Breast cancer after prophylactic bilateral mastectomy in women with a BRCA1 or BRCA2 mutation.
Breast cancer after prophylactic bilateral mastectomy in women with a BRCA1 or BRCA2 mutation.
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DOI：
10.1056/nejm200107193450301
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发表时间：
2001-07-19
影响因子：
158.5
通讯作者：
Klijn, JGM
中科院分区：
文献类型：
--
作者：
Meijers-Heijboer, H;van Geel, B;Klijn, JGM
背景：BRCA1或BRCA2突变的女性患乳腺癌的风险很高，可能会选择预防性双侧全乳房切除术。方法：我们对139名携带致病基因BRCA1或BRCA2突变的女性进行了前瞻性研究，这些女性是鹿特丹家庭癌症诊所乳腺癌监测项目的登记对象。在注册时，这些女性都没有乳腺癌病史。其中76名妇女最终接受了预防性乳房切除术，其余63名仍在定期监测中。结果：在平均(+/-SE)2.9+/-1.4年的随访期内，预防性乳房切除术后未发现乳腺癌病例，而在平均3.0+/-1.5年的平均随访期内，在定期监测的妇女中有8例发生乳腺癌(P=0.003.0 5；风险比0；95%可信区间0至0.36)。在监测组的所有女性中，乳腺癌的平均五年发病率为17%+/-7%。在指数模型的基础上，这一群体的乳腺癌年发病率为2.5%。监测组观察到的乳腺癌数量与预期数量一致(观察与预期病例数之比为1.2；95%可信区间为0.4~3.7；P=0.80)。结论：在BRCA1或BRCA2突变的妇女中，预防性双侧乳房全切除术可降低3年随访的乳腺癌发病率。《英国医学杂志》2001；345：159-。版权所有(C)2001年马萨诸塞州医学会。
Background: Women with a BRCA1 or BRCA2 mutation have a high risk of breast cancer and may choose to undergo prophylactic bilateral total mastectomy. We investigated the efficacy of this procedure in such women.Methods: We conducted a prospective study of 139 women with a pathogenic BRCA1 or BRCA2 mutation who were enrolled in a breast-cancer surveillance program at the Rotterdam Family Cancer Clinic. At the time of enrollment, none of the women had a history of breast cancer. Seventy-six of these women eventually underwent prophylactic mastectomy, and the other 63 remained under regular surveillance. The effect of mastectomy on the incidence of breast cancer was analyzed by the Cox proportional-hazards method in which mastectomy was modeled as a time-dependent covariate.Results: No cases of breast cancer were observed after prophylactic mastectomy after a mean (+/-SE) follow-up of 2.9+/-1.4 years, whereas eight breast cancers developed in women under regular surveillance after a mean follow-up of 3.0+/-1.5 years (P=0.003; hazard ratio, 0; 95 percent confidence interval, 0 to 0.36). The actuarial mean five-year incidence of breast cancer among all women in the surveillance group was 17+/-7 percent. On the basis of an exponential model, the yearly incidence of breast cancer in this group was 2.5 percent. The observed number of breast cancers in the surveillance group was consistent with the expected number (ratio of observed to expected cases, 1.2; 95 percent confidence interval, 0.4 to 3.7; P=0.80).Conclusions: In women with a BRCA1 or BRCA2 mutation, prophylactic bilateral total mastectomy reduces the incidence of breast cancer at three years of follow-up. (N Engl J Med 2001;345:159-64.) Copyright (C) 2001 Massachusetts Medical Society.