乳腺癌术后乳房缺损患者心理健康状况与社会支持度调查分析

目的：调查乳腺癌术后乳房缺损患者心理健康状况与社会支持度情况,探讨二者之间的相关性。方法：应用症状自评量表（SCL-90）和社会支持评定量表（SSRS）对2009年1月～2010年12月在乐山市人民医院肿瘤科治疗的54例乳腺癌术后乳房缺损患者进行问卷调查,对结果进行统计学分析。结果：本组乳腺癌术后乳房缺损患者整体心理健康状况较国内常模差（P〈0．05）;不同社会支持的患者之间的心理健康状况差异具有统计学意义（P〈0．05）;SCL-90总均分与社会支持总分和客观支持呈负相关;人际关系敏感和社会支持总分、主观支持呈负相关;抑郁和社会支持总分、主观支持、客观支持呈负相关;焦虑和社会支持总分、主观支持呈负相关（P〈0．05）。结论：乳腺癌术后乳房缺损患者的心理健康状况与社会支持度密切相关,良好的社会支持可以改善乳腺癌术后乳房缺损患者的心理健康状况。     

乳腺癌患者260例心理健康状况调查

 目的　研究乳腺癌患者心理健康状况以及社会支持等因素对其康复的影响。方法　采用人口学特征调查表、症状自评量表（SCL-90）、社会支持评定量表对260例乳腺癌患者进行问卷调查。结果　乳腺癌患者心理健康水平低于健康人,情绪变化明显。乳腺癌患者能获得较好的社会支持,其中城市患者获得的社会支持好于农村患者,差异有统计学意义（t＝7.91,P＝0.000）。SCL-90总分以及强迫症状、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执、精神病性等因子与社会支持呈负相关（r值分别为-0.278、-0.259、-0.165、-0.294、-0.215、-0.177、-0.175、-0.167、-0.219,P值均＜0.05）。结论　社会支持程度的高低影响乳腺癌患者的心理健康,故应给予患者较好的社会支持以提高其心理健康水平,促进其康复。     

肺癌患者亲属焦虑状况与社会支持的相关性

目的观察肺癌患者亲属的焦虑与社会支持状态,并探讨两者之间的相关性。方法选取2013年3月至2014年9月间接受治疗的肺癌患者的亲属126名,运用焦虑自评量表(SDS)及社会支持量表(SSRS)进行心理健康及社会支持进行测定,并分析两者的相关性。结果肺癌患者亲属的焦虑得分为(35.46±4.12)分,高于国内常模(t=12.46,P<0.05);社会支持总分及各维度分值与国内常模比较,差异均有统计学意义(t值分别为8.42、-5.05、5.23、-6.35,P<0.05);焦虑评分与客观支持、主观支持和对支持的利用度均呈负相关(P<0.05)。结论肺癌患者亲属存在较高的焦虑情绪,其与社会支持水平密切相关,应采取相关措施来改善这一状况。     

乳腺癌化疗患者社会支持与创伤后成长的相关性研究

目的探讨乳腺癌化疗患者创伤后成长和社会支持状况及两者之间的联系。方法选取2016年2月至2017年3月间中国医学科学院北京协和医学院肿瘤医院收治的160例乳腺癌化疗患者,采用一般情况调查表、创伤后成长量表和社会支持量表对患者进行问卷调查。探讨乳腺癌化疗患者创伤后成长和社会支持状况及两者之间的联系。结果乳腺癌化疗患者创伤后成长总分为(68.98±19.31)分,5个维度中人际关系得分最高;社会支持总分(42.48±6.37)分高于国内常模,差异有统计学意义(P<0.05)。社会支持总分和创伤后成长总分呈一定正相关,差异有统计学意义(P<0.01)。结论乳腺癌化疗患者社会支持较好,创伤后成长处于中等水平,有待进一步提高,可通过提高乳腺癌患者社会支持度,更好地促进患者创伤后成长。     

乳腺癌患者自我概念水平与家庭环境状况调查及分析

目的:研究乳腺癌患者自我概念水平和家庭环境状况,探讨二者之间的相应关系。方法:选取社区乳腺癌患者60例作为研究组,同期选取与研究组相匹配的60名正常人群作为对照组,采用自我概念评定量表(TSCS)和家庭环境评定量表(FES-CV)测评两组患者自我概念水平和家庭环境状况,将结果进行统计学处理,分析二者相关性。结果:两组TSCS评比,研究组除自我批评因子得分明显高于对照组外(P<0.01),其余9个因子得分均低于对照组(均P<0.01);两组FES-CV评比,研究组除矛盾性维度评分明显高于对照组外(P<0.01),其余9个维度得分均明显低于对照组(均P<0.01)。自我批评与矛盾性呈高度正相关(P<0.01),与亲密度等9个维度呈高度负相关(P<0.01或P<0.05);心理自我、自我满意、伦理自我、自我认同、自我总分、家庭自我、生理自我、社会自我以及自我行动与矛盾性呈高度负相关(P<0.01或P<0.05)。结论:乳腺癌患者自我概念水平和家庭环境状况低于正常人群,自我概念水平的高低受家庭环境的影响。要塑造乳腺癌患者积极的自我概念,提升心理健康水平,在做好对患者本人心理治疗的同时,亦必须做好对家庭康复环境的干预。     

