Julian-Reynier C, Eisinger F, Moatti J P, Sobol H
INSERM U379, Paoli-Calmettes Institute, Marseilles, France.
Eur J Hum Genet. 2000 Mar;8(3):204-8. doi: 10.1038/sj.ejhg.5200418.
After a BRCA mutation has been identified in the context of hereditary breast/ovarian cancer (HBOC), mammographic screening and prophylactic surgery are two of the main options available to those responsible for the clinical management of healthy women. The aim of this study was to describe the attitudes of specialists towards the clinical management of women with an HBOC risk: this information was collected prior to the publication of the recent French guidelines. A random national sample of 1169 French surgeons, gynaecologists and obstetricians was surveyed using a mailed questionnaire, to which 700 of these physicians (60%) responded. When dealing with a BRCA mutated woman, 88.6% of the respondents said they would recommend mammographic screening, but only 27.1% would recommend that it should be carried out annually from the age of 30 years onwards, as recommended in the French guidelines; 10.9% would find it acceptable to propose prophylactic mastectomy from the age of 30 years, and 22.9% would find it acceptable to propose prophylactic oophorectomy from the age of 35 years. The specialists who agreed with recommending breast/ovarian cancer genetic testing also had more positive attitudes towards prophylactic mastectomy (adj OR = 3.4, 95% CI = 1.4-8.2), as did those who had previously recommended prophylactic mastectomy when gene testing was not yet available (adj OR = 2.06, 95% CI = 1.23-3.44). The respondents' attitudes towards prophylactic oophorectomy and mastectomy were significantly associated (adj OR = 3.9; 95% CI = 2.3-6.5). Previous recommendation of prophylactic mastectomy was associated (P < 0.01) with a higher level of knowledge of breast/ovarian cancer genetics and with medical practice in this field. French physicians' attitudes towards mammographic screening and prophylactic surgery were not in complete agreement with the subsequently published French guidelines, the impact of which has now to be considered. Constantly evolving knowledge about the efficacy of preventive intervention will give practitioners new elements to integrate into their counselling.
在遗传性乳腺癌/卵巢癌（HBOC）背景下鉴定出BRCA突变后，乳腺钼靶筛查和预防性手术是负责健康女性临床管理的人员可采用的两种主要选择。本研究的目的是描述专家对有HBOC风险女性临床管理的态度：这些信息是在最近法国指南发布之前收集的。使用邮寄问卷对1169名法国外科医生、妇科医生和产科医生进行了全国随机抽样调查，其中700名医生（60%）进行了回复。在处理BRCA突变女性时，88.6%的受访者表示他们会推荐乳腺钼靶筛查，但只有27.1%的人会按照法国指南的建议，推荐从30岁起每年进行筛查；10.9%的人认为从30岁起提议进行预防性乳房切除术是可以接受的，22.9%的人认为从35岁起提议进行预防性卵巢切除术是可以接受的。同意推荐乳腺癌/卵巢癌基因检测的专家对预防性乳房切除术也有更积极的态度（调整后比值比=3.4，95%置信区间=1.4-8.2），那些在基因检测尚未可用时曾推荐预防性乳房切除术的专家也是如此（调整后比值比=2.06，95%置信区间=1.23-3.44）。受访者对预防性卵巢切除术和乳房切除术的态度显著相关（调整后比值比=3.9；95%置信区间=2.3-6.5）。先前推荐预防性乳房切除术与对乳腺癌/卵巢癌遗传学的较高知识水平以及该领域的医疗实践相关（P<0.01）。法国医生对乳腺钼靶筛查和预防性手术的态度与随后发布的法国指南并不完全一致，现在必须考虑其影响。关于预防性干预效果的知识不断发展，将为从业者提供新的要素以纳入其咨询中。
