BREAST CANCER BASE

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Female breast cancer has become common malignancy, with the census and the importance of screening technology continues to improve, more and more breast cancer can be detected at an early stage, and to bring about transfer of risk reduction. Concepts and methods of treatment progress, in particular the new medications are constantly discovering and clinical application, adjuvant chemotherapy, hormonal therapy and biological therapy in the treatment of patients comprehensive five-year survival rate increase. After treatment of breast cancer survivors more and more concerned about their time in the treatment of the reactions and complications, and quality of life, it becomes the treatment of breast cancer another important topic.
Chemotherapy and hormonal therapy and ovariectomized so patients can reduce the level of estrogen or early menopause for the adjuvant treatment of breast cancer after reducing recurrence play a useful role, but the level of estrogen decline in many patients have adverse reactions, lead to some long-term complications.
1. Hot flashes : after menopause and the treatment of advanced breast cancer in postmenopausal patients more commonly hot flashes and symptoms of serum estrogen levels below no obvious symptoms [1], the hot flashes occurred mechanism may be part of the hypothalamus to stimulate estrogen decreased [1]. Menstrual women ovariectomized there were hot flashes 75% [3]. Tamoxifen has been in the United States for women over the age of 35 breast cancer prevention in high-risk groups use [4], but taking tamoxifen were often hot flashes, goserelin (GNRH similar agent) is no exception. With placebo-controlled, tamoxifen and / or goserelin were hot flashes flu since the report of 91% (P <0.001) [5], no adjuvant treatment of breast cancer patients there menopausal hot flashes rate of 40% [6]. Light hot flashes were about 1-2 years, but those who may continue for 20 years, and severely affected patients [7]. Alleviate hot flashes most effective way is to estrogen replacement therapy, but to raise the risk of breast cancer recurrence, so they should not be used. Non-hormone therapy such as vitamin-E, clonidine, five serotonin re-uptake inhibitors and other agents such as composite Bellergal-S (Atropa belladonna, ergotamine, phenobarbital) are effective [8]. Megestrol acetate in the treatment of hot flashes efficiency of 80%, perhaps it is combined with tamoxifen a reasonable choice, but not yet widely accepted [9].
2. Vaginal creek : perimenopausal women plagued except hot flashes, vaginal there creek, itching. As often cycle to reduce the level of estrogen; Epithelial urogenital atrophy and thinning of the vaginal mucosa and to lubricate reduce the secretion [10]. The chemotherapy or surgical castration of breast cancer patients, often affect the quality of life and sexual function. Tamoxifen can also accept the formation of menopause, the vaginal tamoxifen have estrogen-like effect, the vagina can improve the creek [11]. There is evidence of vaginal mucosa can be absorbed into the blood estrogen, thus the common local application of estrogen formulations should not be used to improve the symptoms of vaginal dryness.但有一种含雌激素的栓剂Estring（Pharmacia、Upjohn、Kalamazoo、Mi），据称阴道内使用释放缓慢，无明显吸收，也不必担心子宫内膜增生[12]，可以局部应用，然而其长期影响有待于进一步观察。 Other non-hormonal vaginal damper Replens (Warner Wellcome, Morris Plains, NJ) will improve flexibility in the vagina, PH resume, several randomized controlled trials have shown Replens the creek to alleviate vaginal intercourse pain and certain aspects of the effect [13] [14].
    3.性功能改变：乳腺癌病人诊断及首期治疗后的生存质量及性功能测量的标准工具和参考数据相对较少，GANZ等人从医学、统计、治疗及心理变化等方面建立了一个乳腺癌性健康模型，此模型中性兴趣的因素大于33%; sexual dysfunction is more than 33%; sexual satisfaction of at least 27%. Sexual interest is the contents : After the diagnosis of breast cancer with a new spouse, mental and physical health score impressive score. Sexual dysfunction include : vaginal creek, the prevalence of chemotherapy after breast cancer diagnosis for a new spouse. Meets include : equal relationship with the spouse, the spouse whether the existence of the problem [15]. Breast Board cut after cut and the whole recycling physical impression may have an advantage, but to deviate sexual function [16]. While supporting therapy on sexual function larger LINDLEY were assessed in 86 patients with chemotherapy and tamoxifen treatment after 2-5 years, found that before treatment is painful intercourse 11% after treatment was 44%, vaginal creek also rose from 19% to 54% [17], changes in sexual function in the treatment of common. While chemotherapy disorder than tamoxifen and served no adjuvant treatment of patients [18], tamoxifen after serving blood estrogen levels increase, improve vaginal creek, reducing painful intercourse [11]. Prior to assume that tamoxifen can increase levels of sex hormone-binding globulin, reduced biological activity of serum testosterone, libido negative [19], but LINDLEY test found tamoxifen on sex, affecting humans [18]. Since the symptoms of vaginal sex life greatest influence, not using ERT, the non-availability of these hormones vaginal lubricants, hydration agents, improve vaginal symptoms. GANZ others with education, the provision of sexual health and menopause symptoms counseling and drug or behavioral intervention, psychological support and other means, compared with the control group, the treatment group significantly improved sexual function [20].
