Increasing use of contralateral prophylactic mastectomy for breast cancer patients: A trend toward more aggressive surgical treatment
Increasing use of contralateral prophylactic mastectomy for breast cancer patients: A trend toward more aggressive surgical treatment
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DOI：
10.1200/jco.2007.12.3141
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发表时间：
2007-11-20
影响因子：
45.3
通讯作者：
Virnig, Beth A.
中科院分区：
文献类型：
--
作者：
Tuttle, Todd M.;Habermann, Elizabeth B.;Virnig, Beth A.
目的许多单侧乳腺癌患者选择对侧预防性乳房切除术来预防对侧乳腺癌的发生。我们的研究的目的是确定使用和趋势的对侧预防性乳房切除术在美国。患者和方法我们使用的监测，流行病学和最终结果数据库，回顾治疗单侧乳腺癌患者诊断从1998年到2003年。我们确定了对侧预防性乳房切除术的比例，所有手术治疗的患者和所有乳房切除术的比例。结果我们确定了152,755例I期，II期或III期乳腺癌患者，4,969例患者选择对侧预防性乳房切除术。所有手术治疗患者的发生率为3.3%;接受乳房切除术的患者为7.7%。总体失业率从1998年的1.8%大幅上升至2003年的4.5%。同样，接受乳房切除术的患者的对侧预防性乳房切除率从1998年的4.2%显著增加到2003年的11.0%。这些增加的比率适用于所有癌症阶段，并持续到我们的研究期结束。年轻患者年龄、非西班牙裔白色人种、小叶组织学和既往癌症诊断与显著较高的发生率相关。大的肿瘤大小与较高的整体率，但与较低的利率为患者进行乳房切除术。结论使用对侧预防性乳房切除术在美国增加了一倍以上，在最近的6年期间，我们的研究。需要前瞻性研究来了解导致更积极的乳腺癌手术的决策过程。
Purpose Many patients with unilateral breast cancer choose contralateral prophylactic mastectomy to prevent cancer in the opposite breast. The purpose of our study was to determine the use and trends of contralateral prophylactic mastectomy in the United States.Patients and Methods We used the Surveillance, Epidemiology and End Results database to review the treatment of patients with unilateral breast cancer diagnosed from 1998 through 2003. We determined the rate of contralateral prophylactic mastectomy as a proportion of all surgically treated patients and as a proportion of all mastectomies.Results We identified 152,755 patients with stage I, II, or III breast cancer; 4,969 patients chose contralateral prophylactic mastectomy. The rate was 3.3% for all surgically treated patients; 7.7%, for patients undergoing mastectomy. The overall rate significantly increased from 1.8% in 1998 to 4.5% in 2003. Likewise, the contralateral prophylactic mastectomy rate for patients undergoing mastectomy significantly increased from 4.2% in 1998 to 11.0% in 2003. These increased rates applied to all cancer stages and continued to the end of our study period. Young patient age, non-Hispanic white race, lobular histology, and previous cancer diagnosis were associated with significantly higher rates. Large tumor size was associated with a higher overall rate, but with a lower rate for patients undergoing mastectomy.Conclusion The use of contralateral prophylactic mastectomy in the United States more than doubled within the recent 6-year period of our study. Prospective studies are needed to understand the decision-making processes that have led to more aggressive breast cancer surgery.