Life expectancy gains from cancer prevention strategies for women with breast cancer and BRCA1 or BRCA2 mutations.
Life expectancy gains from cancer prevention strategies for women with breast cancer and BRCA1 or BRCA2 mutations.
复制标题
患有乳腺癌和 BRCA1 或 BRCA2 突变的女性可以通过癌症预防策略延长预期寿命。
DOI：
--
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发表时间：
2000
期刊：
影响因子：
--
通讯作者：
J. Weeks
中科院分区：
文献类型：
--
作者：
D. Schrag;K. Kuntz;J. Garber;J. Weeks
CONTEXT
Women with BRCA1- or BRCA2-associated breast cancer are at increased risk for contralateral breast cancer and ovarian cancer and therefore may consider secondary cancer prevention strategies, such as prophylactic surgery and tamoxifen therapy. It is not proven to what extent these strategies reduce risk of second cancers in such patients.
OBJECTIVE
To examine the effect of tamoxifen therapy, bilateral prophylactic oophorectomy (PO), prophylactic contralateral mastectomy (PCM), and combinations of these strategies on life expectancy for women with unilateral breast cancer and a BRCA1 or BRCA2 gene mutation.
DESIGN AND SETTING
Decision analysis using a Markov model. Probabilities for developing contralateral breast cancer and ovarian cancer, dying from these cancers, dying from primary breast cancer, and the reduction in cancer incidence and mortality due to prophylactic surgeries and/or tamoxifen were estimated from published studies.
PARTICIPANTS
Hypothetical breast cancer patients with BRCA1 or BRCA2 mutations facing decisions about secondary cancer prevention strategies.
INTERVENTIONS
Seven strategies, including 5 years of tamoxifen use, PO, PCM, and combinations of these strategies, compared with careful surveillance.
MAIN OUTCOME MEASURES
Total and incremental life expectancy (LE) with each intervention strategy.
RESULTS
Depending on the assumed penetrance of the BRCA mutation, compared with surveillance alone, 30-year-old early-stage breast cancer patients with BRCA mutations gain in LE 0.4 to 1.3 years from tamoxifen therapy, 0.2 to 1.8 years from PO, and 0.6 to 2.1 years from PCM. The magnitude of these gains is least for women with low-penetrance mutations (assumed contralateral breast cancer risk of 24% and ovarian cancer risk of 6%) and greatest for those with high-penetrance mutations (assumed contralateral breast cancer risk of 65% and ovarian cancer risk of 40%.) Older age and poorer prognosis from primary breast cancer further attenuate these gains.
CONCLUSIONS
Interventions to prevent second cancers, particularly PCM, may offer substantial LE gain for young women with BRCA-associated early-stage breast cancer. Estimates of LE gain may help women and their physicians consider the uncertainties, risks, and advantages of these interventions and lead to more informed choices about cancer prevention strategies.
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影响因子：
9.8
作者：
Fodor, FH;Weston, A;Eng, CM
通讯作者：
Eng, CM
DOI：
10.1097/00006254-199202000-00027
发表时间：
1991-09
期刊：
The New England journal of medicine
影响因子：
--
作者：
M. Stampfer;G. Colditz;W. Willett;J. Manson;B. Rosner;F. Speizer;C. Hennekens
通讯作者：
M. Stampfer;G. Colditz;W. Willett;J. Manson;B. Rosner;F. Speizer;C. Hennekens
影响因子：
9.8
作者：
A. Whittemore;G. Gong;Jacqueline;Itnyre
通讯作者：
A. Whittemore;G. Gong;Jacqueline;Itnyre
影响因子：
158.5
作者：
COLDITZ, GA;WILLETT, WC;HENNEKENS, CH
通讯作者：
HENNEKENS, CH
影响因子：
9.8
作者：
Ford, D;Easton, DF;Vasen, H
通讯作者：
Vasen, H