Liu Qiang, a breast specialist at Sun Yat-sen Memorial Hospital of Sun Yat-Sen University, is still saddened by the case of a second-born mother. Because the mother was "very strong", she repeatedly expressed to him, "I only hope that the child can persist until the (new born) child speaks and can listen to the child calling a mother." The "mother" finally lost the contract.

It is the first health killer that Chinese women now face today, breast cancer.

"Too poor," said Liu Qiang. "Because she is pregnant with breast cancer during pregnancy, the degree of malignancy of breast cancer during pregnancy is generally high. Cancer cells have metastasized at the time of birth, and the average survival time of patients with brain metastases is only one. year."

In fact, in cancer, breast cancer research is at the forefront of the world. In the United States, for example, with high R&D investment and high attention, the five-year survival rate of breast cancer patients in the United States reaches 90%. Two-thirds of patients get cured. In recent years, the incidence of breast cancer in the United States has been decreasing year by year.

In the end, this "killer" turned its raging battlefield to a fast-growing country like China. Director Lu Weiming, Department of Breast Surgery, the First Affiliated Hospital of Sun Yat-sen University, noted that the incidence of cancer in China is on the rise, and the absolute increase in breast cancer is the fastest and the number one threat to female patients.

"Chinese-style" breast cancer high-risk period ten years ahead of schedule

In Europe and the United States, the age of breast cancer is 55-65 years old, and China is 10 years ahead of schedule. The highest peak age is 45-55 years old. In addition to genetic factors such as family history, the rapid development of the social economy, resulting in high-stress lifestyles and poor eating habits are closely related to the incidence of breast cancer.

"Working pressure is too great." On the day of the reporter's interview, Liu Qiang's clinic came with a patient whose genetic test showed a mutation in the cancer gene. She recalled herself, “When a senior executive has only slept for a few hours a day for a few years,” this process did not take care of it, but buried the seeds of cancer latent and genetic mutations. "Now women work under pressure, fast pace, and irregular diet. These unhealthy lifestyles can affect the incidence of breast cancer." Liu Qiang said.

The scary thing is that most people lack enough awareness, not only to realize that the risk is coming, but even to help the spread of cancer.

Another pregnant breast cancer patient admitted by Liu Qiang did not find that the cancer cells had metastasized until the symptoms of headache occurred. Prior to this, she confused the swelling of the chest with the "lactosis" during lactation. She once asked the masseur to help with the massage, which promoted the spread of cancer cells.

There are also patients who have been unconscious from the beginning, and have gone to death after consciously, and have blocked their chances of survival. One patient told Liu Qiang, "The beginning is that it may be benign. Later, I felt that it was wrong. I also knew that it was wrong. I thought about it. If I died, I would die."

If urban women still have basic knowledge about breast cancer, the larger blind spot is in the vast rural areas. Liu Qiang found that the patients he encountered with large lumps often came from the countryside, lack of consciousness, and had a late visit.

Just find it earlier and it will be fine.

For professional breast surgeons, the best way to fight breast cancer can be summed up in one sentence: early detection, early treatment, and intervention before the disease worsens. The five-year survival rate after early breast cancer treatment can reach more than 92%, while the survival rate of advanced breast cancer has dropped to less than 50%.

The means of early screening is not mysterious, and the threshold is not high. According to Director Lu Weiming, women over the age of 35 are inspected every six months or every year, and the doctors have a physical examination plus a B-ultrasound. 40-55 years old, check the mammography target every 1-2 years. A larger photo of a molybdenum target for two years is enough. The screening fee for this kind of treatment, the B-ultrasound fee for the tertiary hospital is 135 yuan, and the bilateral mammography is 269 yuan. The cost of more than one hundred yuan a year can increase the probability of early diagnosis and treatment of breast cancer.

But this seems to be a simple shortcut to prevent breast cancer has not been popularized. Liu Qiang and Lu Weiming are still facing anxiety from severe patients who are referred from all over the country every day.

Consciousness or habit is the first difficulty. In the United States, one in eight people will have breast cancer in their lifetime. Therefore, American women attach great importance to breast cancer, and the awareness of regular physical examinations every year is very strong. In China, despite the increasing number of breast cancer patients in recent years, the average person still does not have such awareness. In addition, Liu Qiang believes that Chinese women are more fortunate and do not understand, and if they are lucky, they will easily be delayed and ill.

Even with enough awareness, the imbalance in medical care will be the second problem at hand.

The level of primary medical care is far behind that of first-tier cities such as Beishangguang. Professor Li Jie from the First Affiliated Hospital of Sun Yat-sen University mentioned: "Like some hospitals in our hospitals, Beijing and Shanghai, the early cureable breast cancer survival rate is basically the same as that in Europe and America. The total survival of 5 years can be Up to 90%, the biggest difference is in those places in small and medium-sized cities. On the one hand, patients in small and medium-sized cities have insufficient understanding of breast cancer. Another important aspect is that the distribution of quality medical resources in China is uneven, and the level of diagnosis and treatment is uneven."

