Fryzek Jon P, Ye Weimin, Nyrén Olof, Tarone Robert E, Lipworth Loren, McLaughlin Joseph K
Department of Medicine, International Epidemiology Institute, Rockville, MD 20850, USA.
Breast Cancer Res Treat. 2006 May;97(2):131-4. doi: 10.1007/s10549-005-9099-2. Epub 2005 Dec 3.
While it has been demonstrated that prophylactic mastectomy reduces breast cancer incidence among women at high risk, many women often consider this disfiguring surgery unacceptable. One alternative approach may be breast reduction surgery. In order to evaluate the long-term incidence of breast cancer following surgical removal of breast tissue, we have extended by 9 years the follow-up period of our earlier retrospective cohort study of Swedish women electing cosmetic breast reduction surgery (n=30,444) between 1965 and 1993, yielding an average of nearly 16 years of follow-up. Cancer incidence through 2002 was ascertained via the Swedish Cancer Registry. Standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated comparing women who underwent breast reduction surgery with women in the general Swedish population. Breast cancer was observed in 443 women versus 624 expected for a statistically significant reduced SIR of 0.71 (95% CI=0.65-0.78). Analyses by age at surgery, time since surgery or calendar year of surgery revealed similar reductions in risk. Our study of over 30,000 women with long-term follow-up offers further evidence that women undergoing breast reduction surgery have reduced breast cancer risk. As the evidence from large-scale cohort studies accumulates, direct testing of this reduction in risk through clinical trials should be considered.
虽然已证明预防性乳房切除术可降低高危女性的乳腺癌发病率，但许多女性通常认为这种毁容性手术难以接受。一种替代方法可能是乳房缩小术。为了评估手术切除乳房组织后乳腺癌的长期发病率，我们将之前对1965年至1993年间选择进行美容性乳房缩小术的瑞典女性（n = 30,444）的回顾性队列研究的随访期延长了9年，平均随访时间接近16年。通过瑞典癌症登记处确定了截至2002年的癌症发病率。计算了标准化发病率比（SIR）和95%置信区间（CI），将接受乳房缩小术的女性与瑞典普通人群中的女性进行比较。观察到443名女性患乳腺癌，而预期为624名，SIR在统计学上显著降低至0.71（95%CI = 0.65 - 0.78）。按手术年龄、手术后时间或手术年份进行的分析显示风险有类似降低。我们对30,000多名女性进行的长期随访研究提供了进一步证据，表明接受乳房缩小术的女性患乳腺癌的风险降低。随着大规模队列研究证据的积累，应考虑通过临床试验直接检验这种风险降低情况。
