Tesson Stephanie, Richards Imogen, Porter David, Phillips Kelly-Anne, Rankin Nicole, Costa Daniel, Musiello Toni, Marven Michelle, Butow Phyllis
School of Psychology, The University of Sydney, NSW, Australia; Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, NSW, Australia.
School of Psychology, The University of Sydney, NSW, Australia.
Breast. 2017 Feb;31:233-240. doi: 10.1016/j.breast.2016.11.025. Epub 2016 Dec 13.
Contralateral prophylactic mastectomy (CPM) reduces the risk of contralateral breast cancer (BC) following unilateral BC, but may not increase survival in BRCA1/2 mutation negative women. Despite this, and the risk for adverse physical and psychological impact, uptake is increasing in BRCA1/2 mutation negative women. We aimed to quantify the degree of reduction in lifetime contralateral BC risk women required to justify CPM, and to explore demographic, disease and psychosocial predictors of preferences using Protection Motivation Theory (PMT) as a theoretical framework. Reasoning behind preferences was also examined.
388 women previously diagnosed with unilateral BC, of negative or unknown BRCA1/2 status, were recruited from an advocacy group research database. Two hypothetical risk trade-off scenarios were used to quantify the reduction in lifetime contralateral BC risk that women judged necessary to justify CPM, using a 5% and 20% baseline. Demographic, disease and PMT measures were assessed using a questionnaire.
Most women required their risk to be more than halved from a 5% or 20% baseline to justify CPM. Polarised preferences were also common, with some women consistently accepting or refusing CPM independent of risk/benefit trade-offs. Preferences were associated with coping self-efficacy and having a prior CPM. Explanations for judging CPM worthwhile included reducing or eliminating contralateral BC risk, attaining breast symmetry and reducing worry.
Risk-reduction preferences were highly variable. Decisive factors in women's preferences for CPM related to clinical, psychological and cosmetic outcomes, but not to demographic or disease characteristics.
对侧预防性乳房切除术（CPM）可降低单侧乳腺癌（BC）后患对侧乳腺癌的风险，但对于BRCA1/2基因无突变的女性，该手术可能不会提高生存率。尽管如此，且存在身体和心理不良影响的风险，但BRCA1/2基因无突变的女性对该手术的接受度仍在增加。我们旨在量化为使CPM合理女性所需的终生对侧乳腺癌风险降低程度，并以保护动机理论（PMT）为理论框架，探索偏好的人口统计学、疾病和社会心理预测因素。同时还研究了偏好背后的理由。
从一个倡导组织研究数据库中招募了388名先前被诊断为单侧乳腺癌、BRCA1/2基因状态为阴性或未知的女性。使用两种假设的风险权衡情景，以5%和20%的基线水平来量化女性认为使CPM合理所需的终生对侧乳腺癌风险降低程度。通过问卷调查评估人口统计学、疾病和PMT指标。
大多数女性要求将其风险从5%或20%的基线水平降低一半以上，才能使CPM合理。两极分化的偏好也很常见，一些女性始终接受或拒绝CPM，而与风险/收益权衡无关。偏好与应对自我效能感和曾接受过CPM有关。认为CPM值得的理由包括降低或消除对侧乳腺癌风险、实现乳房对称和减少担忧。
风险降低偏好差异很大。女性对CPM偏好的决定性因素与临床、心理和美容结果有关，而与人口统计学或疾病特征无关。
