiological and clinical characteristics,pathological and molecular characteristics,diagnosis,treatment,prognosis,and future treatment of ILC of breast,so as to better clinicians' understanding of clinical diagnosis and individualized treatment of ILC of breast.
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11. Association of Different Metabolic Obesity Phenotypes with Breast Cancer Risk in Women: a Prospective Cohort Study
ZHOU Jing, JIA Jianguo, LIN Yixin, WU Shuang, DAI Shilong, WANG Mingjun, ZHANG Qingsong
Chinese General Practice    2024, 27 (02): 150-155.   DOI: 10.12114/j.issn.1007-9572.2023.0507
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Background

Earlier studies have investigated the association between overweight/obesity and an elevated risk of breast cancer in women. However, some studies have found that it may not be scientifically accurate to solely analyze the association between overweight/obesity and breast cancer in women for overweight/obesity can be classified into different metabolic phenotypes. The current findings on the association of different metabolic phenotypes with breast cancer remain inconsistent.

Objective

To prospectively analyze the associations of different metabolic obesity phenotypes with the risk of breast cancer in women.

Methods

In this prospective cohort study, female employees (n=23 406) of Kailuan Group who participated in physical examinations for the first time in Kailuan General Hospital and its 11 affiliated hospitals from 2006 to 2008 were selected as the study subjects and received questionnaire investigation, physical examination and laboratory tests. The study subjects were divided into the four groups based on the types of metabolic syndrome and BMI, including metabolically healthy normal weight (MHNW) group (n=12 739), metabolically unhealthy normal weight (MUNW) group (n=1 060), metabolically healthy overweight/obese (MHO) group (n=6 394), and metabolically unhealthy overweight/obese (MUO) group (n=3 213). The subjects were followed up, with the first physical examination attended as the starting point, and new onset breast cancer, death, or the end of follow-up time (2020-12-31) as the endpoints. Multivariate Cox proportional hazard regression model was used to estimate the association of the four groups with the risk of breast cancer.

Results

During an average follow-up of (13.26±1.85) years, with 353 new cases of breast cancer and an incidence density of 11.38 cases per 10 000 person-years in the total population. The incidence cases in the MHNW, MUNW, MHO, and MUO groups were 154, 21, 113, and 65, respectively, with the incidence density of 9.08, 15.37, 13.27, and 15.49 per 10 000 person-years, and the cumulative incidence of 1.22%, 2.01%, 1.67%, and 1.93%, respectively. Multivariate Cox proportional hazard regression model analysis, after adjusting for confounders, showed that compared with the MHNW group, the risk of breast cancer was increased by 42% (HR=1.42, 95%CI=1.11-1.82) and 59% (HR=1.59, 95%CI=1.17-2.17) in the MHO group and MUO group, respectively. Stratified analysis by menopausal status showed that compared to the MHNW group, the MUO group was associated with a 69% increase in risk of premenopausal breast cancer (HR=1.69, 95%CI=1.01-2.83). The risk of postmenopausal breast cancer was increased by 85% (HR=1.85, 95%CI=1.09-3.14), 50% (HR=1.50, 95%CI=1.06-2.13), and 55% (HR=1.55, 95%CI=1.05-2.28) for the MUNW, MHO, and MUO groups, respectively, compared to the MHNW group.

Conclusion

Overweight/obesity is a risk factor for female breast cancer, and overweight/obesity with metabolic abnormalities further increases the risk of breast cancer. Additionally, normal weight postmenopausal women who are metabolically unhealthy may be at an increased risk of postmenopausal breast cancer.

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12. Research Progress on the Pathogenesis and Preventive Treatment of Ischemic Stroke in Breast Cancer-related Ischemic Stroke
Xiaoyue SUN, Fengling WANG, Aihua WANG
Chinese General Practice    2022, 25 (29): 3710-3714.   DOI: 10.12114/j.issn.1007-9572.2022.0198
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Breast cancer and ischemic stroke are two important diseases that endanger human health. More and more studies have shown that the incidence of breast cancer with ischemic stroke is higher than that of the general population, however, its pathogenesis, optimal treatment and prevention strategies are still unclear. This article summarized the evidence literature on the epidemiology, risk factors, clinical and imaging features, pathogenesis and prevention measures of breast cancer-related ischemic stroke, aiming to sort out the research progress of breast cancer-related ischemic stroke, as well as the potential strategies to solve the above problems.

