Julian-Reynier C M, Bouchard L J, Evans D G, Eisinger F A, Foulkes W D, Kerr B, Blancquaert I R, Moatti J P, Sobol H H
INSERM U379, Epidemiology and Social Sciences Applied to Medical Innovation, Paoli-Calmettes Institute, 232 Boulevard Sainte Marguerite, 13273 Marseilles cedex 9, France.
Cancer. 2001 Aug 15;92(4):959-68. doi: 10.1002/1097-0142(20010815)92:4<959::aid-cncr1406>3.0.co;2-v.
The authors investigated the acceptability to women of the preventive strategies available for dealing with hereditary breast/ovarian carcinoma in France, the United Kingdom, and Canada, countries selected because of their cultural differences. The authors aimed to discover the existence of specific factors that may affect acceptability of these preventative measures.
A cross-sectional, multicenter survey was conducted in Marseilles, France (n = 141), in Manchester, England (n = 130), and in Montreal, Quebec (n = 84). All of the women attending cancer genetic clinics for the first time because of a family history of breast-ovarian carcinoma completed a self-administered questionnaire before their clinic consultation.
Variations in responses to different preventative options presented on the questionnaire were seen within the sample of patients considered as a whole. The highest levels of acceptability were obtained for mammographic screening (87%) and chemoprevention (58%). In contrast, prophylactic oophorectomy and prophylactic mastectomy were thought to be acceptable at an early age (before 35 years), an age associated with the highest prophylactic efficacy, by only 19% and 16% of the respondents, respectively. After multivariate adjustment, the statistical data showed that the British respondents were more in favor of oophorectomy (P < 0.0001) and more in favor of chemoprevention than the French (P < 0.001) and the Canadian respondents (P < 0.001). The British (overall adjusted response [OR(adj)] = 3.9; P < 0.001) and Canadian respondents (OR(adj) = 3; P < 0.01) were more in favor of prophylactic mastectomy than the French. The cumulated acceptability of mammography before the age of 40 years was found to be greater in the French (OR(adj) = 2.8; P < 0.01) and Canadian (OR(adj) = 3.1; P < 0.05) samples than in the British sample.
These results demonstrated the existence of international variations in the acceptability of the preventive strategies available for women at risk for hereditary breast/ovarian carcinoma. Therefore, these results suggested that when establishing medical recommendations or planning public health interventions, physicians must integrate the population's perception of advantages and drawbacks with the patient's individual decision making.
作者调查了法国、英国和加拿大这三个因文化差异而被选中的国家中，女性对可用于应对遗传性乳腺癌/卵巢癌的预防策略的接受程度。作者旨在发现可能影响这些预防措施接受程度的特定因素。
在法国马赛（n = 141）、英国曼彻斯特（n = 130）和加拿大魁北克省蒙特利尔（n = 84）进行了一项横断面多中心调查。所有因乳腺癌-卵巢癌家族史首次前往癌症遗传诊所就诊的女性，在诊所咨询前完成了一份自填式问卷。
在将所有患者视为一个整体的样本中，对问卷中列出的不同预防选项的回答存在差异。乳房X光筛查（87%）和化学预防（58%）的接受程度最高。相比之下，只有19%和16%的受访者认为在与最高预防效果相关的年龄（35岁之前）进行预防性卵巢切除术和预防性乳房切除术是可以接受的。经过多变量调整后，统计数据显示，英国受访者比法国受访者（P < 0.0001）和加拿大受访者（P < 0.001）更倾向于卵巢切除术，且比法国受访者（P < 0.001）和加拿大受访者（P < 0.001）更倾向于化学预防。英国受访者（总体调整后反应[OR(adj)] = 3.9；P < 0.001）和加拿大受访者（OR(adj) = 3；P < 0.01）比法国受访者更倾向于预防性乳房切除术。结果发现，在40岁之前进行乳房X光检查的累积接受程度在法国样本（OR(adj) = 2.8；P < 0.01）和加拿大样本（OR(adj) = 3.1；P < 0.05）中高于英国样本。
这些结果表明，对于有遗传性乳腺癌/卵巢癌风险的女性，可用预防策略的接受程度存在国际差异。因此，这些结果表明，在制定医疗建议或规划公共卫生干预措施时，医生必须将人群对利弊的看法与患者的个人决策相结合。
