Impact of family history on choosing risk-reducing surgery among BRCA mutation carriers
Impact of family history on choosing risk-reducing surgery among BRCA mutation carriers
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DOI：
10.1016/j.ajog.2013.01.026
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发表时间：
2013-04-01
影响因子：
9.8
通讯作者：
Gordon, Ora
中科院分区：
文献类型：
--
作者：
Singh, Krishna;Lester, Jenny;Gordon, Ora
目的：尽管在BRCA突变携带者中，降低风险的乳房切除术（RRM）和降低风险的双侧输卵管卵巢切除术（RRBSO）具有显著的生存益处，但只有少数人选择接受这些手术。本研究探讨了可能影响BRCA突变妇女预防性手术决策的因素，研究设计：未受影响的BRCA突变携带者在我们中心接受咨询，并在1998年至2010年期间接受预防性手术或参加我们机构的高风险监测项目。医疗记录进行了审查，收集的数据包括年龄，家族史，奇偶校验，突变类型，乳腺活检或美容手术的历史，和摄取的预防surgics.Results：在136例未受影响的妇女与BRCA突变，摄取RRM为42%，摄取RRBSO为52%。一级和二级亲属死于乳腺癌的家族史可预测RRM和RRBSO的摄取（比值比[OR]，11.0; P = 0.005; OR，15.8; P = 0.023），母亲死于盆腔癌的病史可预测RRBSO的摄取（OR，7.9; P = 0.001）。胎次也预测了RRM和RRBSO的摄取（OR分别为4.2; P = 0.001和5.4; P = 0.003）。年龄时的基因检测和乳腺活检或整容手术的历史没有预测的RRM uptake.CONCLUSION：癌症风险的看法在很大程度上受到个人的家族史的特定功能，可能是动机在预防性手术比实际的癌症风险估计本身。在为高危女性提供咨询时，对癌症统计风险之外的微妙因素的认识是相关的。
OBJECTIVE: Despite substantial survival benefits of risk-reducing mastectomy (RRM) and risk-reducing bilateral salpingo-oophorectomy (RRBSO) among BRCA mutation carriers, only a minority elect to undergo these procedures. This study investigates factors that might influence decision making regarding prophylactic surgeries among women with BRCA mutations.STUDY DESIGN: Unaffected BRCA mutation carriers who were counseled at our center and either underwent prophylactic surgery or participated in a high-risk surveillance program at our institution from 1998 through 2010 were included in the study. Medical records were reviewed and data collected included age, family history, parity, mutation type, history of breast biopsy or cosmetic surgery, and uptake of prophylactic surgeries.RESULTS: Among 136 unaffected women with BRCA mutations, uptake of RRM was 42% and uptake of RRBSO was 52%. Family history of first- and second-degree relatives being deceased from breast cancer was predictive of uptake of RRM and of RRBSO (odds ratio [OR], 11.0; P = .005; and OR, 15.8; P = .023, respectively), and history of a mother lost to pelvic cancer was predictive of uptake of RRBSO (OR, 7.9; P = .001). Parity also predicted both RRM and RRBSO uptake (OR, 4.2; P = .001; and OR, 5.4; P = .003, respectively). Age at the time of genetic testing and history of breast biopsy or cosmetic surgery were not predictive of RRM uptake.CONCLUSION: Perceptions of cancer risk are heavily influenced by particular features of an individual's family history and may be motivators in preventive surgery more than actual cancer risk estimations themselves. Awareness of subtle factors beyond the statistical risk for cancers is relevant when counseling at-risk women.