早期乳腺癌女性对侧预防性乳房切除术使用情况的差异。
Disparities in contralateral prophylactic mastectomy use among women with early-stage breast cancer.
作者信息
Kim Younji, McCarthy Anne Marie, Bristol Mirar, Armstrong Katrina
机构信息
Massachusetts General Hospital, 50 Staniford Street, 9-940L, Boston, MA 02114 USA.
Harvard Medical School, Boston, MA USA.
出版信息
NPJ Breast Cancer. 2017 Jan 27;3:2. doi: 10.1038/s41523-017-0004-z. eCollection 2017.
Contralateral prophylactic mastectomy use has increased over the past decades among women with early-stage breast cancer. Racial differences in contralateral prophylactic mastectomy use are well described, but with unclear causes. This study examined contralateral prophylactic mastectomy use among black and white women and the contribution of differences in perceived risk to differences in use. We surveyed women diagnosed with early-stage unilateral breast cancer between ages 41-64 in Pennsylvania and Florida between 2007-2009 to collect data on breast cancer treatment, family history, education, income, insurance, and perceived risk. Clinical factors-age,stage at diagnosis, receptor status-were obtained from cancer registries. The relationships between patient factors and contralateral prophylactic mastectomy were assessed using logistic regression. The interaction between race and contralateral prophylactic mastectomy on the perceived risk of second breast cancers was tested using linear regression. Of 2182 study participants, 18% of whites underwent contralateral prophylactic mastectomy compared with 10% of blacks ( < 0.001). The racial difference remained after adjustment for clinical factors and family history (odds ratio = 2.32, 95% confidence interval 1.76-3.06, < 0.001). The association between contralateral prophylactic mastectomy and a reduction in the perceived risk of second breast cancers was significantly smaller for blacks than whites. Blacks were less likely than whites to undergo contralateral prophylactic mastectomy even after adjustment for clinical factors. This racial difference in use may relate to the smaller impact of contralateral prophylactic mastectomy on the perceived risk of second breast cancers among blacks than among whites. Future research is needed to understand the overall impact of perceived risk on decisions about contralateral prophylactic mastectomy and how that may explain racial differences in use.
在过去几十年中，早期乳腺癌女性对侧预防性乳房切除术的使用有所增加。对侧预防性乳房切除术使用方面的种族差异已有详尽描述，但原因尚不清楚。本研究调查了黑人和白人女性对侧预防性乳房切除术的使用情况，以及感知风险差异对使用差异的影响。我们在2007年至2009年间对宾夕法尼亚州和佛罗里达州年龄在41至64岁之间被诊断为早期单侧乳腺癌的女性进行了调查，以收集有关乳腺癌治疗、家族史、教育程度、收入、保险和感知风险的数据。临床因素（年龄、诊断时的分期、受体状态）从癌症登记处获取。使用逻辑回归评估患者因素与对侧预防性乳房切除术之间的关系。使用线性回归测试种族与对侧预防性乳房切除术对第二次患乳腺癌感知风险的相互作用。在2182名研究参与者中，18%的白人接受了对侧预防性乳房切除术，而黑人中这一比例为10%（P<0.001）。在对临床因素和家族史进行调整后，种族差异仍然存在（优势比=2.32，95%置信区间1.76 - 3.06，P<0.001）。黑人中对侧预防性乳房切除术与第二次患乳腺癌感知风险降低之间的关联明显小于白人。即使在对临床因素进行调整后，黑人接受对侧预防性乳房切除术的可能性也低于白人。这种使用上的种族差异可能与对侧预防性乳房切除术对黑人第二次患乳腺癌感知风险的影响小于白人有关。未来需要进行研究，以了解感知风险对侧预防性乳房切除术决策的总体影响，以及这如何解释使用上的种族差异。
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