Division of Clinical Psychology, Liverpool University, Ground Floor Whelan Building, Quadrangle, Brownlow Hill, Liverpool, L69 3GB England, UK; Liverpool Psychology Service for Cancer, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP England, UK.
Breast Unit, Linda McCartney Centre, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP England, UK.
Breast. 2013 Apr;22(2):179-184. doi: 10.1016/j.breast.2012.06.005. Epub 2012 Jun 29.
Although controversial, use of contralateral risk-reducing mastectomy (CRRM) is increasing. It is not clear whether reduction of objective breast cancer risk or other factors determine decisions for CRRM. We aimed to identify factors that influence these decisions by scrutinising how decisions were made in one centre.
We reviewed a consecutive series of 60 patients considered for CRRM in one centre. Data sources, analysed using qualitative methods, were records of routine psychological assessment, surgeon letters, case-notes and interviews with four surgeons.
Perceptions of objective risk did not generally drive patients' requests or surgeons' decisions. Instead, CRRM appeared to be mainly performed for psychological reasons: to reduce patients' cancer worry and to achieve cosmetic benefits.
Routine use of the term 'risk-reducing' surgery masks a clinical decision which usually reflects influences other than risk. As CRRM is often carried out for psychological reasons it follows that evidence about its psychosocial outcomes is needed.
尽管存在争议，但对侧预防性乳房切除术（CRRM）的应用正在增加。目前尚不清楚是降低客观乳腺癌风险还是其他因素决定了 CRRM 的决策。我们旨在通过仔细研究一个中心的决策过程来确定影响这些决策的因素。
我们回顾了在一个中心考虑进行 CRRM 的 60 例连续患者。使用定性方法分析了数据来源，包括常规心理评估记录、外科医生的信件、病例记录和对四位外科医生的访谈。
对客观风险的看法通常不会驱动患者的请求或外科医生的决策。相反，CRRM 似乎主要是出于心理原因而进行的：减轻患者的癌症担忧并获得美容益处。
常规使用“降低风险”手术一词掩盖了通常反映风险以外因素的临床决策。由于 CRRM 通常是出于心理原因进行的，因此需要有关其社会心理结果的证据。
