Šašková P, Pavlišta D, Dostálek L
Rozhl Chir. 2017 Fall;96(8):328-333.
Genetic mutations are responsible for 5-10% of all breast and ovarian carcinomas, while most of them are caused by a mutation of the BRCA gene. Women with this type of mutation have a lifetime risk of breast and ovarian cancer and therefore, they require very intensive medical care, including surgical prevention. Specifically, prophylactic bilateral mastectomy and prophylactic salpingo-oophorectomy are done, which undoubtedly decrease the riskof cancer. The aim of this review article is to inform healthcare professionals and the general public about the satisfaction of BRCA positive women with their decision to undergo these prophylactic surgeries, and also about the impact of these procedures on sexuality, menopausal symptoms, mental health and the overall quality of life.
Search of original studies and review articles onthe influence of prophylactic surgeries on the life of women with BRCA genemutation.
In general, although some changes are observed after the prophylactic surgeries, the overall quality of life does not change. A significant reduction in anxiety and fear of cancer is observed after both prophylactic bilateral mastectomy andprophylactic bilateral salpingo-oophorectomy, providing great psychological relief to the affected women. However, prophylactic bilateral salpingo-oophorectomy causes premature menopause in premenopausal women at the time of surgery and the associated occurrence of menopausal symptoms. Some of the symptoms can be significantly reduced by hormone replacement therapy but will not be eliminated altogether. In postmenopausal women, no or minimal worsening of menopausal symptoms was reported. After prophylactic bilateral mastectomy, particularly appearance-related problems were observed. In both types of surgery, sexual problems were also observed.
The relief of reducingthe risk of cancerappears to be so great and so important for women that it outweighs the other negative effects of these prophylactic procedures.Key words: BRCA1/2 mutation - breast cancer - ovarian cancer - prophylactic bilateral salpingo-oophorectomy - prophylactic bilateral mastectomy.
基因突变为所有乳腺癌和卵巢癌的5%-10%负责，而其中大多数是由BRCA基因的突变引起的。患有这种类型突变的女性有患乳腺癌和卵巢癌的终生风险，因此，她们需要非常密集的医疗护理，包括手术预防。具体而言，会进行预防性双侧乳房切除术和预防性输卵管卵巢切除术，这无疑会降低患癌风险。这篇综述文章的目的是让医疗保健专业人员和普通公众了解BRCA阳性女性对接受这些预防性手术决定的满意度，以及这些手术对性功能、更年期症状、心理健康和整体生活质量的影响。
检索关于预防性手术对BRCA基因突变女性生活影响的原始研究和综述文章。
总体而言，尽管在预防性手术后观察到了一些变化，但整体生活质量并未改变。在预防性双侧乳房切除术和预防性双侧输卵管卵巢切除术后，焦虑和对癌症的恐惧都有显著降低，为受影响的女性提供了极大的心理缓解。然而，预防性双侧输卵管卵巢切除术会使绝经前女性在手术时提前绝经，并伴有更年期症状的出现。其中一些症状可以通过激素替代疗法显著减轻，但不会完全消除。在绝经后女性中，未报告更年期症状有加重或仅有轻微加重。在预防性双侧乳房切除术后，尤其观察到了与外观相关的问题。在这两种手术中，也都观察到了性方面的问题。
降低患癌风险带来的缓解对女性来说似乎是如此之大且如此重要，以至于它超过了这些预防性手术的其他负面影响。关键词：BRCA1/2突变 - 乳腺癌 - 卵巢癌 - 预防性双侧输卵管卵巢切除术 - 预防性双侧乳房切除术
