Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers:: The PROSE study group
Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers:: The PROSE study group
复制标题
DOI：
10.1200/jco.2004.04.188
复制
发表时间：
2004-03-15
影响因子：
45.3
通讯作者：
Weber, BL
中科院分区：
文献类型：
--
作者：
Rebbeck, TR;Friebel, T;Weber, BL
目的关于BRCA1和BRCA2(BRCA1/2)突变的女性预防性双侧乳房切除术降低乳腺癌风险的数据有限，尽管这种风险管理策略在临床上得到了应用。因此，我们估计了携带这些突变的妇女手术后乳腺癌风险降低的程度。患者和方法研究了483名具有疾病相关种系BRCA1/2突变的妇女乳腺癌的发生情况。2例突变携带者接受了双侧预防性乳房切除术，并从中心确定和手术开始进行前瞻性跟踪，并对两个随访期进行了分析。对照组为BRCA1/2突变携带者，无双侧预防性乳房切除病史，与患者的基因、中心和出生年份相匹配，排除了既往或同时诊断为乳腺癌的病例和对照组。结果105名接受双侧预防性乳房切除术的女性中有2名(1.9%)确诊为乳腺癌，378名未行预防性手术的对照女性中有184名(48.7%)确诊为乳腺癌，平均随访时间为6.4年。在双侧预防性卵巢切除术之前或同时接受双侧预防性卵巢切除术的女性中，双侧预防性乳腺癌的风险降低了约95%，而在卵巢完整的女性中，双侧预防性乳腺切除术的乳腺癌风险降低了约90%。结论在BRCA1/2突变的女性中，双侧预防性乳腺切除术可降低约90%的乳腺癌风险。(C)2004年，由美国临床肿瘤学会提供。
Purpose Data on the efficacy of bilateral prophylactic mastectomy for breast cancer risk reduction in women with BRCA1 and BRCA2 (BRCA1/2) mutations are limited, despite the clinical use of this risk-management strategy. Thus, we estimated the degree of breast cancer risk reduction after surgery in women who carry these mutations.Patients and Methods Four hundred eighty-three women with disease-associated germline BRCA1/2 mutations were studied for the occurrence of breast cancer. Cases were mutation carriers who underwent bilateral prophylactic mastectomy and who were followed prospectively from the time of their center ascertainment and their surgery, with analyses performed for both follow-up periods. Controls were BRCA1/2 mutation carriers with no history of bilateral prophylactic mastectomy matched to cases on gene, center, and year of birth, Both cases and controls were excluded for previous or concurrent diagnosis of breast cancer. Analyses were adjusted for duration of endogenous ovarian hormone exposure, including age at bilateral prophylactic oophorectomy if applicable.Results Breast cancer was diagnosed in two (1.9%) of 105 women who had bilateral prophylactic mastectomy and in 184 (48.7%) of 378 matched controls who did not have the procedure, with a mean follow-up of 6.4 years. Bilateral prophylactic mastectomy reduced the risk of breast cancer by approximately 95% in women with prior or concurrent bilateral prophylactic oophorectomy and by approximately 90% in women with intact ovaries.Conclusion Bilateral prophylactic mastectomy reduces the risk of breast cancer in women with BRCA1/2 mutations by approximately 90%. (C) 2004 by American Society of Clinical Oncology.