Frost M H, Schaid D J, Sellers T A, Slezak J M, Arnold P G, Woods J E, Petty P M, Johnson J L, Sitta D L, McDonnell S K, Rummans T A, Jenkins R B, Sloan J A, Hartmann L C
Division of Medical Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
JAMA. 2000 Jul 19;284(3):319-24. doi: 10.1001/jama.284.3.319.
Prophylactic mastectomy is a preventive option for women who wish to reduce their risk of breast cancer. There has been concern about possible negative psychological sequelae following this procedure. However, few data are available regarding long-term satisfaction and psychological and social function following this procedure.
To evaluate patients' long-term satisfaction and psychological and social function following prophylactic mastectomy.
DESIGN, SETTING, AND PARTICIPANTS: Descriptive study of all women known to be alive (n = 609) who had a family history of breast cancer and elected to undergo bilateral prophylactic mastectomy at a large, tertiary US health care clinic between 1960 and 1993, 94% (n = 572) of whom completed a study questionnaire.
Satisfaction with procedure and effects on psychological and social function, based on responses to the study-specific questionnaire.
Mean time from prophylactic mastectomy to last follow-up was 14.5 years. Most women (70%) were satisfied with the procedure; 11% were neutral; and 19% were dissatisfied. Among the psychological and social variables, the most striking finding was that 74% reported a diminished level of emotional concern about developing breast cancer. The majority of women reported no change/favorable effects in levels of emotional stability (68%/23%), level of stress (58%/28%), self-esteem (69%/13%), sexual relationships (73%/4%), and feelings of femininity (67%/8%). Forty-eight percent reported no change in their level of satisfaction with body appearance; 16% reported favorable effects. However, 9%, 14%, 18%, 23%, 25%, and 36% reported negative effects in these 6 variables, respectively.
This study suggests that positive outcomes following prophylactic mastectomy include decreased emotional concern about developing breast cancer and generally favorable psychological and social outcomes. These must be weighed against the irreversibility of the decision, potential problems with implants and reconstructive surgery, and occurrence of adverse psychological and social outcomes in some women. JAMA. 2000;284:319-324
预防性乳房切除术是希望降低患乳腺癌风险的女性的一种预防选择。人们一直担心该手术后可能产生负面心理后遗症。然而，关于该手术后长期满意度以及心理和社会功能的数据很少。
评估预防性乳房切除术后患者的长期满意度以及心理和社会功能。
设计、地点和参与者：对所有已知在世的女性（n = 609）进行描述性研究，这些女性有乳腺癌家族史，并于1960年至1993年在美国一家大型三级医疗诊所选择接受双侧预防性乳房切除术，其中94%（n = 572）完成了研究问卷。
根据对特定研究问卷的回答，对手术的满意度以及对心理和社会功能的影响。
从预防性乳房切除术到最后一次随访的平均时间为14.5年。大多数女性（70%）对手术满意；11%持中立态度；19%不满意。在心理和社会变量中，最显著的发现是74%的女性报告对患乳腺癌的情感担忧程度降低。大多数女性报告在情绪稳定性（68%/23%）、压力水平（58%/28%）、自尊（69%/13%）、性关系（73%/4%）和女性气质感受（67%/8%）方面没有变化/有积极影响。48%的女性报告对身体外观的满意度没有变化；16%报告有积极影响。然而，分别有9%、14%、18%、23%、25%和36%的女性报告在这6个变量中有负面影响。
本研究表明，预防性乳房切除术后的积极结果包括对患乳腺癌的情感担忧减少以及总体上良好的心理和社会结果。这些结果必须与该决定的不可逆转性、植入物和重建手术的潜在问题以及一些女性出现的不良心理和社会结果相权衡。《美国医学会杂志》。2000年；284:319 - 324