4. Cardiovascular diseases : Postmenopausal women endogenous estrogen levels decline, LDL-cholesterol increased significantly, this change for at least 60 years old (50 years of age or menopause) [21]. Estrogen can HDL-cholesterol increased, LDL-cholesterol dropped; Help vascular epithelial function, also antithrombin -3; Regulation can hemodynamics, thereby preventing atherosclerosis [21]. But in the treatment of sexually-menopausal breast cancer among women, estrogen to reduce the extent of coronary heart disease risk impact was unclear. Tamoxifen for a period of two years in a randomized controlled trial found that the treatment group had LDL-cholesterol dropped by 18%, HDL-cholesterol treatment, after a decline of 7%, but decreased levels, a relatively high HDL, right coronary artery disease patients have a protective effect [22]. Long-term tamoxifen use of the risk of heart disease, remains to be studied. (Scotland, Sweden, United States) 3 tamoxifen trial proved to be lower coronary heart disease mortality [23]. Chemotherapy of the heart toxicity problem : Back in 60-70 years, it is reported anthracycline drugs can induce heart failure, particularly when large doses. Von Hoff with daunorubicin, adriamycin treatment, respectively 5613,4018 patients, with the dose increase, the incidence of heart failure increased exponentially. High-dose cyclophosphamide treatment even to hemorrhage pericarditis, these patients showed more than half of heart failure. In 1991, large-scale study found 5-fluorouracil toxicity heart rate of 3% [24]. Therefore cardiac toxicity of chemotherapy on the role should not be overlooked.
5. Osteoporosis : a skeleton of estrogen receptors, estrogen is the target organ, one can protect bone density. Postmenopausal estrogen levels decrease bone loss and an increased risk of fractures, but estrogen reduce breast cancer risk reduction, and vice versa [25]. In breast cancer survivors, chemotherapy for six months, ovarian function often diminishes, bone loss increased significantly. TAM in the treatment of breast cancer patients, postmenopausal TAM was the former anti-estrogen effect, resulting in increased bone loss [26], while the latter menopause, TAM is like estrogen, to protect bone mineral density [27]. Ganz and others to have a diagnosis of breast cancer up to 10 years to accept the different treatment of 158 breast cancer survivors of bone density and fracture analysis of the incident and found acceptable adjuvant therapy in the past 10 years the incidence of fractures were significantly higher in the treatment group [28]. Phosphate oral dicloxacillin, selective estrogen receptor modulators can reduce bone loss [29], the latter in certain organs were excited on the role, in other organs was on the inhibitory effect can prevent osteoporosis [30]. In addition, diet, exercise, adequate calcium intake have a certain effect [31] [32].
6. Cognitive Dysfunction : The study found menstrual cycle, estrogen level is high, female language function and motor skills higher; Estrogen and progesterone are high, a strong non-verbal memory [33]. Sherwin were 19 cases of recent pre-menopausal breast cancer patients receiving preoperative GnRH antagonist treatment randomly assigned to receive estrogen and placebo for 8 weeks and found that estrogen deficiency language and memory decline, but in the estrogen group again shows that estrogen on language and memory function useful, there are unspoken in the non-verbal memory [34]. Neural anatomy proved in human brain as the leaf area, hypothalamus, pituitary, hippocampal CA1 have estrogen receptors, and estrogen with neurotrophic factor coordination, enhance cholinergic of brain activity can improve cognitive function; Another can inhibit monoamine oxidase, the protection of neurotransmitters, and Cognitive the vertebral hippocampus cells can promote synapse formation [35]. For breast cancer patients after treatment, early menopause, estrogen reduced physiological menopause more rapid increase in the risk of cognitive impairment increased with Alzheimer's disease (AD) patients still do not understand the danger. The study found patients with AD estrogen levels low peer controls [35]. Poganini others to the collection of 1,163 breast cancer patients, including 710 standard serving five years of tamoxifen, and not for treatment of patients who survive, there are memory (V 3.8% 1.5% P <0.04) [36]. Chemotherapy also can affect cognitive function, in the Netherlands a random test, breast cancer patients who receive stem cell support of the high-dose chemotherapy (CEF), the control on non-chemotherapy patients, the application of neuro-psychological tests and found that more chemotherapy patients complained reduced memory and attention problems, the administration after years of therapy remains the same [37]. Another group controlled trial is the standard-dose chemotherapy (CMF program) chemotherapy patients with non-contrast, found that the chemotherapy patients include attention, processing speed, memory and visual motor function are impaired [38]. Chemotherapy-induced cognitive impairment may contribute to the neurotoxicity [37], use of CMF, CAF, the FEC different options, long-term controlled study which found help chemotherapy agent on the larger role of cognitive impairment [38].
In short, the post-operative breast cancer adjuvant therapy in reducing the recurrence of cancer patients and reduce mortality is yes, we must apply. But after adjuvant therapy can cause chronic complications, the current study focuses on how to reduce breast cancer adjuvant treatment of these adverse reactions and improve the patient's quality of life.

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