Nightingale Breast Unit, University Hospital South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK.
Lancet Oncol. 2013 Jun;14(7):e262-9. doi: 10.1016/S1470-2045(13)70047-0.
Recent studies have shown that the number of women undergoing risk-reducing mastectomy has increased rapidly in the USA in the past 15 years. Although a small rise in the number of bilateral risk-reducing procedures has been noted in high-risk gene mutation carriers who have never had breast cancer, this number does not account for the overall increase in procedures undertaken. In patients who have been treated for a primary cancer and are judged to be at high risk of a contralateral breast cancer, contralateral risk-reducing mastectomy is often, but not universally, indicated. However, many patients undergoing contralateral risk-reducing mastectomy might not be categorised as high risk and therefore any potential benefit from this procedure is unproven. At a time when breast-conserving surgery has become more widely used, this sharp increase in contralateral risk-reducing mastectomy is surprising. We have reviewed the literature in an attempt to establish what is driving the increase in this procedure in moderate-to-low-risk populations and to assess its justification in terms of risk-benefit analysis.
最近的研究表明，在过去的 15 年中，美国接受降低风险的乳房切除术的女性人数迅速增加。尽管在从未患有乳腺癌的高危基因突变携带者中，双侧降低风险手术的数量略有上升，但这一数字并不能说明总体手术数量的增加。对于已接受原发性癌症治疗且被认为有罹患对侧乳腺癌高风险的患者，通常会进行对侧降低风险的乳房切除术，但并非普遍如此。然而，许多接受对侧降低风险的乳房切除术的患者可能不属于高危人群，因此该手术的潜在益处未经证实。在保乳手术已经更广泛应用的时代，对侧降低风险的乳房切除术的急剧增加令人惊讶。我们已经查阅了文献，试图确定是什么因素导致中低风险人群中这种手术的增加，并根据风险效益分析来评估其合理性。
