Gabriel C A, Tigges-Cardwell J, Stopfer J, Erlichman J, Nathanson K, Domchek S M
Department of Medicine and Abramson Cancer Center, University of Pennsylvania, 14 Penn Tower, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Fam Cancer. 2009;8(1):23-8. doi: 10.1007/s10689-008-9208-6. Epub 2008 Aug 29.
Risk-reducing salpingo-oophorectomy (RRSO) reduces the risk of developing ovarian and breast cancer in BRCA 1 and BRCA 2 (BRCA1/2) mutation carriers. The short-term use of hormone replacement therapy (HRT) after RRSO may relieve menopausal symptoms and does not appear to affect the breast cancer risk reduction gained by RRSO. Multiple factors may influence decisions regarding whether or not total abdominal hysterectomy (TAH) is done at the time of RRSO, whether HRT is elected after surgery, and if so, which type of HRT is selected. Our investigation has been to examine factors associated with TAH and HRT use and to determine if the choice of TAH at the time of RRSO and the type of HRT that was chosen has changed since the report of data from the Women's Health Initiative (WHI) in 2002, which showed that the relative risk for breast cancer is higher in subjects who used combined estrogen-progestin HRT compared with those who used estrogen alone.
We identified 73 female BRCA1/2 mutation carriers who were known to have undergone RRSO between 1/1972 and 11/2005 who had no history of breast or ovarian cancer at the time of the surgery. Information regarding whether or not TAH was done in addition to RRSO, the type of HRT, and the subsequent diagnosis of breast cancer was collected.
Of 73 unaffected BRCA1/2 carriers known to have had RRSO, 40 (40/73, 55%) also underwent TAH. Thirty-three of 73 (33/73, 45%) began HRT following RRSO. Of 33 HRT users, 17 (17/33, 52%) used estrogen only and 14 (14/33, 42%) used combined hormonal therapy. There was no difference in use of HRT in women with TAH (17/40, 43%) vs. those without (16/33, 48%) (P = 0.6). There was no difference in the proportion of women who underwent TAH before and after the WHI report in 2002. Use of HRT, most notably combined estrogen-progestin HRT, appears to have declined since 2002, although this result did not reach statistical significance.
In this single institution study, the majority of BRCA1/2 mutation carriers undergoing RRSO also underwent TAH, and a substantial number took HRT. TAH did not increase the likelihood of taking HRT compared to RRSO alone.
降低风险的输卵管卵巢切除术（RRSO）可降低携带BRCA 1和BRCA 2（BRCA1/2）基因突变者患卵巢癌和乳腺癌的风险。RRSO术后短期使用激素替代疗法（HRT）可缓解更年期症状，且似乎不会影响RRSO带来的降低乳腺癌风险的效果。多种因素可能会影响关于RRSO时是否进行全腹子宫切除术（TAH）、术后是否选择HRT以及若选择HRT则选择何种类型HRT的决策。我们的研究旨在检查与TAH和HRT使用相关的因素，并确定自2002年妇女健康倡议（WHI）发布数据报告以来，RRSO时TAH的选择以及所选择的HRT类型是否发生了变化，该报告显示，与仅使用雌激素的受试者相比，使用雌激素 - 孕激素联合HRT的受试者患乳腺癌的相对风险更高。
我们确定了73名已知在1972年1月至2005年11月期间接受RRSO且手术时无乳腺癌或卵巢癌病史的女性BRCA1/2基因突变携带者。收集了关于除RRSO外是否进行TAH、HRT类型以及随后乳腺癌诊断的信息。
在73名已知接受RRSO的未患癌BRCA1/2携带者中，40名（40/73，55%）还接受了TAH。73名中的33名（33/73，45%）在RRSO后开始使用HRT。在33名HRT使用者中，17名（17/33，52%）仅使用雌激素，14名（14/33，42%）使用联合激素疗法。接受TAH的女性（17/40，43%）与未接受TAH的女性（16/33，48%）在HRT使用方面无差异（P = 0.6）。2002年WHI报告前后接受TAH的女性比例无差异。自2002年以来，HRT的使用，尤其是雌激素 - 孕激素联合HRT的使用似乎有所下降，尽管这一结果未达到统计学显著性。
在这项单机构研究中，大多数接受RRSO的BRCA1/2基因突变携带者也接受了TAH，并且有相当数量的人使用了HRT。与仅进行RRSO相比，TAH并未增加使用HRT的可能性。
