Falco Giuseppe, Rocco Nicola, Bordoni Daniele, Marano Luigi, Accurso Antonello, Buccelli Claudio, Di Lorenzo Pierpaolo, Capasso Emanuele, Policino Fabio, Niola Massimo, Ferrari Guglielmo
Breast Surgery Unit Arcispedale-IRCCS Santa Maria Nuova, Reggio Emilia, Italy.
Department of Clinical Medicine and Surgery, University of Naples "Federico II", Napoli, Italy.
Open Med (Wars). 2016 Aug 2;11(1):238-241. doi: 10.1515/med-2016-0047. eCollection 2016.
The use of contralateral risk reducing mastectomy (CRRM) is indicated in women affected by breast cancer, who are at high risk of developing a contralateral breast cancer, particularly women with genetic mutation of BRCA1, BRCA2 and P53. However we should consider that the genes described above account for only 20-30% of the excess familiar risk. What is contralaterally indicated when genetic assessment results negative for mutation in a young patient with unilateral breast cancer? Is it ethically correct to remove a contralateral "healthy" breast? CRRM rates continue to rise all over the world although CRRM seems not to improve overall survival in women with unilateral sporadic breast cancer. The decision to pursue CRRM as part of treatment in women who have a low-to-moderate risk of developing a secondary cancer in the contralateral breast should consider both breast cancer individual-features and patients preferences, but should be not supported by the surgeon and avoided as first approach with the exception of women highly worried about cancer. Prospective studies are needed to identify cohorts of patients most likely to benefit from CRRM.
对于罹患乳腺癌且对侧乳腺癌发病风险较高的女性，尤其是携带BRCA1、BRCA2和P53基因突变的女性，建议进行对侧预防性乳房切除术（CRRM）。然而，我们应该认识到，上述基因仅占家族性额外风险的20%-30%。对于单侧乳腺癌的年轻患者，若基因评估结果显示无突变，那么对侧应如何处理？切除对侧“健康”乳房在伦理上是否正确？尽管CRRM似乎并不能提高单侧散发性乳腺癌女性的总体生存率，但全球范围内CRRM的比例仍在持续上升。对于对侧乳房发生继发性癌症风险较低至中等的女性，将CRRM作为治疗方案的一部分时，应综合考虑乳腺癌的个体特征和患者偏好，但外科医生不应支持该方案，除非女性对癌症极度担忧，否则应避免将其作为首选方法。需要开展前瞻性研究，以确定最有可能从CRRM中获益的患者群体。
