Friedenson B
Department of Biochemistry and Molecular Biology at the University of Illinois at Chicago, Chicago, Illinois, USA.
MedGenMed. 2001 Nov 2;3(6):2.
A clinician faces a problem in how best to counsel the woman with a family history of breast or ovarian cancer about her options for pregnancy prevention. The physician must guide her as she makes new and complex decisions. Recent data strongly support an amplified effect of the estrogens in oral contraceptives for the woman with a genetic risk for breast cancer. Nonetheless, a woman's immediate need to prevent pregnancy may be much more important to her than worrying about the long-term risk of breast cancer. Another factor is that oral contraceptives prevent ovarian cancer, so the physician may wish to prescribe them to protect her from ovarian cancer. In some genetic backgrounds, however, oral contraceptives not only do not prevent ovarian cancer, but they may raise the risk of breast cancer so significantly that they should not be taken. With other genetic backgrounds, oral contraceptives will protect the woman from ovarian cancer without much effect on her breast cancer risk. When does each of these cancer risks or benefits become significant? The clinician can provide an important benefit to a woman who must prevent pregnancy yet worries about her cancer risk. The physician can help her evaluate the evidence, with its gaps and uncertainties, in the context of her own preferences. To assist in this evaluation, this decision aid provides base-line estimates of the cancer risk that accompanies each of a woman's options. In some cases, genetic testing is likely to provide valuable information as she makes choices about contraception and the risks vs. benefits of different alternatives available to her.
临床医生在如何最好地为有乳腺癌或卵巢癌家族史的女性提供预防妊娠的建议方面面临一个问题。在她做出新的复杂决定时，医生必须给予指导。最近的数据有力地支持了口服避孕药中的雌激素对有乳腺癌遗传风险的女性具有放大作用。然而，对一名女性来说，她当下预防妊娠的需求可能比对乳腺癌长期风险的担忧重要得多。另一个因素是口服避孕药可预防卵巢癌，所以医生可能希望开此类药物来保护她免受卵巢癌侵害。然而，在某些遗传背景下，口服避孕药不仅无法预防卵巢癌，反而可能显著提高乳腺癌风险，以至于不应服用。在其他遗传背景下，口服避孕药会保护女性免受卵巢癌侵害，而对其乳腺癌风险影响不大。这些癌症风险或益处何时会变得显著呢？对于必须预防妊娠但又担心癌症风险的女性，临床医生可以提供重要帮助。医生可以在她自身偏好的背景下，帮助她评估证据及其存在的差距和不确定性。为协助这一评估，本决策辅助工具提供了女性每种选择所伴随的癌症风险基线估计。在某些情况下，基因检测在她选择避孕方式以及不同选择的风险与益处时，可能会提供有价值的信息。