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13. Skin metastasis of breast cancer misdiagnosed as sebaceous cyst with infection:a case report
LI Xiaobin,WANG Bin
Chinese General Practice    2020, 23 (20): 2604-2606.   DOI: 10.12114/j.issn.1007-9572.2020.00.164
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Breast cancer results in the highest morbidity and mortality rates among women.Skin metastasis of breast cancer is uncommon in clinical settings,and is easily misdiagnosed.We reported a case with skin metastasis of breast cancer who was admitted to PLA 518 Hospital on 25 February 2019,with an experience of being misdiagnosed as sebaceous gland cyst accompanied by infection,and reviewed the related cases reported in other studies,then discussed the diverse and complex clinical manifestations as well as pathogenesis of skin metastasis of breast cancer,hoping to enrich clinicians’ knowledge of the disease to reduce the possibility of making a misdiagnosis or missed diagnosis and improve the possibility of making an accurate diagnosis based on clinical manifestations,or in combination with CT scan and pathological examination if necessary,by which proper treatment can be delivered as early as possible.
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14. Latest Developments in Natural History and Tumor Growth Rate of Breast Cancer 
GAO Ying,WEI Wei,ZHANG Peng,ZHANG Qing
Chinese General Practice    2021, 24 (30): 3794-3798.   DOI: 10.12114/j.issn.1007-9572.2021.02.002
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In developed countries,early screening for breast cancer is already part of health services. The screening effect is greatly affected by the screening interval,which is determined by the natural history and tumor growth rate of breast cancer in the target population. In this review,we systematically reviewed the previous global studies on natural history of breast cancer,analyzed the most important parameter of tumor progression,namely,tumor growth rate,and its influencing factors,and summarized that most natural history progression models of breast cancer are multi-phased,usually covering four-phases of non-detectable,pre-clinical,clinical and death,with more potentially associated tumor characteristic parameters incorporated;the growth rate of breast tumor is assessed by pre-clinical sojourn time and doubling time;tumor growth rate is influenced by age,BRCA1/2 gene mutation,family history of breast cancer,other traditional breast cancer risk factors,tumor histopathology features,other clinical information and so on. Understanding the growth pattern of breast cancer and its influencing factors will help to formulate the optimal screening strategy and improve early screening effects. As tumor growth rate is associated with the survival of breast cancer patients,effective assessment of tumor growth will give support to develop new treatment strategies and personalized screening interval.
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15. Status and Influencing Factors of the Fear of Cancer Recurrence in Breast Cancer Survivors #br#
ZHANG Yang1,CHENG Chun-yan2,CUI Pan-pan2,CHEN Chang-ying1,2*
Chinese General Practice    2018, 21 (20): 2479-2483.   DOI: 10.3969/j.issn.1007-9572.2018.00.075
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Objective To explore the status and influencing factors of the fear of cancer recurrence(FCR) among breast cancer survivors.Methods By convenience sampling,280 breast cancer patients who received postoperative chemotherapy in the First Affiliated Hospital of Zhengzhou University from September 2016 to March 2017 were enrolled.A self-developed sociodemographic data questionnaire,Chinese version of the Fear of Progression Questionnaire-Short Form
(FoP-Q-SF),Chinese version of the Hospital Anxiety and Depression Scale(HADS) and Chinese version of the Perceived Social Support Scale(PSSS) were used to survey them for collecting the sociodemographic characteristics,status of FCR,anxiety and depression,and social support.Results A total of 280 questionnaires were handed out,and 270 responsive ones were returned.The effective recovery rate was 96.4%.The mean score of FoP-Q-SF was(36.8±10.7),171 cases(63.3%) had a FCR score≥34 and the mean score was(19.3±5.5) for physical health,and(17.5±6.2) for social and family.The mean score was(16.6±7.4) for HADS,(8.9±4.3) for anxiety subscale and(7.8±3.9) for depression subscale.The mean score of PSSS was(59.9±13.9),the family support score was(21.7±5.1),and the score of external support of family dimension was (38.2±9.8).The mean FoP-Q-SF score varied significantly by age,marital status,employment status,average household monthly income,cancer stage and treatment response(P<0.05).FoP-Q-SF score of breast cancer patients was positively correlated with HADS score(r=0.665,P<0.01),but negatively correlated with PSSS score(r=-0.464,P<0.01).Multiple linear regression analysis revealed that age(t=-3.908),marital status(t=-3.218),HADS score(t=11.327),and the score of PSSS(t=-4.672)were associated factors of FoP-Q-SF score of breast cancer patients(P<0.05).Conclusion The prevalence rate of FCR was high among breast cancer survivors,which was significantly affected by age,marital status,anxiety,depression and social support.
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16. Study on the Effect of Baseline Blood Lipid Level on the Prognosis of Patients with Non-triple-negative Breast Cancer 
WU Wenxia,ZHANG Meng
Chinese General Practice    2021, 24 (26): 3316-3322.   DOI: 10.12114/j.issn.1007-9572.2021.01.009
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Background Dyslipidemia is one of high risk factors of breast cancer. Current studies have found that the level of blood lipid metabolism may also be closely related to the stage,pathology,overall survival(OS) and disease free survival(DFS) of breast cancer,but the results were stil controversial. Objective To explore the effect of baseline blood lipid metabolism on the prognosis of non-Triple Negative Breast Cancer(TNBC). Methods Retrieved from January 2019 to March 2021 in Sun Yat-sen memorial Hospital from January 2016 to March 2017 in the electronic medical record system,202 cases of non-triple-negative breast cancer patients were included. All the patients had no history of diabetes,dyslipidemia,cardiovascular or cerebrovascular disease. The clinical general information including age,menopausal status,history of hypertension,body mass index(BMI),fasting blood glucose,blood lipids〔including total cholesterol(TC),triacylglycerol(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),apolipoprotein A1(APOA1),apolipoprotein B(APOB),apolipoprotein E(APOE)〕,high-sensitivity C-reactive protein (hsCRP),uric acid,pathological results 〔including tumor size(T stage),lymph node metastasis(N stage),ER,PR,HER-2,Ki-67,tissue grade〕were collected. The OS and DFS time until three years of diagnosis were recorded. The patients were divided into two groups according to the breast cancer stage. Group 1was stage Ⅰ-Ⅱ and group 2 was stage Ⅲ. Kaplan-Meier curves were used to determine OS and DFS rates. Log rank-tests were performed to compare differences in survival curves. Multivariable Cox proportional hazards regression models were used to study the associations between pre-diagnostic lipids and DFS,OS of non-TNBC. Results The TG level of group 2 was higher than that of group 1,while the level of HDL-C was lower than that of group 1
(P<0.05). The optimal cutoff values of the TG level and HDL-C were determined to be 1.39 mmol/L〔AUC=0.626,95%CI(0.562,0.690)〕 and 1.14 mmol/L〔AUC=0.599,95%CI(0.531,0.668)〕,respectively. The proportion of stage Ⅲ was higher in patients with TG≥1.39 mmol/L or HDL-C<1.14 mmol/L than TG<1.39 mmol/L or HDL-C≥1.14 mmol/L(P<0.05). Patients with TG≥1.39 mmol/L had higher proportion of lymph node metastasis than with TG<1.39 mmol/L. Patients had more advanced T stage in group with HDL-C<1.14 mmol/L than HDL-C≥1.14 mmol/L. Patients with HDL-C≥1.14 mmol/L had higher OS(98.1%)and DFS(89.8%) than HDL-C<1.14 mmol/L,which was 90.9% and 77.4% respectively(χ2=4.669,P=0.031;χ2=3.859,P=0.049). After adjusting for menopausal status,BMI,blood pressure and blood glucose levels,baseline HDL-C<1.14 mmol/L is considered recurrence,metastasis〔HR=2.907,95%CI(1.024,8.255),P=0.045〕 and death〔HR=8.718,95%CI (1.148,66.198),P=0.036〕 influencing factors. Conclusion HDL-C<1.14 mmol/L might be an influencing factor for the poor clinical prognosis of non-triple-negative breast cancer.
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17. Factors Affecting Margin Positivity in Frozen-section Analysis during Breast-conserving Surgery 
CHEN Xiao,LI Ying,JING Yi,YANG Xiaonan,ZHANG Sheng
Chinese General Practice    2019, 22 (33): 4058-4063.   DOI: 10.12114/j.issn.1007-9572.2019.00.310
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Background Breast-conserving surgery combined with whole breast radiotherapy has become the standard treatment for early breast cancer,but the most important disadvantage of breast-conserving surgery is that there may be tiny residual lesions at or close to the margin.Several studies have demonstrated that intraoperative frozen-section analysis(FSA) can assess the situation of margins,and prevent reoperation and reduce the local recurrence rate.Objective To explore the factors influencing surgical margin positivity in FSA during breast-conserving surgery.Methods According to the study criteria,we enrolled 629 patients undergoing FSA during breast-conserving surgery Tianjin Medical University Cancer Institute and Hospital from August 1,2014 and October 31,2016.We collected their clinical data,and analyzed the prevalence and associated factors of initial positive margin,the value of the distance from the mass to the nipple in the diagnosis of initial positive margin,and factors associated with the number of initial positive margins.Results Among the 629 patients,434(69.0%) were found with initial negative margins,other 195 (31.0%) with initial positive margins.After extended resection,the margins of 92 (47.2%) patients became negative,but the margins of 7 (3.6%) patients were still positive.96 patients (49.2%) immediately underwent total mastectomy after being found with initial positive margins.526 patients (83.6%) had successful breast-conserving surgery.Those with initial positive margins and initial negative margins showed significant differences in terms of the distance from the mass to the nipple,tumor distribution along the duct,pathological type and lymph node metastasis prevalence (P<0.05).Multivariate logistic regression analysis showed that the distance from the mass to the nipple〔OR=0.830,95%CI (0.700,0.982),P=0.030〕,and tumor distribution along the duct〔OR=0.232,95%CI (0.103,0.521),P<0.001〕,pathological type 〔invasive carcinoma of no special type:OR=0.268,95% CI (0.090,0.798),P=0.018〕,lymph node metastasis〔OR=0.154,95%CI (0.075,0.318),P<0.001〕 were the influencing factors of the initial positive margin in breast-conserving surgery.The ROC curve of the distance from the mass to the nipple for the diagnosis of initial positive margin was drawn,the area under the ROC curve was 0.572〔95%CI(0.520,0.624)〕,the optimal cut-off value was 4.55 cm,and the sensitivity was 0.815,the specificity was 0.333.The prevalence of 1,2,3 and 4 or more initial positive margins was 50.8%(99/195),28.2%(55/195),11.3%(22/195),and 9.7%(19/195),respectively.Menopause,and implementation of preoperative breast MRI were associated with less initial positive margins(P<0.05).Conclusion The distance from the mass to the nipple,tumor distribution along the duct,pathological type (mainly invasive carcinoma of no special type),and lymph node metastasis are the influencing factors of the initial positive margin in breast-conserving surgery.Non-menopausal patients and those receiving no preoperative breast MRI are more likely to be found with more initial positive margins.
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18. Construction and Application of a VR Platform Based on the Omaha System for Rehabilitation Management of Breast Cancer Patients 
JIN Ai-xiang,CHEN Xiao-min,ZHANG Xiao-fei,CHEN Jie
Chinese General Practice    2018, 21 (24): 2987-2993.   DOI: 10.12114/j.issn.1007-9572.2018.00.026
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Objective To build a virtual reality (VR) model for a breast cancer combined rehabilitation program based on breast cancer rehabilitation principles and the Omaha system,and to explore its clinical application.Methods According to the operation type and stage of postoperative recovery,combined with the natural language processing of the Omaha system and feedback from patient information,the core physical and psychological rehabilitation functions of the VR platform were developed and implemented.A total of 120 breast cancer patients treated in the Zhejiang Province People's Hospital between January 2016 and May 2017 were selected and divided into observation group (VR group,n=60) and control group(conventional rehabilitation group,n=60) with a random number table method.The scores of various dimensions and average scores of quality of life scales(SF-36) between the two groups were compared.Results A VR platform for postoperative rehabilitation of breast cancer patients based on the Omaha system was developed.After a 3-month application,the scores of various dimensions and average scores of SF-36 in the observation group were significantly higher than those in the control group(P<0.05).Conclusion The VR platform based on the Omaha system for rehabilitation management is easy to operate and apply.It is an effective physical and psychological postoperative rehabilitation model for breast cancer patients,and it provides a new option for personalized rehabilitation of breast cancer patients.
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19. The Value of Ultrasound Elastography and Molybdenum Target X-ray in the Diagnosis of Breast Invasive Ductal Carcinoma 
FANG Kaifeng,DING Guanbao,HAN Lu
Chinese General Practice    2021, 24 (15): 1959-1961.   DOI: 10.12114/j.issn.1007-9572.2021.00.467
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Background Breast cancer is one of the most common malignant tumors in women,so it is extremely important to find an effective method for early diagnosis of breast cancer.Objective To investigate the value of ultrasonic elastography and molybdenum target X-ray in the diagnosis of breast invasive ductal carcinoma.Methods From October 2017 to December 2019,102 female patients with suspected breast invasive ductal carcinoma treated in the Wanbei Coal Electricity Group General Hospital were selected as research objects.Ultrasonic elastography and molybdenum target X-ray examination were performed before operation or biopsy,with pathological diagnosis as the gold standard.The correlation between histological grade and ultrasonic elasticity score of breast invasive ductal carcinoma was analyzed.The ROC curves of ultrasound elastography and molybdenum target X-ray in the diagnosis of breast invasive ductal carcinoma were drawn.Results 98 cases of invasive ductal carcinoma of breast were confirmed by the gold standard.The histological grade of breast invasive ductal carcinoma was positively correlated with ultrasonic elasticity score(rs= 0.452,P=0.003).When the optimal cutoff value of ultrasound elastography was 4,the sensitivity,specificity and AUC in diagnosis of breast invasive ductal carcinoma were 88.1%,92.1% and 0.953〔95%CI(0.912,0.995)〕;when the optimal cutoff value of molybdenum target X-raywas 4b,the sensitivity,specificity and AUC in diagnosis of breast invasive ductal carcinoma were 72.4%,83.3% and 0.855〔95%CI(0.805,0.893)〕.AUC of ultrasound elastography in the diagnosis of breast invasive ductal carcinoma was higher than that of molybdenum target X-ray(Z=3.337,P<0.05).Conclusion The diagnostic value of ultrasound elastography is higher than molybdenum target X-ray in the diagnosis of breast invasive ductal carcinoma,and ultrasound elastography is positively correlated with the histological grade of breast invasive ductal carcinoma,which is greatly significant in the evaluation of maligant degree of clinical diagnosis of breast invasive ductal carcinoma.
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20. Screening and Diagnosis Value of Acoustic Radiation Force Impulse Imaging Quantification in Combination with Superb Microvascular Imaging in Early Breast Cancer 
WANG Lei,DENG Kexue,SUI Xiufang,ZHANG Jie,ZHANG Hang
Chinese General Practice    2020, 23 (18): 2309-2313.   DOI: 10.12114/j.issn.1007-9572.2020.00.095
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Background Breast cancer is a common malignant tumor in women.The acoustic radiation force impulse imaging(ARFI) and superb microvascular imaging(SMI) are common screening and diagnosis methods of early breast cancer,but each of them has its own advantages and disadvantages.So far,the application of ARFI combined with SMI in the diagnosis of early breast cancer has not been reported.Objective To investigate the screening and diagnosis value of ARFI in combination with SMI in early breast cancer.Methods 160 cases with breast lump as a primary manifestation visiting Anhui Provincial Hospital Affiliated to Anhui Medical University from January 2017 to December 2018 were enrolled.All of them accepted ARFI quantification,SMI,and pathological examination successively.Consistence of examination result with pathological findings,sensitivity,and specificity were compared between ARFI,SMI,and ARFI in combination with SMI.Results 124 cases of early breast cancer and 36 cases of benign lesions were confirmed by pathological examination,and the diagnosis rate of breast cancer was 72.3%.The consistence of ARFI,SMI,and ARFI in combination with SMI results with pathological results was moderate,moderate and very good,respectively(Kappa=0.569,0.529,0.880,P<0.05).The mean sensitivity of ARFI,SMI and ARFI with SMI was 79.8%,78.2%,and 95.2%,respectively,showing a significant difference (P<0.05).And the combination of ARFI and SMI showed a higher mean sensitivity than each alone(P<0.05).The mean specificity of ARFI,SMI and ARFI with SMI was 88.9%,86.1%,and 97.2%,respectively,demonstrating no obvious difference (P>0.05).Conclusion ARFI and SMI are both important examinations in screening and diagnosing early breast cancer.And combined use of the two may increase diagnostic sensitivity,which can be used clinically according to patients' specific conditions.
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21. Clinical Characteristics and Traditional Chinese Medicine of Hyperlipidemia in Estrogen Receptor Positive Breast Cancer Patients during Endocrine Therapy: a Real World Study
LIU Bingwei, WANG Jing, QIAO Xue, MU Silin, SHI Guangxi, LI Jingwei
Chinese General Practice    2023, 26 (36): 4558-4564.   DOI: 10.12114/j.issn.1007-9572.2023.0136
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Background