乳腺癌放疗患者疾病不确定感与社会支持的关系评价

目的 探讨乳腺癌放疗患者疾病不确定感与社会支持的关系.方法 随机抽取100例接受放射治疗的乳腺癌患者的临床资料.对患者进行问卷调查,共发放问卷100份,回收问卷100份,回收率为100.00％.观察患者疾病不确定感、社会支持状况、疾病不确定感和社会支持的相关性.结果 患者疾病不确定感的平均得分为(82.91±8.32)分.患者社会支持总平均得分低于国内常模分值,差异有统计学意义(P＜0.05).患者疾病不确定感总分、与疾病相关信息缺乏或不一致性与社会支持呈负相关,患者不明确性、复杂性与社会支持总均分、客观支持、对支持的利用度呈负相关,不可预测性与社会支持及其三个维度无相关性.结论 护理人员需注重乳腺癌患者疾病不确定感和社会支持,减少患者的疾病不确定感,提高社会支持.     

老年前列腺癌患者主观幸福感与社会支持的相关性研究

目的 探讨老年前列腺癌患者主观幸福感、社会支持状况及两者的相关性。方法 采用自制的一般情况调查表、幸福感指数量表及社会支持评定量表,对2014年8月至2015年8月收治的200例住院老年前列腺癌患者进行问卷调查。结果 老年前列腺癌患者的主观幸福感总分为（7.05±3.48）分,社会支持总分为（28.75±4.37）分。不同病程、文化程度、婚姻状况及住院次数患者的主观幸福感总分、社会支持总分差异有统计学意义（P＜0.05）;社会支持总分及主观支持、客观支持、社会支持利用度的得分与主观幸福感总分、总体情感指数得分、生活满意度得分两两间均存在一定相关性（P＜0.001）,其中社会支持总分与主观幸福感总分呈高度相关（r=0.834,P＜0.001）。结论 老年前列腺癌患者主观幸福感与社会支持均较低,两者呈高度相关。应注意加强对老年前列腺癌患者的社会支持,帮助建立良好的社会支持系统,以提高主观幸福感。     

住院癌症患者社会支持与生活质量关系的研究

目的:探讨住院癌症患者社会支持与生活质量的关系.方法:采用自编一般情况问卷、社会支持评定量表和生活质量量表对80例住院癌症患者进行测量.结果:住院癌症患者的社会支持水平普遍较高(42.25±7.48),在客观支持上存在性别差异,男性的客观支持高于女性;有配偶的患者的社会支特明显高于无配偶的患者,并且主要表现在主观支持上.社会支持总分和主观支持都与功能领域、躯体功能、认知功能、总体健康状况呈正相关,与症状领域呈负相关,P值均＜0.05.客观支持与躯体功能呈正相关,与症状领域负相关,P值均＜0.05.对支持的利用度与功能领域、躯体功能、总体健康状况正相关,P值均＜0.05.对支持的利用度可以作为患者生活质量的一个预测变量.结论:癌症患者的社会支持与生活质量有密切关系,特别是主观支持和对支持的利用度,提高患者对支持的利用度可以提高患者的生活质量.     

乳腺癌保乳术中胸外侧筋膜皮瓣在乳房缺损修复中的应用

目的 探讨胸外侧筋膜皮瓣在乳腺癌保乳术中修复乳房缺损的应用效果.方法 回顾分析行乳腺癌保乳术的73例乳腺癌患者的临床资料,根据乳房修复方法进行分组,其中对照组35例采用背阔肌肌皮瓣移植,观察组38例采用胸外侧筋膜皮瓣移植,观察2组患者术中出血量、手术时间、术后乳房重建效果、复发率及并发症发生情况,并对患者满意度进行调查评估.结果 所有患者均成功完成手术,且术后均无肿瘤复发.2组患者手术时间、术中出血量比较,差异有统计学意义(P＜0.05);2组患者术后乳房外观比较差异无统计学意义(P＞0.05);患者对手术满意度评价,差异无统计学意义(P＞0.05);观察组术后并发症发生率低于对照组,组间差异有统计学意义(P＜0.05).结论 在乳腺癌病灶切除术中,利用胸外侧筋膜皮瓣填充乳房缺损部位能够明显缩短手术时间,降低术后并发症的发生率.     

