《Lancet Oncology》杂志 2022年5月刊载[ May;23(5):e200.]美国 Weill Medical College of Cornell University and New York-Presbyterian Hospital,的Jonathan Knisely的来信《筛查乳腺癌脑转移。Screening for breast cancer brain metastases》（ doi: 10.1016/S1470-2045(22)00201-7.）。
吡咯替尼（pyrotinib）联合卡培他滨治疗HER2阳性乳腺癌脑转移患者的2期临床试验结果令人欣慰，乳腺癌脑转移既常见又令人担忧。新的具有中枢神经活性的系统治疗（CNS-active systemic therapies）将使许多患者受益。
值得注意的是，可能是因为没有临床试验数据将诊断无症状脑转移瘤与提高生存率联系起来，即使是对于发生脑转移瘤风险非常高的乳腺癌分子亚型，不鼓励对有颅内外转移或复发乳腺癌患者进行无症状脑转移瘤的MRI扫描（MRI scanning for asymptomatic brain metastases in patients with extracranial metastatic or recurrent breast cancer is discouraged, even for molecular subtypes of breast cancer that have a very high risk of developing brain metastases—perhaps because no clinical trial data has linked the diagnosis of asymptomatic brain metastases to improved survival.）。欧洲内科肿瘤学会指南建议对无症状的转移性HER2阳性或三阴性乳腺癌患者，只有当它会改变系统治疗建议时，才进行进行脑部成像（The European Society for Medical Oncology guidelines recommend brain imaging for asymptomatic patients with metastatic HER2- positive or triple-negative breast cancer only if it will alter systemic therapy recommendations ）。这些指南中的建议是不合时宜的（anachronistically），未能认识到早期发现脑转移瘤所带来的重要优势（fail to acknowledge important advantages that are derived from the early detection of brain metastases）。
症状性脑转移瘤由无症状脑转移瘤发展而来。即使是多个较小的脑转移瘤也可以通过门诊立体定向放射外科得到控制，颅内控制也可以通过具有中枢神经系统活性的系统治疗方案得到帮助。对当有症状时所发现的较大的脑转移瘤可能需要附加开颅术以减轻肿块占位效应，成本和并发症发生率较高。
我们未来的实践应该以我们今天开始的以证据为基础的临床试验为指导。对新诊断的或复发的全身转移性乳腺癌患者，以及脑转移瘤风险高的患者，即使患者没有症状，应该进行筛查（Patients with breast cancer who have newly diagnosed or recurrent systemic metastatic disease and are at high risk of developing brain metastases should be screened for them, even if the patients are asymptomatic.）。应鼓励发现有脑转瘤移的患者参加临床试验，评估系统性和局灶性治疗对颅内疾病控制、并发症发生率和生存率的贡献（Patients who are found to have brain metastases should be encouraged to participate in clinical trials that evaluate the contribution of systemic and focal therapies to intracranial disease control, morbidity, and survival）。
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