Predictors and outcomes of contralateral prophylactic mastectomy among breast cancer survivors
Predictors and outcomes of contralateral prophylactic mastectomy among breast cancer survivors
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DOI：
10.1007/s10549-006-9423-5
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发表时间：
2007-09-01
影响因子：
3.8
通讯作者：
Schwartz, Marc D.
中科院分区：
文献类型：
--
作者：
Graves, Kristi D.;Peshkin, Beth N.;Schwartz, Marc D.
携带BRCA 1或BRCA 2（BRCA 1/2）突变的乳腺癌患者有患对侧乳腺癌的风险。为了降低患对侧乳腺癌的风险，一些患者除了对受影响的乳房进行乳房切除术外，还选择对未受影响的乳房进行预防性手术（对侧预防性乳房切除术，CPM）。方法本研究旨在确定在BRCA 1/2遗传咨询和检测后一年内CPM的预测因素和结果。435名接受BRCA 12基因检测结果阳性或无信息的单侧乳腺癌妇女在接受遗传咨询和检测前以及收到结果后1个月、6个月和12个月完成评估。结果在测试之前，16%的患者接受了CPM（与受影响乳房的乳房切除术相结合）。在测试后的一年中，18%的测试结果为阳性，3%的测试结果为无意义，选择了CPM。检测后的CPM与阳性基因检测结果、癌症诊断时的年轻年龄[比值比（OR）= 0.94]和基线时较高的癌症特异性痛苦（OR = 3.28）相关。CPM与12个月时的痛苦结局无关。结论：在检测结果呈阳性后，18%的曾患单侧乳腺癌的女性发生了CPM。在年轻时患乳腺癌的妇女，特别是那些基因检测结果阳性和癌症特异性痛苦较高的妇女，比接受无信息检测结果和诊断时痛苦较少和年龄较大的妇女更有可能选择CPM。CPM似乎并不影响痛苦的结果。
Background Women affected with breast cancer who carry a BRCA1 or BRCA2 (BRCA1/2) mutation are at risk of developing contralateral breast cancer. To reduce the risk of contralateral breast cancer, some patients opt for prophylactic surgery of the unaffected breast ( contralateral prophylactic mastectomy, CPM) in addition to mastectomy of the affected breast. Methods We conducted the present study to determine the predictors and outcomes of CPM in the year following BRCA1/2 genetic counseling and testing. Four hundred and thirty-five women affected with unilateral breast cancer who received positive or uninformative BRCA1/2 genetic test results completed assessments prior to genetic counseling and testing and 1, 6, and 12 months after receipt of results. Results Prior to testing, 16% had undergone CPM ( in conjunction with mastectomy of the affected breast). In the year following testing, 18% with positive test results and 3% with uninformative test results opted for CPM. CPM following testing was associated with a positive genetic test result, younger age at cancer diagnosis [ odds ratio ( OR) = 0.94], and higher cancer-specific distress at baseline ( OR = 3.28). CPM was not associated with distress outcomes at 12 months. Conclusions Following a positive test result, 18% of women previously affected with unilateral breast cancer had a CPM. Women affected with breast cancer at a younger age, particularly those with positive genetic test results and higher cancer-specific distress, are more likely to choose CPM than women who receive uninformative test results and who are less distressed and older at diagnosis. CPM does not appear to impact distress outcomes.