Breast cancer is the most prevalent malignancy in the world. Endocrine therapy reduces the level of estrogen in vivo, thus affecting the blood lipid level, which reduces the quality of life and the treatment compliance of patients.

Objective

To analyze the clinical characteristics and traditional Chinese medicine (TCM) prescription of hyperlipidemia in estrogen receptor (ER) positive breast cancer patients during endocrine therapy in real world.

Methods

Based on method of retrospective study, a total of 238 patients with ER positive breast cancer who received endocrine therapy in Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2012 to March 2022 were selected as the study subjects. The data including age, triglyceride, total cholesterol, low density lipoprotein, endocrine therapy drugs, TCM prescriptions of the patients were exported through the search platform of scientific research big data to establish a clinical data table of the patients. ER positive breast cancer patients with normal baseline blood lipid levels were divided into the normal group and dyslipidemia group according to the blood lipid levels during endocrine therapy, and hyperlipidemia was classified into hypercholesterolemia, hypertriglyceridemia and mixed hyperlipidemia. The exported prescriptions were analyzed for frequency, four properties, five flavors, channel tropism and medication regularity by using the "prescription analysis", an auxiliary platform for TCM inheritance, to obtain new prescriptions.

Results

Among 238 ER positive breast cancer patients, 97 patients (40.8%) had normal baseline blood lipid levels, of whom 42 patients (205 person-time return visit) developed dyslipidemia during standardized endocrine therapy. Among the patients with dyslipidemia, 37.6% (77/205) occurred in the age group of 51 to 60 years as the highest number; 86 person-time with dyslipidemia received exemestane treatment, accounting for the highest proportion of 42.0%. Among the 42 patients with dyslipidemia (205 person-time return visit) , hyperlipidemia occurred in 99 person-time, and hypercholesterolemia occurred in 49.5% (49/99) . There was no statistically significance difference in the age of patients with three types of hyperlipidemia (P>0.05) . There were statistically significance differences in the proportion of endocrine therapy types among patients with three types of hyperlipidemia (P<0.05) . There were 189 kinds of TCM prescriptions for hyperlipidemia in ER positive breast cancer patients during endocrine treatment, licorice was the most frequently used medicine (408 times) , the highest frequency of use was tonifying qi drug (22.6%) . The channels of TCM collected by the big data platform were mainly distributed in the spleen, lung and liver channels. The properties of TCM were mainly cold, flat and warm, and the flavors were mainly sweet, bitter and pungent. The combination of "Astragalus and Licorice" had the highest frequency. Six core drug combinations and three new prescriptions were obtained through complex system entropy clustering analysis.

Conclusion

The highest incidence of hyperlipidemia in ER positive breast cancer patients during endocrine therapy is 51-60 years old, and hypercholesterolemia is the most common. The position of hyperlipidemia in ER positive breast cancer patients during endocrine therapy is in the spleen. The medication are maily used for invigorating spleen to remove dampness, tonifying qi and regulating stomach.