直肠癌造口患者术后心理健康、应对方式与生存质量的相关性

[目的]分析直肠癌造口患者术后心理健康、应对方式的特点和生存质量,探讨三者之间的关系.[方法]选取直肠癌造口手术患者150例,采用症状自评量表(SCL-90)、癌症患者生存质量核心量表(EORTC QLQ-C30)、和医学应对问卷(MCMQ)分别测评患者的心理健康状况、生存质量状况和应对方式.[结果]直肠癌造口患者术后SCL-90总分为179.898分,高于全国常模160分.直肠癌造口患者术后面对因子、回避因子、屈服因子得分依次降低.肠癌造口患者术后总体健康状况得分、躯体功能、角色功能、认知功能得分低于参考值;疲乏症状、睡眠困难、经济困难得分高于参考值.直肠癌造口患者术后SCL-90总分与患者总体健康状况、躯体功能、角色功能、认知功能得分呈负相关,与疲乏、睡眠困难、经济困难得分呈正相关;应对方式中,面对因子与患者总体健康状况、躯体功能、社会功能呈正相关,与疲乏、疼痛、经济困难呈负相关;回避因子与食欲下降呈正相关;屈服因子与总体健康状况、认知功能、情绪功能、社会功能呈负相关,与疲乏、疼痛、恶性呕吐、呼吸困难、睡眠困难、食欲下降、便秘、经济困难呈正相关.[结论]直肠癌造口术后患者术后存在一定的心理健康问题.健康的心理状况、多采取积极的应对方式,有助于提高患者直肠癌造口术后生存质量水平.     

The Impact of Breast Density on Breast Cancer Risk and Breast Screening

Whether measured by qualitative assessment of the parenchyma pattern or quantitatively by percent mammographic density, breast density is consistently a strong and independent risk factor for breast cancer (BC). Density is also a relatively common risk factor, and therefore an important contributor to BC risk at a population level. Including density (with other risk factors) in risk prediction models improves predictive accuracy; however, better standardization and/or automation of density measures will make the integration of breast density into risk assessment, and its application in tailored screening and primary prevention, more feasible. High breast density reduces screening sensitivity and is associated with risk of interval BC in screening; it is also associated with cancers that have poorer prognostic features. Non-randomized studies of adjunct ultrasound screening in women with mammography-negative dense breasts have provided evidence on incremental detection of BC with adjunct ultrasound and high false-positives but have not examined impact on clinical end-points, mortality, or balance of potential benefits versus harms.     

乳腺干细胞和乳腺癌

乳腺干细胞是一种未分化的细胞，具有永远增殖和自我更新能力。乳腺癌中的癌症干细胞可能起源于正常干细胞，以细胞表面标志CD44^＋/CD24^-/low识别。癌症干细胞可能为肿瘤转移和复发的原因。识别乳腺癌干细胞和普通癌症细胞之间的差异，可以发展更有效的诊断和治疗方法。     

Management of Rare Breast Tumors and Male Breast Cancer

Purpose of Review

There is very little clinical trial data available to guide the management of uncommon breast cancers. This review draws on classic and recent retrospective data to synthesize a clearer understanding of the biology and behavior of these rare tumors.

Recent Findings

Avoid disfiguring surgery in the pursuit of very wide margins for benign phyllodes tumors unless there are adverse histological features. Encapsulated papillary carcinoma is very good prognosis breast cancer; do not over treat. Metaplastic carcinoma is a basal type breast cancer that may be more responsive to “BRCA1-like” treatments. Complete excision of the capsule is curative for most implant-associated anaplastic large cell lymphomas. Aromatase inhibitors are still controversial for male breast cancer; tamoxifen is standard.

Summary

Available data are useful for guiding the treatment of rare breast cancers, but it must be recognized that there is still a great deal to be learned about each of these entities.

     

血管生成在乳腺非典型增生及癌变过程中的作用

为探讨乳腺非典型增生至癌变过程中血管生成的作用及其规律以及血管生成与非典型增生程度及癌变的关系，本研究应用免疫组化法，以ＦⅧ为标志物对８６例良、恶性乳腺病变组织中的血管内皮细胞进行组化染色。分别以微机图像分析系统和人工计数对微血管内皮细胞面积（ＭＥＡ）和微血管密度（ＭＶＤ）进行定量分析。结果发现，中重度非典型增生及癌变组织中的血管生成量ＭＥＡ和ＭＶＤ均明显高于正常乳腺、单纯上皮增生和轻度非典型增生（Ｐ＜０．０５）。结论：乳腺非典型增生过程中已有血管生成并随非典型增生程度的增加而增多；乳腺增生组织中的血管生成可反映乳腺癌前病变的恶性倾向     

A Review of Breast Density Implications and Breast Cancer Screening

Breast density is an independent risk factor for breast cancer and significantly decreases the sensitivity of mammography. Assessing a woman’s risk of developing breast cancer is becoming increasingly important for establishing individual screening recommendations and preventive strategies. This article reviews the factors influencing mammographic density (MD), the available methods of MD assessment, and its effect on breast cancer. Finally, we discuss the supplemental screening methods for women with dense breast tissue.     

