<Oncology Frontier>: What is the advisability of screening for brain metastases both in HER2-positive and HER2-negative metastatic breast cancer patients?

　　《肿瘤瞭望》：对HER2阳性和HER2阴性转移性乳腺癌患者，进行脑转移筛查的可行性如何？

　　Dr Wong: We have noticed certain groups of patients are more at risk of developing brain metastases. One of those is the HER2 overexpression tumors. For the HER2-negative cancers， we have noticed that it is the triple-negatives (negative for ER， PR and HER2) who are at increased risk of developing brain metastases. Many clinicians feel that it is reasonable for them to screen for occult metastases in the brain with a routine MRI at the time of diagnosis. I wouldn’t say that is wrong but we don’t have strong data to prove such an approach will improve patient outcomes for disease-free survival or overall survival.  Certainly， at the recently concluded Advanced Breast Cancer Consensus Conference in Lisbon， the general consensus was no， even in the selective high-risk groups of HER2-positive or triple-negative breast cancer patients.The experts’ opinion is that we will still not recommend routine screening for brain metastases by MRI. I think it is something that we not apply across the board but select patients if we choose to screen.

　　Wong教授：我们发现部分乳腺癌患者发生脑转移的风险更大。其中一部分是HER2过表达的患者。对于HER2阴性乳腺癌患者，我们发现三阴乳腺癌患者（ER、PR和HER2均阴性）发生脑转移的风险增加。不少医生认为对于这些患者，诊断时使用MRI对潜在的脑转移病灶进行筛查是有必要的。我不敢说这种观点是错误的，但目前没有充分的数据支持这种做法可以改善患者的无肿瘤生存期和总生存期。当然，最近在里斯本闭幕的晚期乳腺癌共识会议上得出的观点是不支持这一做法的，即便对于部分高危HER2阳性患者和三阴乳腺癌患者，也不推荐进行筛查。专家的意见是仍不推荐使用MRI对脑转移进行筛查。