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22. Therapeutic Effect of Shenbai Fuzheng Granules Combined with Apatinib in the Treatment of Metastatic Breast Cancer with Multi-line Therapy Failure 
LUO Yue-qiong,LIAO Da-zhong
Chinese General Practice    2018, 21 (25): 3107-3112.   DOI: 10.12114/j.issn.1007-9572.2018.25.015
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Objective To investigate the effect of Shenbai Fuzheng Granules combined with Apatinib in the treatment of metastatic breast cancer with multi-line therapy failure and its effect on vascular endothelial growth factor receptor 2(VEGFR2) and immune function.Methods A total of 96 patients with metastatic breast cancer who failed multi-line treatment were randomly divided into the control group(n=48) and the experimental group(n=48).The control group was treated with oral Apatinib and the experimental group was given oral Shenbai Fuzheng Granules combined with Apatinit.The clinical efficacy,traditional Chinese medicine(TCM) syndrome scores,levels of serum insulin-like growth factors-1(IGF-I),CA153,interleukin8(IL-8),VEGFR2,CD4+,CD8+,CD4+/CD8+,natural killer cell(NK),IgG,IgA,adverse reactions,progression-free survival(PFS) and overall survival(OS) were compared between two groups.Results The treatment efficiency and tumor control rate in the experimental group were significantly higher than those in the control group(P<0.05).The TCM syndrome scores of the experimental group after the treatment were significantly lower than those before the treatment and those of the control group after the treatment(P<0.05).After treatment,the levels of serum IGF-I,CA153,IL-8 and VEGFR2 in two groups were significantly lower than those before the treatment(all P<0.05),and these indexes in the experimental group were significantly lower than those in the control group(all P<0.05).After treatment,the experimental group demonstrated higher levels of serum CD4+,CD4+/CD8+,NK,IgG,IgA and lower level of serum CD8+ compared with the control group(P<0.05).The total incidence of adverse reactions in the experimental group was not significantly different from that in the control group(P>0.05).The PFS and OS of the experimental group were significantly longer than those of the control group(P<0.05).Conclusion The effect of Shenbai Fuzheng Granules combined with Apatinib in the treatment of metastatic breast cancer with multi-line treatment failure is effective,which can effectively reduce the level of VEGFR2 and improve the immune function with higher safety.
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23. 自制手指爬墙运动指导表对乳腺癌术后患肢功能恢复的影响
周春兰,李晓瑾,李文姬,马兰兰,吴艳妮
Chinese General Practice    2015, 18 (6): 625-628.   DOI: 10.3969/j.issn.1007-9572.2015.06.004
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目的  探讨自制手指爬墙运动指导表对乳腺癌术后患者患肢功能恢复的影响。方法  选择2013年1—5月广东省某三级甲等医院乳腺中心行手术治疗的乳腺癌患者80例,采用随机数字表法将患者分为对照组和干预组,各40例。住院期间对两组患者进行常规功能锻炼指导,出院后对照组按照常规出院指导进行功能锻炼,干预组在此基础上使用自制手指爬墙运动指导表进行患肢功能锻炼。于术后出院前和干预后1、2、3个月,患者每月返院化疗时,以患肢前位爬高、前位抬高、侧位爬高、侧位抬高为评价指标,记录患者患肢恢复情况。结果  干预组1例患者脱落,患者创口出现皮下积液,可能与患肢过度锻炼有关。两组患者年龄、受教育程度、术式、职业、人均收入、医疗方式、分期比较,差异均无统计学意义(P>0.05)。两组患者不同时间前位爬高、前位抬高、侧位爬高、侧位抬高比较,差异均有统计学意义(P<0.05)。组间比较显示,出院前及干预后1个月两组患者前位爬高、前位抬高比较,差异无统计学意义(P>0.05);干预后1个月两组患者侧位爬高、侧位抬高比较,差异无统计学意义(P>0.05);干预后2、3个月干预组患者前位爬高、前位抬高、侧位爬高、侧位抬高均高于对照组(P<0.05)。组内比较显示,两组患者干预后3个月前位爬高、前位抬高均高于出院前及干预后1、2个月(P<0.05);两组患者干预后3个月侧位爬高、侧位抬高均高于干预后1、2个月(P<0.05)。结论  自制手指爬墙运动指导表有助于乳腺癌术后患者患肢功能的恢复。
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24. Research Progress in the Treatment of Hormone Receptor/Human Epidermal Growth Factor Receptor 2-positive Breast Cancer 
WU Yanqi,LUO Ting
Chinese General Practice    2021, 24 (8): 1028-1032.   DOI: 10.12114/j.issn.1007-9572.2019.00.744
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Breast Cancer is the most common cancer among women in China.According to the expression of estrogen receptor(ER)and progesterone receptor(PR) and the status of human epidermal growth factor receptor 2(HER2) gene amplification,breast cancer has been classified into various molecular subtypes.And the prognosis of different subtypes is also different.HER2 positive breast cancer behaves more aggressively and has a worse prognosis than HER2 negative breast cancer.Moreover,there are interactive crosstalks between HR and HER2 signaling pathways so that endocrine therapy and anti-HER2 therapy could influence and restrict each other.Nowadays,how to treat HR+/HER2+ breast cancer reasonably and effectively has been one of the difficulties in the treatment of breast cancer.In this article,the treatment situation of HR+/HER2+ breast cancer and the exploration of anti-HER2 therapy,endocrine therapy,immunotherapy,PI3K/mTOR pathway inhibitors,and other aspects associated with HR+/HER2+ breast cancer have been briefly described.
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25. Evaluation of Evidence-based Resources for Early Postoperative Functional Exercise in Patients with Breast Cancer
DING Xiaotong,LI Huiping,YANG Yajuan,SU Dan,ZHANG Ting
Chinese General Practice    2018, 21 (32): 4011-4017.   DOI: 10.12114/j.issn.1007-9572.2018.00.130
Abstract592)      PDF(pc) (1095KB)(755)    Save
Objective To summarize and evaluate the best evidence of early postoperative functional exercise in breast cancer patients.Methods In June 2017,clinical practice guidelines,systematic reviews and related evidence-based resources pertaining to early postoperative functional exercise in breast cancer were retrieved through the Chinese databases,English databases and guideline websites by computer.The publication-data limit was set by May 2017.The literatures screened were read and the literature quality was assessed by two investigators.All data needed were extracted from the literatures that met the quality.Results Nineteen articles were enrolled,including three clinical practice guidelines,nine systematic reviews,and seven related evidence-based resources.The three clinical practice guidelines mainly included principles of functional exercises,forms of instruction,the content of functional exercises,standard requirements and considerations.The 16 systematic reviews and related evidence-based resources mainly included principles of functional exercises,forms of instruction,functions of educators,the content of exercise,effect evaluation of exercise,parameters of exercise and the evaluating indicator.It was suggested that professionals should follow the principle of gradual progress,combined with paper-based materials to guide patients.Preoperative assessment of bilateral upper extremity function should be performed.1-2 days after the operation,the shoulder joint should remain motionless,and activities of fingers,wrists and elbow joints be performed.The time of shoulder joint activity is controversial,so professionals should weigh the pros and cons,according to the patients' situation (such as drainage,wound healing,or subcutaneous effusion) to guide patients with shoulder joint activity at their discretion.If the patient has the factors that affect wound healing and drainage,one week of functional exercise can be delayed (9-10 days after the operation).Conclusion Evidence-based exercise instruction projects have not been found so far in China.Investigators should propose evidence-based guidelines based on the latest best evidence of early functional exercise,clinical context of care,the patient's needs and preferences and professional judgment.
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26. Promoter Methylation Status of GSTP1,BRCA1 and MGMT in Breast Cancer Tissues and Its Correlation with Clinical Pathological Features 
QIAN Xiao-ying,LIN Hai-feng,ZHOU An-xi,ZHUO Man-yun
Chinese General Practice    2018, 21 (24): 2952-2956.   DOI: 10.12114/j.issn.1007-9572.2018.00.141
Abstract591)      PDF(pc) (1161KB)(558)    Save
Objective To analyze the promoter methylation status of GSTP1,BRCA1 and MGMT in breast cancer tissues and its correlation with clinical pathological features.Methods According to the inclusion criteria,we enrolled 100 cases of breast cancer from the Second Affiliated Hospital of Hainan University from January 2015 to June 2016.The promoter methylation status of GSTP1,BRCA1 and MGMT in breast cancer tissues and tissues adjacent to breast cancer was detected by methylation-specific PCR and its relationship with clinical pathological features was analyzed.Cox regression analysis was performed to investigate the relationship between the promoter methylation status and prognosis of the patients.Results Promoter methylation level of GSTP1,BRCA1 and MGMT in breast cancer tissues was higher than that in tissues adjacent to breast cancer(P<0.05).The proportion of methylated genes in breast cancer tissue was higher than that of the methylated breast cancer adjacent tissue (P<0.05).The promoter methylation level of these genes differed significantly by breast cancer staging and prevalence of lymphatic metastasis(P<0.05).Patients with breast cancer of≥20 mm in maximum diameter showed higher methylation level in the promoter region of GSTP1 compared with those with breast cancer of <20 mm in maximum diameter(P<0.05).Moreover,breast cancer patients with lymphatic metastasis presented higher methylation level in the promoter region of GSTP1 compared with those without(P<0.05).Younger than 50 years old and estrogen receptor negative were associated with higher methylation level in the promoter region of BRCA1(P<0.05).Patients with histological Ⅲbreast cancer,stage Ⅱ-Ⅳ breast cancer or breast cancer with lymphatic metastasis demonstrated higher methylation level in the promoter regions of MGMT compared with those with histological Ⅰ-Ⅱ breast cancer,stage Ⅰ breast cancer or breast cancer without lymphatic metastasis(P<0.05).Cox regression analysis showed that the methylation in the promoter regions of GSTP1,BRCA1 and MGMT genes were associated with the prognosis of breast cancer (P<0.05).Conclusion The promoter regions of GSTP1,BRCA1 and MGMT in breast cancer tissue was higher than that of the methylated breast cancer adjacent tissue.The methylation of GSTP1,BRCA1 and MGMT genes are correlated with clinicopathological characteristics and progression of breast cancer.
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27. Multimodal Ultrasound Characteristics Associated with Molecular Subtypes of Breast Cancer 
WU Fang,CHENG Jing,CAO Chunli,MA Ting,TONG Caixia,CAO Yuwen
Chinese General Practice    2020, 23 (30): 3878-3883.   DOI: 10.12114/j.issn.1007-9572.2020.00.321
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Background  High heterogeneity in breast cancer distinguishes individual biological behavior,prognosis and treatment.Individualized molecular subtype-specific therapy has been widely used clinically.Studies have shown that some ultrasound features are associated with molecular subtyping,but it is difficult to screen relevant predictors out of various ultrasound parameters.Objective To identify the multimodal ultrasound characteristics associated with molecular subtypes of breast cancer.Methods  This prospective study was conducted in 91 women with pathology-confirmed breast cancer from the First Affiliated Hospital,School of Medicine,Shihezi University during January 2017 to February 2019.Postoperative immunohistochemical results,including Luminal(Luminal A and Luminal B subtypes) and non-Luminal(HER2-enriched and triple-negative subtypes) breast cancer,were collected and compared in terms of multimodal ultrasound characteristics〔including findings of two-dimensional ultrasound,virtual touch tissue imaging quantification(VTIQ) and contrast-enhanced ultrasonography〕.Univariate and multivariate Logistic regression were used to identify the ultrasound characteristics associated with molecular subtypes of breast cancer.Results  The Luminal A,Luminal B,HER2-enriched and triple-negative subtypes numbered 11,49,18,and 13,respectively.Luminal and non-Luminal breast cancer patients showed significant differences in two-dimensional ultrasonic border(degree of clearness) and marginal features(spiculated or lobulated),contrast-enhanced ultrasonic margin,range and peripheral radial enhancement,and VTIQ-generated shear-wave elastographic features(P<0.05).Multivariate Logistic regression analysis showed that two-dimensional ultrasonic spiculated or lobulated border and margin,contrast-enhanced ultrasonic peripheral radial enhancement,and increased VTIQ-measured shear-wave elastographic value of the marginal zone were independently associated with luminal breast cancer(P<0.05).Conclusion Different molecular subtypes of breast cancer have different ultrasound morphological,blood supply and elastographic characteristics.The two-dimensional ultrasonic spiculated or lobulated margin,contrast-enhanced ultrasonic peripheral radial enhancement,and increased VTIQ-measured shear-wave elastographic value of the marginal zone are closely associated with luminal breast cancer,which may be used as auxiliary indicators in diagnosing,prognosis evaluating and developing individualized treatment regimen.
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28. Clinical Value of MRI Combined with Mammography in the Diagnosis of Non-tumor Breast Cancer 
DAI Lijuan,SHI Gaofeng,YANG Li,LI Min,ZHOU Yan
Chinese General Practice    2019, 22 (30): 3683-3688.   DOI: 10.12114/j.issn.1007-9572.2019.00.516
Abstract573)      PDF(pc) (1855KB)(1065)    Save
Background Non-tumor breast cancer does not have typical characteristics of breast cancer,and the detection rate in its early screening is lower than that in mass-type breast cancer.Objective To explore the value of MRI combined with mammography in the diagnosis of non-tumor breast cancer.Methods From January 2015 to July 2016,82 female patients who met the clinical criteria for palpation and mammography in the Fourth Hospital of Hebei Medical University were diagnosed as non-tumor breast lesions,and they were recruited as research subjects and divided into the malignant group and the benign group according to postoperative pathological results as the gold standard.The results of MRI and mammography were compared between the two groups.The sensitivity,specificity and accuracy of MRI and mammography based on BI-RADS classification were analyzed.Then,individual analysis was performed based on the signs and parameters of MRI and mammography.Logistic regression analysis was used to establish a fitted equation for the signs and parameters of MRI combined with mammography in the diagnosis of non-tumor breast cancer.The ROC curve for the diagnosis of non-tumor breast cancer was plotted and the area under the ROC curve(AUC),sensitivity,and specificity were calculated.Results According to the postoperative pathological results,53 patients were included in the malignant group and 29 patients were included in the benign group.For the MRI examination,the ADC value of the malignant group was lower than that of the benign group,while the outflow type in the time-to-intensity curve(TIC) type and the uneven enhancement ratio in the strengthening mode were higher than those in the benign group(P<0.05).The malignant group had a higher proportion of clustered microcalcification than the benign group(P<0.05).Based on the BI-RADS classification criteria,the sensitivity of MRI for the diagnosis of non-tumor breast cancer was 81.13%(43/53),the specificity was 65.52%(19/29),and the accuracy was 75.61%(62/82).The sensitivity of mammography was 66.04%(35/53),the specificity was 72.41%(21/29),and the accuracy 68.29%(56/82).In MRI examination,the accuracy of the ADC value,TIC type,and enhancement mode were greater than 70.0%(76.30%,77.80%,and 74.39%,respectively).In mammography examination signs(focal asymmetric density,clustered microcalcification,gland architectural distortion or disorder,and mixed signs),only the accuracy of clustered microcalcification was greater than 60.0%(70.73%).The fitted equation of the combined diagnosis model was Logit(P)=-6.369×ADC value+2.580×TIC type+ 1.856×enhancement mode +1.927×clustered microcalcification.The best cut-off value for the combined diagnosis model was 0.708,the AUC value was 0.919,the sensitivity was 84.91%,and the specificity was 93.10%.Conclusion Both MRI and mammography have different deficiencies in the diagnosis of non-tumor breast cancer.Logistic regression analysis is used to fit the ADC value,enhancement mode and TIC type in MRI and clustered microcalcification in mammography.This combined diagnosis model can significantly improve the diagnostic value of non-tumor breast cancer.
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29. Development of a Breast Cancer Screening Capacity Assessment System for Primary Care Institutions
LIU Xuewei, LU Xinlin, ZHONG Xinyuan, RUAN Zhanliang, WANG Yanbo, WANG Yuan, LU Wenli
Chinese General Practice    2024, 27 (19): 2415-2420.   DOI: 10.12114/j.issn.1007-9572.2023.0057
Abstract569)   HTML2)    PDF(pc) (1917KB)(804)    Save
Background

