Rosenberg Shoshana M, Sepucha Karen, Ruddy Kathryn J, Tamimi Rulla M, Gelber Shari, Meyer Meghan E, Schapira Lidia, Come Steven E, Borges Virginia F, Golshan Mehra, Winer Eric P, Partridge Ann H
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Ann Surg Oncol. 2015 Nov;22(12):3809-15. doi: 10.1245/s10434-015-4572-6. Epub 2015 May 1.
Rates of contralateral prophylactic mastectomy (CPM) have increased in the United States, with younger women with breast cancer the most likely to have CPM.
As part of an ongoing cohort study of young women diagnosed with breast cancer at age ≤40 years, we conducted multinomial logistic regression of data from 560 women with unilateral Stage I-III disease to identify factors associated with: (1) CPM versus unilateral mastectomy (UM); (2) CPM versus breast-conserving surgery (BCS).
Median age at diagnosis was 37 years; 66 % of women indicated that their doctor said that BCS was an option or was recommended. Of all women, 42.9 % had CPM, 26.8 % UM, and 30.4 % BCS. Among women who said the surgical decision was patient-driven, 59.9 % had CPM, 22.8 % BCS, and 17.3 % UM. Clinical characteristics associated with CPM versus BCS included HER2 positivity, nodal involvement, larger tumor size, lower BMI, parity, and testing positive for a BRCA mutation. Emotional and decisional factors associated with CPM versus UM and BCS included anxiety, less fear of recurrence, and reporting a patient-driven decision. Women who reported a physician-driven decision were less likely to have had CPM than both of the other surgeries, whereas higher confidence with the decision was associated with having CPM versus BCS.
Many young women with early-stage breast cancer are choosing CPM. The association between CPM and emotional and decisional factors suggest that improved communication together with better psychosocial support may improve the decision-making process.
在美国，对侧预防性乳房切除术（CPM）的比例有所上升，患有乳腺癌的年轻女性最有可能接受CPM。
作为一项正在进行的对年龄≤40岁被诊断为乳腺癌的年轻女性队列研究的一部分，我们对560名单侧I - III期疾病女性的数据进行了多项逻辑回归分析，以确定与以下情况相关的因素：（1）CPM与单侧乳房切除术（UM）；（2）CPM与保乳手术（BCS）。
诊断时的中位年龄为37岁；66%的女性表示她们的医生说过BCS是一种选择或被推荐。在所有女性中，42.9%接受了CPM，26.8%接受了UM，30.4%接受了BCS。在表示手术决策由患者主导的女性中，59.9%接受了CPM，22.8%接受了BCS，17.3%接受了UM。与CPM和BCS相关的临床特征包括HER2阳性、淋巴结受累、肿瘤尺寸较大、BMI较低、生育情况以及BRCA突变检测呈阳性。与CPM和UM以及BCS相关的情感和决策因素包括焦虑、对复发的恐惧较小以及报告决策由患者主导。报告决策由医生主导的女性接受CPM的可能性低于其他两种手术，而对决策的更高信心与接受CPM而非BCS相关。
许多早期乳腺癌的年轻女性正在选择CPM。CPM与情感和决策因素之间的关联表明，改善沟通以及更好的心理社会支持可能会改善决策过程。