Knowledge of Breast Density and Awareness of Related Breast Cancer Risk

Little is known about women’s knowledge of breast density or between-race differences in this knowledge. In the current study, we examined knowledge of breast density and awareness of its role as a breast cancer risk factor among women who had previously taken part in a breast imaging study. Seventy-seven women (54.5 % Black) returned a survey assessing perceptions and accuracy of breast density knowledge, knowledge of one’s own breast density, and breast cancer risk awareness. White women had greater perceived knowledge of breast density compared to Black women; however, differences in the accuracy of definitions of breast density were due to education. Black women were less likely to know how dense their own breasts were. Black and White women both lacked awareness that having dense breast increased breast cancer risk. The results highlight the need to disseminate information regarding breast density to women, while ensuring that the information is equally accessible to both Black and White women.     

Normal Breast Lobular Architecture in Breast Biopsy Samples From Breast Cancer Cases and Benign Disease Controls

Rodent studies suggest a relationship between lobular maturation and breast cancer risk. Human data are sparse, and were developed using whole mounts of mastectomy or mammoplasty samples, without consideration of menstrual phase in premenopausal women. We studied normal breast lobules in relation to cancer risk in 284 women, using surgical biopsy material (mean two sections and 43.2 lobular structures per subject): 167 were premenopausal; 89 with breast cancer (cases) and 78 undergoing benign breast biopsy (controls). Of 117 postmenopausal women, 67 were cases and 50 were controls. Normal lobular type was classified based on size, and was designated predominant if it constituted 60% or more of the total lobules classified. The control group showed 66% type I, 34% type II and 1% type III lobules while cases showed 69% type I, 31% type II and 7% type III structures. Predominant lobule type showed no association with cancer (p = 0.9). Postmenopausal women had a substantially higher proportion of type I lobules compared to premenopausal women, irrespective of the parity or cancer status (p < 0.001). Lobule type was not associated with menstrual phase classified by dates; however, when menstrual phase was classified using breast morphological characteristics, type I lobules were more abundant in follicular phase and type II in the luteal phase (p < 0.001). In conclusion, we did not observe a relationship between lobular architecture and breast cancer susceptibility when using smaller breast samples usually available in epidemiological studies, but these data highlight the need for menstrual phase stratification in future investigations.     

miRNA-29在正常乳腺、原发性乳腺癌及转移性乳腺癌组织中的表达意义

目的 探讨微小RNA-29 (miRNA-29)在正常乳腺、原发性乳腺癌以及转移性乳腺癌组织中的表达,并分析miRNA-29、基质金属蛋白酶-2(MMP-2)在疾病发生与进展中的作用.方法 选取286例乳腺癌患者,其中原发性乳腺癌205例,转移性乳腺癌81例,同期选取150例无乳腺疾病的健康妇女为对照组.采用RT-PCR检测miRNA-29与MMP-2表达水平.结果 三组乳腺标本中miRNA-29与MMP-2水平比较差异均具有统计学意义(P＜0.05),其miRNA-29与MMP-2表达呈负相关性,而肿瘤大小、病理分期、HER-2及ki-67均与miRNA-29表达具有密切相关性(P＜0.05).结论 miRNA-29与乳腺癌的发生、发展与转移等过程均具相关性,明确其表达水平有助于病情评估及临床治疗.     

Long-Term Psychological Sequelae of Mastectomy and Breast Conserving Treatment for Breast Cancer

Psychiatric and psychosocial adaptation to two types of treatment for primary breast cancer, modified radical mastectomy and partial mastectomy with radiotherapy, was studied five years after the primary treatment. 102 consecutive patients with pT1NOMO breast cancer were invited to follow-up which was done by standardized questionnaires. Nineteen women declined the invitation and 25 others were not included for various reasons, leaving 58 to complete the interviews. 30% of the women reported accentuated mental symptoms compared to the state before treatment, with no significant difference between the two treatment groups. Psychiatric state, marital adjustment and fear of cancer recurrence were also similar in the two groups. However, breast conserving treatment seems to preserve the woman's female identity and acceptance of body configuration. We conclude that breast conservation does not in itself prevent mental sequelae after treatment for primary breast cancer. Selective psychoprophylactic programs and reorganization of the postoperative follow-up should be tried to diminish unwanted psychological reactions.