Due to many barriers, it is difficult for primary medical institutions to ensure substantial achievements in breast cancer screening. So it is particularly important to establish a system for scientifically and effectively assessing the capacities of primary care institutions in conducting breast cancer screening.

Objective

To construct a system for assessing the capacities of primary care institutions for conducting breast cancer screening.

Methods

From September to October 2022, through literature review and group discussion, we developed an item pool of the initial version of Breast Cancer Screening Capacity Assessment System for Primary Care Institutions (BCSCASPCI) . Then we conducted an online Delphi survey between November and December 2022 using a self-developed questionnaire with a purposive sample of 21 experts for understanding their views regarding the initial version of BCSCASPCI, and the response coefficient, authority coefficient, and the Kendall's W of the survey were calculated. Finally, based on the results of the survey and a group discussion, the final version of the BCSCASPCI was determined. The Analytic Hierarchy Process was used to determine the weight coefficients of its indicators and to examine the logical consistency of indicators.

Results

All the experts returned effective questionnaires, achieving a response rate of 100.0%, and the authority coefficient was 0.812, and the Kendall's W was 0.209 (P<0.001) . The final version of the BCSCASPCI consists of 3 primary indicators (structure, process, and outcome) , 10 secondary indicators, and 56 tertiary indicators. The weight coefficients of the 3 primary indicators were 0.310 8, 0.195 8 and 0.493 4, respectively. The consistency ratios of indicators at each level were <0.100.

Conclusion

Our BCSCASPCI has proven to be highly authoritative and scientific, and is expected to provide guidance and reference for studies related to breast cancer screening capacity assessment. But the applicability and application effects of the system still needs further verification.

