Contant C M E, Menke-Pluijmers M B E, Seynaeve C, Meijers-Heijboer E J, Klijn J G M, Verhoog L C, Tjong Joe Wai R, Eggermont A M M, van Geel A N
Department of Surgical Oncology, University Hospital Rotterdam/Daniel den Hoed Cancer Centre, Zuiderziekenhuis Rotterdam, The Netherlands.
Eur J Surg Oncol. 2002 Sep;28(6):627-32. doi: 10.1053/ejso.2002.1279.
Women with a proven BRCA1 or BRCA2 germ-line mutation or with a 50% risk of carrying the mutation, have an increased risk of breast cancer. Regular surveillance, chemoprevention or prophylactic mastectomy (PM) are options to detect breast cancer at an early stage or to reduce the risk. We describe the management of women who have opted for PM, the postoperative complications of PM, especially in combination with immediate breast reconstruction (IBR), and the oncological follow-up.
The medical records of all women who underwent a PM from December 1993 to December 1999 have been reviewed with respect to management, patient characteristics, complications and oncological follow-up.
During the study period 112 women with a median age of 38.8 years opted for a PM: 76 were germline mutation carriers. After PM, 79 women without breast or ovarian cancer in their medical history, were free of disease after 2.5 years (median). Before PM, 29 women had been treated for breast cancer, 3.9 years (median) previously; 5 of these women had developed metastatic disease by the last consultation. Before PM, 2 patients had been treated for DCIS and 2 patients for ovarian cancer. Four DCIS were found; none of these women had evidence of disease 4.0 years (median) after PM. In 59 women laparoscopic prophylactic bilateral oophorectomy (PBO) was performed; 36 simultaneously with PM and 23 separately. A total of 103 women (92%) opted for IBR. After PM, the complication rate for IBR was 21%: 11% within 6 weeks and 10% at long-term follow-up (median 3.5) after PM, including the removal of 10 prostheses.
Women with an increased risk of breast cancer due to a genetic predisposition should be adequately informed about the different treatment options in the setting of a multidisciplinary approach. PM can simultaneously be combined with PBO and IBR. IBR can facilitate the decision to undergo a PM. PM followed by IBR has an acceptable complication rate.
携带已证实的BRCA1或BRCA2种系突变或携带该突变风险为50%的女性患乳腺癌的风险增加。定期监测、化学预防或预防性乳房切除术（PM）是早期发现乳腺癌或降低风险的选择。我们描述了选择PM的女性的管理、PM的术后并发症，尤其是与即刻乳房重建（IBR）联合时的并发症，以及肿瘤学随访情况。
回顾了1993年12月至1999年12月期间所有接受PM的女性的病历，内容涉及管理、患者特征、并发症和肿瘤学随访。
在研究期间，112名中位年龄为38.8岁的女性选择了PM：76名是种系突变携带者。PM后，79名既往无乳腺癌或卵巢癌病史的女性在2.5年（中位时间）后无疾病。PM前，29名女性曾在3.9年（中位时间）前接受过乳腺癌治疗；其中5名女性在最后一次会诊时已发生转移性疾病。PM前，2名患者曾接受过导管原位癌（DCIS）治疗，2名患者曾接受过卵巢癌治疗。发现4例DCIS；这些女性在PM后4.0年（中位时间）均无疾病证据。59名女性接受了腹腔镜预防性双侧卵巢切除术（PBO）；36名与PM同时进行，23名单独进行。共有103名女性（92%）选择了IBR。PM后，IBR的并发症发生率为21%：6周内为11%，PM后长期随访（中位时间3.5年）时为10%，包括取出10个假体。
因遗传易感性而患乳腺癌风险增加的女性应在多学科方法的背景下充分了解不同的治疗选择。PM可同时与PBO和IBR联合。IBR可促进接受PM的决定。PM后行IBR的并发症发生率可接受。
