Dana-Farber Cancer Institute, Boston, MA, USA.
University of Rhode Island, Kingston, RI, USA.
Psychooncology. 2018 Jun;27(6):1524-1529. doi: 10.1002/pon.4683. Epub 2018 Apr 6.
Young women with unilateral breast cancer are increasingly choosing contralateral prophylactic mastectomy (CPM), despite its limited medical benefit for most women. The purpose of this study was to better understand this choice through a qualitative exploration of surgical decision-making in young survivors, including how issues particular to younger women affected their decision and the post-surgical experience.
Women age ≤ 40 years with stage 0 to III breast cancer, 1 to 3 years from diagnosis who had undergone breast cancer surgery were recruited to participate. Four focus groups were conducted: 2 with women who had bilateral mastectomy and 2 with women who kept their contralateral breast. Focus groups were recorded and transcribed with identifiers removed. Emergent themes were identified by thematic content analysis using NVivo 11.
Of the 20 participants, median age at diagnosis was 37 years. Emergent themes were categorized into the following domains: (1) emotions/feelings surrounding surgery/decision about surgery; (2) factors affecting the decision; (3) communication and interaction with the healthcare team; (4) impact on post-surgical life and recovery; and (5) support needs. Young women who chose CPM often were concerned about a future breast event, despite this low risk, suggesting some gain peace of mind by choosing CPM. Young survivors also had many physical and emotional concerns after surgery for which they did not always feel prepared.
Informational resources and decision aids may enhance patient-doctor communication and help young survivors better understand risk and manage expectations surrounding short and longer-term physical and emotional effects after surgery.
尽管大多数女性接受预防性对侧乳房切除术（CPM）的获益有限，但患有单侧乳腺癌的年轻女性越来越多地选择该手术。本研究旨在通过对年轻幸存者的手术决策进行定性探索，更好地了解这一选择，包括特定于年轻女性的问题如何影响她们的决策以及术后体验。
招募年龄≤40 岁、分期为 0 至 III 期的乳腺癌患者，诊断后 1 至 3 年，已接受乳腺癌手术。共进行了 4 次焦点小组讨论：2 次是接受双侧乳房切除术的女性，2 次是保留对侧乳房的女性。去除标识符后，使用 NVivo 11 对焦点小组记录和转录进行主题内容分析，以识别出现的主题。
20 名参与者的中位诊断年龄为 37 岁。出现的主题分为以下几个领域：（1）手术相关的情绪/感受/决定手术的因素；（2）影响决策的因素；（3）与医疗团队的沟通和互动；（4）对术后生活和恢复的影响；以及（5）支持需求。选择 CPM 的年轻女性常常担心未来的乳房事件，尽管这种风险较低，但通过选择 CPM，她们可能会获得一些安心。年轻幸存者在手术后也有许多身体和情绪上的担忧，对此她们并不总是感到有准备。
信息资源和决策辅助工具可以增强医患沟通，帮助年轻幸存者更好地了解风险，并管理手术前后短期和长期的身体和情绪影响的预期。