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30. 三阴性乳腺癌患者miR-155表达水平及其对预后的预测价值研究
段卫明1,姚利2,陶敏1*,陈子兴2
Chinese General Practice    2017, 20 (22): 2763-2767.   DOI: 10.3969/j.issn.1007-9572.2017.22.015
Abstract564)      PDF(pc) (910KB)(480)    Save
目的  探讨三阴性乳腺癌(TNBC)患者miR-155的表达水平及其对预后的预测价值。方法  选取2006年6月-2008年12月苏州大学附属第一医院病理科存档的10%甲醛溶液固定和石蜡包埋的TNBC术后标本72例。收集患者病理资料和随访数据,采用实时定量聚合酶链反应(RTQ-PCR)测定miR-155表达水平,采用免疫组织化学二步法测定Ki-67表达水平。采用受试者工作特征(ROC)曲线分析miR-155、Ki-67对TNBC患者术后复发的预测价值。结果  72例患者的中位miR-155相对表达量为0.899(1.236)。以该中位数为截断值,将患者分为miR-155高表达组和低表达组,不同年龄、肿瘤分级、临床分期、Ki-67表达水平及是否绝经、是否有淋巴结转移患者的miR-155表达情况比较,差异无统计学意义(P>0.05)。术后3年复发患者25例(34.7%),复发患者miR-155表达水平高于未复发者,差异有统计学意义(P<0.05)。miR-155、Ki-67预测TNBC患者术后复发的ROC曲线下面积(AUC)分别为0.777、0.636,miR-155和Ki-67联合预测TNBC患者术后复发的AUC为0.829。结论  术后复发TNBC患者的miR-155表达水平高于未复发患者,miR-155可能是预测TNBC术后复发的有效标志物。
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31. Prognostic Impact of Dapagliflozin in Elderly Breast Cancer Survivors with Heart Failure with Preserved Ejection Fraction and Type 2 Diabetes
YANG Chen, CHEN Tong, ZHANG Lifang, ZHANG Hongxu, LI Pengfei, ZHANG Xuejuan
Chinese General Practice    DOI: 10.12114/j.issn.1007-9572.2024.0326
Online available: 2025-03-31