Even if it is also the top three hospitals in the first-tier cities, the level of experience of receiving patients can also become a key point in the differentiation of medical standards. Liu Qiang mentioned that the patient who was also in the top three hospitals before, the B-ultrasound report showed that it was three levels, which means that the possibility of benign is great, and the follow-up will be fine. However, when he gave the other person a physical examination, he found that the tumor was rough, and he chose to re-examine the image and found that it was 4C, and the degree of malignancy reached more than 50%. This is still the case in the top three hospitals. The situation of primary hospitals should not be optimistic.

The limitations of artificial level, the imbalance of medical capabilities between regions and hospitals, led Lu Weiming and Li Jie of the First Affiliated Hospital of Sun Yat-sen University to seek artificial stimuli to assist breast cancer screening.

One of the starting points is the difficulty of screening for molybdenum targets. Regardless of whether it is domestic or foreign, mammography is the first choice for breast cancer screening for high-risk groups of breast cancer over 45 years old. However, Li Jie mentioned, “There are many difficulties in domestic molybdenum target screening: including the relatively small and dense breast in China, which is not conducive to the diagnosis of molybdenum target; there is a lack of good imaging doctors with sufficient qualifications in China; The human eye has a certain accuracy limit, and only sees a certain range of image resolution with a certain resolution.".

This is precisely the advantage of artificial intelligence in medicine. For example, in the screening of breast cancer based on mammography, computer vision has a natural advantage in identifying lesions that may be overlooked by the naked eye. Lv Weiming and Li Jie led the Tencent Shadow AI Imaging Cooperation Project in July this year to release the Breast Cancer Screening AI System, which has achieved remarkable results in detecting the core indicators of the lesions - the sensitivity of detecting breast calcification and malignant masses respectively 99% and 90.2%, the sensitivity and specificity of benign and malignant breast tumors reached 87% and 96% - although more clinical tests are still needed, the data itself has been obtained by Li Jie et al. Approved by a senior doctor.

Legend: Artificial intelligence identifies lesions and distinguishes between benign and malignant tumors

"The human operation has the influence of time and experience. (The interpretation of the image) will inevitably have some errors." In another academic forum in June this year, Dr. Yu Xiangyang from the Sun Yat-sen University Cancer Hospital, who also studied AI medical applications, proposed One view, "The daily image report has about 10% of errors, and most of the diagnosis errors occur in the judgment stage." The application of AI technology can solve the instability of human eye discrimination. Moreover, this AI assistant "never tires" can learn at a high speed.

Facing the "difficult old man"

Another possibility brought about by artificial intelligence is to alleviate the shortage of high-quality doctors, and thus partially cope with the problem of the imbalance of medical resources.

AI doctors are based on a large number of case training, and have been verified by top doctors in the top three hospitals, which may provide more guidance for grassroots doctors with relatively insufficient experience. Liu Qiang is particularly concerned about this. At the time of the visit, he saw that several patients were trapped in the pre-treatment, and the primary doctors failed to give a professional treatment plan, resulting in unsatisfactory disease control. "If you have artificial intelligence, he may not be able to cure a particularly heavy patient, but it is a good thing that ordinary patients can be cured."

According to Yan Kezhou, an AI scientist at Tencent's photography, the decision to use mammography to screen AI products is not good. A key factor is the number of difficult cases that it “understands”, that is, there is a wide enough “reading volume”. If AI can really help the grassroots doctors, the premise is that it has more experience and a more standardized and professional approach than the grassroots doctors. "We want the AI ​​to exceed the doctor's effect. The most important thing is to let the ordinary doctors or the people who have exhausted their life and energy can't see the difficult cases." After finding the difficult cases, please ask the experts of the top three hospitals, the disease The science cross-confirmed the diagnosis and finally entered it into the AI ​​system to allow it to iterate step by step.

This artificially cultivated AI doctor has grown rapidly. After only a few years of public beta, accumulated data, and feedback learning in more than a dozen hospitals, it took only half a year to reduce the false positive rate (FP value) of the AI ​​system to 20%. . It is foreseeable that such "exponential" growth will continue, and the vision of AI doctors will continue to broaden and grow into an excellent helper.

At the First Affiliated Hospital of Sun Yat-sen University, Guo Jie, a breast cancer patient, came to see Director Lu Weiming as usual. It has been eight years since the discovery of breast cancer in 2010. Because she found the breast-conserving surgery earlier, she only needs to review and take the medicine regularly, and she is no longer in danger.

But this will be a long-term battle. Whether it is a patient like Guo Jie, or a professional doctor in breast medicine such as Li Jie, Lu Weiming, Liu Qiang.

They are all worried about the increase in the incidence of breast cancer in China. The patient's ignorance of breast cancer leads to a delay in treatment and intervention, an increase in physical and mental pain, and even a desperation from birth to death.

One can save one more. For Lu Weiming and Li Jie who actively embrace AI and study AI technology for early screening of breast cancer, they hope that the machine can make up for the shortcomings of the people and find more accurate and help more patients.

But in the end, the improvement of women's own regular screening awareness is the fundamental way to solve the "Chinese-style" breast cancer problem.

"We really want to help the patients really, because we have seen many patients coming from the primary hospitals. The biggest tumor is 20 centimeters, just like a basketball. So we still have to call everyone to do early screening. Treatment. Artificial intelligence can play an important role in early screening, and avoid the problem of uneven distribution of quality medical resources, difficulty sinking to the grassroots level, and enable high-quality medical resources to help patients." Li Jie said.

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