Department of Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610, Singapore.
Breast. 2014 Feb;23(1):56-62. doi: 10.1016/j.breast.2013.10.008. Epub 2013 Nov 23.
Contralateral prophylactic mastectomy (CPM) removes the non-diseased breast in women who have unilateral breast cancer. This reduces the incidence of contralateral breast cancer, and potentially improves survival in high risk patients. Such surgical risk-reduction strategy is increasingly being adopted in the United States, despite a decreasing incidence of contralateral breast cancer. The use of CPM in an Asian population is yet unknown. We present the first Asian report on CPM rates and trends in Singapore, the country with the highest incidence of breast cancer in Asia.
A retrospective review of all patients who had breast cancer surgery from 2001 to 2010 at the largest healthcare system in Singapore was performed. Patient demographics and tumour characteristics were analysed with regards to type of surgery performed. Factors associated with CPM were identified.
From 2001 to 2010, a total of 5130 patients underwent oncological breast surgery. A decreasing trend of mastectomies (82.7%-70.8%), an upward trend of breast conserving surgery (BCS) (17.3%-29.2%) and an increasing trend in CPM (0.46%-1.25%) is observed. Patients who opted for CPM are likely to be younger (48.4 ± 9.4 years), married (60%), parous (56.7%), with no family history of breast/ovarian cancer (66.7%), and diagnosed at an earlier stage. The rate of synchronous occult breast malignancy was found to be 10% (n = 30), and these were in patients who were of a low cancer-risk profile.
This retrospective study reflects an increasing incidence of breast cancer in Singapore, with a decrease in mastectomies, and an increase in BCS and CPM rates, similar to Western data. Similar to Western populations, the Asian woman who opts for CPM is likely to be young and have an earlier stage of breast cancer. In contrast, the Asian woman is likely to have no family history of breast or ovarian cancers. Commonly cited reasons for increased CPM rates such as the increased availability of genetic counselling and pre-operative MRI evaluation, along with wide use of reconstruction, do not feature as dominant factors in our population, suggesting that the Asian patients may have different considerations when electing for CPM.
对侧预防性乳房切除术（CPM）可切除单侧乳腺癌患者的非患病乳房。这可以降低对侧乳腺癌的发生率，并有可能提高高危患者的生存率。尽管对侧乳腺癌的发生率正在下降，但这种手术风险降低策略在美国越来越多地被采用。CPM 在亚洲人群中的使用情况尚不清楚。我们首次在新加坡报告了 CPM 率和趋势，新加坡是亚洲乳腺癌发病率最高的国家。
对 2001 年至 2010 年在新加坡最大的医疗保健系统中接受乳腺癌手术的所有患者进行了回顾性分析。分析了患者的人口统计学和肿瘤特征与所行手术类型的关系。确定了与 CPM 相关的因素。
2001 年至 2010 年，共有 5130 例患者接受了肿瘤乳房手术。行乳房切除术的比例呈下降趋势（82.7%-70.8%），行保乳手术的比例呈上升趋势（17.3%-29.2%），CPM 的比例呈上升趋势（0.46%-1.25%）。选择 CPM 的患者更可能年轻（48.4±9.4 岁）、已婚（60%）、已育（56.7%）、无乳腺癌/卵巢癌家族史（66.7%），且诊断为早期阶段。发现同步隐匿性乳腺癌的发生率为 10%（n=30），这些患者的癌症风险较低。
这项回顾性研究反映了新加坡乳腺癌发病率的上升，乳房切除术减少，保乳手术和 CPM 率增加，与西方数据相似。与西方人群一样，选择 CPM 的亚洲女性可能较为年轻，且患有早期乳腺癌。相比之下，亚洲女性可能没有乳腺癌或卵巢癌家族史。常被认为是 CPM 率增加的原因，如遗传咨询和术前 MRI 评估的增加，以及重建的广泛使用，在我们的人群中并不是主要因素，这表明亚洲患者在选择 CPM 时可能有不同的考虑因素。
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