32. 乳腺癌术后淋巴水肿预防行为相关临床实践指南现况及内容研究
王惠雪,李惠萍*,杨娅娟,苏丹,张婷
Chinese General Practice    2017, 20 (6): 639-644.   DOI: 10.3969/j.issn.1007-9572.2017.06.002
Abstract552)      PDF(pc) (817KB)(627)    Save
目的  对国内外乳腺癌术后淋巴水肿预防行为相关临床实践指南内容进行总结分析,为构建适合我国的乳腺癌术后淋巴水肿预防行为临床实践指南提供参考。方法  2016年6月,通过计算机检索得到乳腺癌术后淋巴水肿预防行为相关临床实践指南,以纳入的相关临床实践指南为分析单位,提取相关的文献指南内容,根据内容提取主题。结果  共纳入4篇英文临床实践指南和1篇中文临床实践指南,其中仅有1篇尚未更新。最终析出16条涉及淋巴水肿预防行为的推荐意见,按照提及频次由高到低前4项内容依次是:锻炼(5次)、压缩服装的使用(4次)、感染(蜂窝织炎)的处理(4次)、皮肤护理(4次)。结论  国内关于乳腺癌术后淋巴水肿预防行为的指南和规范较少,研究人员应结合我国的实际情况,构建适合本土的针对乳腺癌术后淋巴水肿预防行为的临床实践指南。
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33. Ultrasonic Features of Invasive Ductal Carcinoma and Its Molecular Subtypes in Young Women 
吕琪,吴军刚,贾春梅,陈菲,王婧婕,胡田
Chinese General Practice    2020, 23 (3): 358-362.   DOI: 10.12114/j.issn.1007-9572.2019.00.491
Abstract518)      PDF(pc) (1871KB)(977)    Save
Background By comparatively analyzing breast cancer epidemics at home and abroad,we found that the average timing of breast cancer in China is 5-10 years earlier than that in western countries.And breast cancer in young women is more aggressive,resulting poorer prognosis.At present,there are few reports on imaging studies of breast cancer in young women.Objective To explore the ultrasonographic features of invasive ductal carcinoma and its molecular subtypes in young women.Methods Participants were 249 cases of invasive ductal carcinoma recruited from First Hospital of Shanxi Medical University from September 2014 to July 2018,all were female,aged 22 to 75 years old,undergoing preoperative breast ultrasonography,and receiving definite diagnosis by postoperative pathological examination.Ultrasonographic data were collected,including the maximum diameter,shape,aspect ratio,bounder,margin,internal echo,calcification,posterior echo,and blood flow,and were compared between the young group(91 cases,≤35 years old) and middle-aged and elderly group(158 cases,>35 years old).According to the immunohistochemical determination results of estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor receptor 2(HER2) and Ki-67,invasive ductal carcinoma in the young group was divided into Luminal A,Luminal B,HER2-enriched,and basal-like molecular subtypes,and the ultrasonographic features of the subtypes were compared.Results There were significant differences in maximum diameter,internal echo,calcification and posterior echo of the carcinoma between young and middle-aged and elderly groups (P<0.05).The numbers of Luminal A,Luminal B,HER2-enriched,and basal-like molecular subtypes of invasive ductal carcinoma in young group were 6,53,22,and 10,respectively.These four subtypes showed significant differences in the shape,boundary,internal echo and calcification(P<0.05).Higher percentages of Luminal B and HER2-enriched subtypes were found with calcification compared with other two subtypes(P<0.05).Conclusion Ultrasound images of invasive ductal carcinoma in young women were characterized by large maximal diameter,uneven internal echo,and often accompanied with calcification,and less posterior echo attenuation.And the ultrasound features were related to their molecular subtypes.
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34. 超声心动图与心电图对乳腺癌患者综合治疗后心脏损伤的评估
赵静,陈晨
Chinese General Practice    2015, 18 (35): 4313-4316.   DOI: 10.3969/j.issn.1007-9572.2015.35.010
Abstract509)      PDF(pc) (586KB)(480)    Save
背景与目的  心功能检查主要用于冠心病、高血压等疾病的诊断及随访,但在恶性肿瘤治疗中心脏功能的损伤已经日益受到关注,故近年来心功能检查在肿瘤患者中的应用也越来越多。本研究旨在观察乳腺癌综合治疗后超声心动图及心电图的变化,探讨两者对乳腺癌综合治疗后心脏损伤的评估价值。方法  回顾性分析复旦大学附属肿瘤医院2010年7月-2012年7月收治的160例乳腺癌患者的心电图和超声心动图检测结果,根据治疗方式分为化疗组(75例)、放疗组(45例)及靶向治疗组(40例),比较3组治疗前后超声心动图和心电图检测结果,分析各治疗方式对患者心脏的影响。结果  治疗后,3组心率(HR)和校正后的心室复极时间(QTc)比较,差异均有统计学意义(P<0.05),化疗组及靶向治疗组的HR和QTc与治疗前比较,差异均有统计学意义(P<0.05)。治疗后,3组左心室射血分数(LVEF)、左心室短轴缩短率(FS)、左房室瓣舒张早期最大峰值速度(E峰)比较,差异有统计学意义(P<0.05);左房室瓣舒张早期最大峰值速度与舒张晚期最大峰值速度比值(E/A)、舒张早期左房室瓣环组织速度(Ea峰)、舒张早期左房室瓣环组织速度与晚期左房室瓣环组织速度比值(Ea/Aa)比较,差异无统计学意义(P>0.05)。治疗后化疗组、靶向治疗组超声心动图指标与治疗前比较,差异均有统计学意义(P<0.05);治疗后放疗组LVEF、Ea峰、Ea/Aa与治疗前比较,差异有统计学意义(P<0.05),其余指标间差异无统计学意义(P>0.05)。结论  化疗、放疗、靶向治疗后乳腺癌患者的心功能均有变化。从超声心动图及心电图结果分析,放疗对心功能的影响较小,化疗及靶向治疗影响较大,且两者差异不明显,靶向治疗对心脏的收缩功能影响较大。
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35. Effects of Dioscin on the Growth of Tamoxifen-resistant Breast Cancer Cells 
CHEN Haiyan,DING Xiaoqing
Chinese General Practice    2019, 22 (29): 3570-3575.   DOI: 10.12114/j.issn.1007-9572.2019.00.270
Abstract507)      PDF(pc) (1404KB)(593)    Save
Background Tamoxifen is a main drug used for endocrine treatment of breast cancer.It is difficult to treat breast cancer resistant to tamoxifen,and new treatments are needed urgently.Diosgenin(Dio) can inhibit the growth of cancer to some extent.Studying the effect of Dio on the growth of tamoxifen-resistant(TAM-R) breast cancer cells can provide a reference for clinical treatment.Objective To study the effects of Dio on the growth of TAM-R breast cancer cells.Methods From January 2017 to June 2018,TAM-R breast cancer cells were cultured.Corresponding experiments were carried out on cell growth and apoptosis,autophagy and apoptotic markers,and anti-cancer proteins.The details are as follows:automated cell counters were used to count the number of TAM-R breast cancer cells in six groups(control,Dio 0.625 μg/ml,Dio 0.800 μg/ml,Dio 1.000 μg/ml,Dio 1.250 μg/ml and Dio 2.500 μg/ml) after being treated by different doses of Dio for five days,and to measure the apoptosis of TAM-R breast cancer cells in 6 groups(control,TAM 10-7 mol/L,Dio 1 μg/ml,Dio 2 μg/ml,TAM 10-7 mol/L+Dio 1 μg/ml,and TAM 10-7 mol/L+Dio 2 μg/ml) treated with different doses of TAM and Dio for three days.Immunoblotting was used to detect the effects of different doses of Dio on TAM-R autophagy markers LC3 and Beclin-1,and apoptotic markers Bax,Bim,pAMPK and p53 proteins in four groups(control,Dio 0.80 μg/ml,Dio 1.25 μg/ml,and Dio 2.50 μg/ml).Autophagy of TAM-R breast cancer cells treated with Dio and its inhibitors and inducers in six groups(control,Rapamycin 20 nmol/L,Chloroquine 10 μmol/L,TAM 10-7 mol/L,Dio 1 μg/ml,and TAM 10-7 mol/L+Dio 1 μg/ml) was observed by autophagic fluorescence microscopy.Results The number of TAM-R breast cancer cells differed significantly across different groups (P<0.05).To be specific,the control group had much less TAM-R breast cancer cells than Dio groups(P<0.05).The number of apoptotic TAM-R breast cancer cells varied obviously across different groups(P<0.05).Specifically,the control group showed much less apoptotic TAM-R breast cancer cells than other five groups(P<0.05).Moreover,TAM 10-7 mol/L+Dio 2 μg/ml group showed significantly less TAM-R breast cancer cells than Dio 2 μg/ml group(P<0.05).The expressions of LC3,Beclin-1,Bax,Bim,pAMPK and p53 varied significantly across the groups (P<0.05).Fluorescence microscopy showed that autophagic activity level of TAM 10-7 mol/L + Dio 1 μg/ml group was higher than that of Dio 1 μg/ml group and TAM 10-7 mol/L group.Conclusion Dio could inhibit the growth of TAM-R breast cancer cells,and strengthen the growth inhibition and apoptosis enhancement effects of TAM on such cells.Moreover,both autophagy and apoptotic marker proteins were also influenced.
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36. Breast Cancer Prevention and Control Process Based on General Hospital-Community Collaboration Model
CHEN Ge,ZHU Ji,MA Qia-yi,BI Fang-fang,WANG Jie,LI Li,TAN Yu-ting,WANG Lei
Chinese General Practice    2018, 21 (19): 2291-2296.   DOI: 10.12114/j.issn.1007-9572.2018.00.006
Abstract506)      PDF(pc) (1498KB)(456)    Save
Objective To construct a complete,standardized and patient-centered breast cancer prevention and control process based on general hospital-community collaboration model with clear division of labor at all levels of medical institutions through integrating and optimizing the commonly used breast cancer screening tools and based on the foundation of regional family doctor contracted service.Methods Through literature review,the current guidelines for breast cancer prevention and control at home and aboard were summarized.And then expert consultation method,brainstorming method and flow chart method were used to build the breast cancer prevention and control process.Results The prevention and control process of breast cancer mainly consisted of three steps.Step 1:To build residents' awareness of cancer prevention through the health education from community general practitioners.Step 2:Gail-2 risk assessment and clinical breast examination were carried out by community general practitioners to screen out high-risk groups of breast cancer,and these high-risk residents were transferred to higher level of medical institutions.Step 3:Breast cancer was diagnosed and treated through mammography and other breast-related examination performed by specialists in general hospitals,and a rehabilitation prescription was issued.Conclusion The establishment of breast cancer prevention and control process could enable the implementation of clinical guidelines for breast cancer and form a practical and feasible plan of breast cancer focusing on patient as the center with the reasonable division of labor among general hospital specialists and community general practitioners.It also completed the entire process from the early detection and early diagnosis to early treatment of breast cancer,avoiding the waste of medical resources because of multiple examinations and visits.At the same time,it could improve the ability of general practitioners in the clinical examination and control of breast cancer.
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37. Effect of 5-ALA Mediated Photodynamic Therapy Combined with Lapatinib on Breast Cancer Cell:a Potential Strategy to Improve HER2-positive Breast Cancer Therapeutic Efficacy 
SUN Bei,ZHANG Li,LIU Xiaodong,TONG Zhongsheng
Chinese General Practice    2019, 22 (21): 2551-2556.   DOI: 10.12114/j.issn.1007-9572.2019.00.165
Abstract494)      PDF(pc) (2336KB)(553)    Save
Background Photodynamic therapy(PDT)has a good therapeutic effect on proliferative diseases,and it shows high efficiency and small toxic and side effects in anti-tumor treatment.Lapatinib(LAP)is an oral tablet,which mainly acts on human epidermal growth factor receptor 1 and 2(HER1 and HER2),and belongs to double-targeted receptor tyrosine kinase inhibitors.However,the synergistic effect of PDT and LAP is still not clear.Objective To investigate the inhibitory effect and mechanism of PDT with a novel photosensitizer,5-aminolaevulinic acid(5-ALA)on HER2 positive breast cancer cells SKBR3,and to discuss the therapeutic effect of PDT with LAP on HER2-positive breast cancer,providing evidence for the treatment and research of HER2 positive breast cancer.Methods This study was conducted from May 2016 to December 2017.SKBR3 cells were randomly divided into blank control group(without intervention),LAP group〔intervened with LAP of different concentration gradients(0.50,1.00,2.00,5.00,10.00 μmol/L)〕and PDT group〔first intervened with 5-ALA of different concentration gradients(0.25,0.50,1.00,2.00,4.00 mmol/L),then were exposed to laser〕,LAP+PDT group〔first intervened with different concentration gradients of LAP(0.50,1.00,2.00,5.00,10.00 μmol/L),then with different concentration gradients of 5-ALA(0.25,0.50,1.00,2.00,4.00 mmol/L),and later were exposed to laser〕,respectively.Half maximal inhibitory concentration(IC50)of LAP and 5-ALA was calculated,respectively,and their optimal concentrations for LAP,PDT and LAP+PDT subgroups were determined.Cell growth inhibition rates in each group at 24,48 hours after intervention with the optimal concentration were estimated and compared.SKBR3 cells in the log-phase of growth were randomly divided into blank control group(without intervention),LAP group(intervened with 1.00 μmol/L LAP),PDT group(intervened with 1.00 mmol/L 5-ALA,followed by laser irradiation),LAP+PDT group(intervened with 1.00 μmol/L LAP,then 1.00 mmol/L 5-ALA,followed by laser irradiation).Flow cytometry was used to detect the apoptotic status of each group.In addition,fluorescence intensity of green fluorescent protein and mitochondrial membrane potential were detected by Rhodamine 123,and the expression of HER2 was detected by Western blotting.Results The IC50 of LAP was 1.65 μmol/L,and 1.00 μmol/L(the growth inhibition rate of LAP group was 40.12%)was chosen as the administration concentration of LAP and LAP+PDT groups.The IC50 of 5-ALA was 1.57 mmol/L.The administration concentration of 5-ALA in PDT and LAP+PDT groups was determined as 1.00 mmol/L(the growth inhibition rate of PDT group was 41.23%).When LAP was 1.00 mmol/L and 5-ALA was 1.00 μmol/L,the growth inhibition rate of LAP+PDT group was 79.71%.Combined treatment Q≈1.23.The growth inhibition rates of LAP,PDT and LAP+PDT groups at 24 and 48 hours were higher than those of blank control group(P<0.05);the growth inhibition rates of PDT group at 48 hours were higher than those of LAP group(P<0.05);the growth inhibition rates of LAP+PDT group at 24 and 48 hours were higher than those of LAP group and PDT group(P<0.05).Compared with the blank control group,the cells in LAP and PDT groups mainly manifested as apoptosis,while those in LAP + PDT group showed obvious apoptosis and necrosis,and the proportion of early apoptosis was very low.The fluorescence intensity of green fluorescent protein in LAP and PDT groups decreased,and that of LAP + PDT group decreased most obviously.Mitochondrial membrane potential in LAP,PDT and LAP + PDT groups was lower than that in blank control group(P<0.05);mitochondrial membrane potential in PDT group and LAP + PDT group was lower than that in LAP group(P<0.05);mitochondrial membrane potential in LAP + PDT group was lower than that in PDT group(P<0.05).The expression of HER2 in blank control group was higher than that of other groups(P<0.05),and it in LAP group was higher than that of PDT and LAP + PDT groups,too(P<0.05),and similar status was found when compared HER2 in PDT group with that of LAP + PDT group(P<0.05).Conclusion 5-ALA had obvious inhibitory effect on SKBR3 cells,and the inhibitory effect became stronger when PDT was used in combination with LAP.The mechanism is related to the reduction of mitochondrial membrane potential and the expression of HER2 in cancer cells.Therefore,PDT combined with LAP is expected to improve the quality of life and survival rate of HER2-positive breast cancer patients,and has a good application prospect.
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38. 白介素1受体相关激酶1在乳腺癌紫杉醇耐受患者治疗中的作用机制研究
施华球*,谢瑞莲
Chinese General Practice    2017, 20 (2): 165-171.   DOI: 10.3969/j.issn.1007-9572.2017.02.009
Abstract486)      PDF(pc) (720KB)(459)    Save
目的 探讨白介素1受体相关激酶1(IRAK1)在乳腺癌紫杉醇耐受患者治疗中的作用机制。方法 选取2013年5月-2015年9月赣南医学院第一附属医院肿瘤科收集的乳腺组织(对照)及乳腺癌组织,其中对照女性16例,Basal-like型乳腺癌患者38例,Luminal-A型乳腺癌患者25例,Luminal-B型乳腺癌患者31例,HER2过表达型乳腺癌患者31例,三阴乳腺癌患者58例。取对照乳腺组织及乳腺癌组织,采用实时荧光定量PCR(qPCR)检测IRAK1 mRNA的相对表达水平,采用酶联免疫吸附试验(ELISA)法检测炎性因子白介素(IL)-6、IL-8和CXC趋化因子配体1(CXCL-1)表达水平。培养乳腺癌细胞株HMEC、MCF7、MB415、MB436、MB468、BT549、SUM159,采用体外低浓度梯度递增联合大剂量间断冲击方法诱导乳腺癌细胞株产生紫杉醇耐受性,检测未经处理的细胞株和紫杉醇耐受细胞株IRAK1 mRNA相对表达水平。经shRNA或空白序列NC-shRNA转染紫杉醇耐受乳腺癌细胞株,采用qPCR检测增殖相关基因细胞周期蛋白(Cyclin)D1、增殖细胞核抗原(PCNA)和Cyclin A相对表达水平,凋亡相关基因p53、c-myc、Bcl-2、c-erb-2相对表达水平,迁移相关基因Cullin 1、Bcl-6和KLF6相对表达水平,采用ALDEFLUOR实验检测醛脱氢酶(ALDH)活性。结果 各类型乳腺癌紫杉醇耐受患者IRAK1 mRNA相对表达水平均高于不耐受患者(P<0.05),三阴乳腺癌紫杉醇耐受患者IRAK1 mRNA相对表达水平均高于其他类型乳腺癌紫杉醇耐受患者(P<0.05)。对照者及各类型乳腺癌紫杉醇耐受患者IL-6、IL-8、CXCL-1表达水平比较,差异均有统计学意义(P<0.05)。紫杉醇耐受的各乳腺癌细胞株IRAK1 mRNA相对表达水平均高于未经紫杉醇处理的细胞株(P<0.05)。经shRNA转染的紫杉醇耐受的各乳腺癌细胞株Cyclin D1、PCNA、Cyclin A相对表达水平均低于经NC-shRNA转染的各乳腺癌细胞株,p53、c-myc、Bcl-2、c-erb-2相对表达水平均高于经NC-shRNA转染的各乳腺癌细胞株,Cullin 1、Bcl-6相对表达水平、ALDH活性均低于经NC-shRNA转染的各乳腺癌细胞株,KLF6相对表达水平高于经NC-shRNA转染的各乳腺癌细胞株(P<0.05)。结论 IRAK1在紫杉醇耐受的乳腺癌细胞,尤其是三阴乳腺癌细胞中发挥重要作用。抑制IRAK1表达可显著降低乳腺癌细胞的增殖和迁移能力,诱导癌细胞凋亡,IRAK1抑制剂可用于乳腺癌尤其是三阴乳腺癌的治疗。
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39. 不同分子类型乳腺癌骨形态发生蛋白6表达的临床意义
丁梅,胡芬,王增辉,杨艳玲,马振玲,李宗富,李润华
Chinese General Practice    2016, 19 (11): 1305-1309.   DOI: 10.3969/j.issn.1007-9572.2016.11.016
Abstract462)      PDF(pc) (681KB)(383)    Save
目的   探讨不同分子类型乳腺癌患者骨形态发生蛋白6(BMP-6)表达情况及其与临床病理特征的关系。方法  选取2013年1月-2015年3月在唐山市协和医院普外科接受手术并经病理证实的女性乳腺癌患者426例,其中Luminal A型149例,Luminal B型97例,表皮生长因子受体2(Her-2)阳性型72例,Basal-like型108例。采用实时荧光定量反转录PCR检测不同分子类型乳腺癌BMP-6 mRNA表达情况,采用免疫组织化学染色法检测不同分子类型乳腺癌BMP-6表达情况,并对不同分子类型乳腺癌患者临床特征进行比较。结果  不同分子类型乳腺癌组织BMP-6 mRNA表达水平比较,差异有统计学意义(P<0.05);其中Basal-like型BMP-6 mRNA表达水平低于Luminal A型(P<0.05)。不同分子类型乳腺癌组织BMP-6 mRNA表达水平均低于癌旁组织(P<0.01)。不同分子类型乳腺癌组织BMP-6表达水平比较,差异有统计学意义(χ2=19.01,P=0.02);其中Luminal A型阴性(-)率低于Basal-like型(χ2=5.17,P=0.002);Luminal A型强阳性(+++)率高于Basal-like型(χ2=8.84,P<0.001)。不同分子类型乳腺癌患者淋巴结转移率比较,差异无统计学意义(P>0.05);不同分子类型乳腺癌患者肿瘤最大径分布、内脏转移率比较,差异均有统计学意义(P<0.01);其中Basal-like型内脏转移率高于Luminal A型(χ2=14.71,P<0.001)。结论  BMP-6在不同分子类型乳腺癌中的表达具有差异性,临床或可对不同类型的乳腺癌患者采取不同的BMP-6治疗方案。
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40. Risk Factors for Endometrial Lesions Detected by Hysteroscopy in Breast Cancer Patients Taking Tamoxifen
LI Yujing, JIN Yichao, CHEN Xing, JI Mengying, DAI Huihua
Chinese General Practice    2023, 26 (32): 4026-4030.   DOI: 10.12114/j.issn.1007-9572.2023.0161
Abstract453)   HTML23)    PDF(pc) (850KB)(287)    Save
Background

Breast cancer has become the most common malignant tumor threatening the health of Chinese women in recent years. The use of tamoxifen (TAM) has successfully reduced the recurrence and progression of estrogen receptor-positive breast cancer, however, it also increases the risk of endometrial lesions.

Objective

To explore the risk factors for endometrial lesions in breast cancer patients taking TAM, determine the optimal threshold value of endometrial thickness, and improve the positive detection rate of hysteroscopy.

Methods

Breast cancer patients taking TAM (20 mg/d) who underwent hysteroscopic endometrial biopsy admitted to the Department of Gynecology of the First Affiliated Hospital with Nanjing Medical University from January 2015 to January 2022 were retrospectively selected as the study objects and divided into the negative hysteroscopic endometrial biopsy group (normal endometrium) and positive hysteroscopic endometrial biopsy group (endometrial lesions including endometrial polyps, endometrial hyperplasia without atypia, endometrial atypical hyperplasia and endometrial carcinoma). Clinical data of the patients were collected, including age, BMI, history of hypertension and diabetes, delivery times, presence of menopause and abnormal uterine bleeding/postmenopausal bleeding (AUB/PMB), receiving of chemotherapy, duration of TAM treatment, use of gonadotropin-releasing hormone agonists (GnRH-a), endometrial thickness, echo features of intrauterine lesions. Multivariate Logistic regression analysis was used to explore the risk factors for endometrial lesions in breast cancer patients taking TAM. The receiver operating characteristic (ROC) curve of endometrial thickness for predicting endometrial lesions detected by hysteroscopy was plotted, and the area under the ROC curve (AUC) and its 95%CI were calculated to determine the optimal cut-off value of endometrial thickness for receiving hysteroscopic surgery.

Results

The proportion of patients with AUB/PMB, duration of TAM treatment≥24 months, intrauterine hyperechoic lesions and endometrial thickness in the positive hysteroscopic endometrial biopsy group were higher than those in the negative hysteroscopic endometrial biopsy group (P<0.05). Multivariate Logistic regression analysis showed that AUB/PMB〔OR=7.731, 95%CI (1.949, 30.699), P=0.004〕, endometrial thickening〔OR=1.223, 95%CI (1.091, 1.371), P=0.001〕 and intrauterine hyperechoic lesions〔OR=13.383, 95%CI (2.751, 65.103), P=0.001〕were independent risk factors for endometrial lesions detected by hysteroscopy in breast cancer patients taking TAM. The AUC of endometrial thickness for predicting endometrial lesions detected by hysteroscopy in breast cancer patients taking TAM was 0.753〔95%CI (0.638, 0.868), P<0.001〕, with the Youden index of 0.54, optimal cut-off value of 9.15 mm, sensitivity and specificity of 0.755 and 0.786, respectively.

Conclusion

The risk of endometrial lesions is increased in breast cancer patients taking TAM with AUB/PMB, endometrial thickness≥9.15 mm suggested by ultrasound and intrauterine hyperechoic lesions, when the hysteroscopy and endometrial biopsy should be actively considered.

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