Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Expert Rev Anticancer Ther. 2020 Mar;20(3):159-166. doi: 10.1080/14737140.2020.1732213. Epub 2020 Feb 28.
: The contralateral prophylactic mastectomy (CPM) rate in the U.S. has been steadily increasing. This is of particular concern because many women who undergo this procedure are candidates for breast-conserving surgery.: CPM's medical benefit is related to the risk of contralateral cancer development and whether CPM provides a survival benefit. Contralateral cancer rates have decreased, and CPM does not provide a survival benefit. Other potential benefits of the procedure may be improved quality of life; these data are reviewed. Research efforts have been undertaken to better understand the decision-making process of patients who consider, and ultimately undergo, this procedure.: Decisional traits, personal values, the desire for peace of mind, and the desire to obtain breast symmetry are important factors that drive a woman's decision to undergo CPM. Additionally, many patients lack the knowledge on how different types of breast surgery impact outcomes. To improve the shared decision-making process, a stepwise approach to address possible misconceptions, and clarify the real risks/benefits of this procedure should be utilized. A clear recommendation (for/against) should be made for every patient with newly diagnosed breast cancer who considers CPM. Communication tools to assist patients and surgeons in this process are sorely needed.
: 美国的预防性对侧乳房切除术（CPM）率一直在稳步上升。这尤其令人担忧，因为许多接受该手术的女性都是保乳手术的候选者。: CPM 的医学益处与对侧癌症发展的风险以及 CPM 是否提供生存益处有关。对侧癌症的发生率已经下降，CPM 并不能提供生存益处。该手术的其他潜在益处可能是改善生活质量；审查了这些数据。为了更好地了解考虑并最终接受该手术的患者的决策过程，已经开展了研究工作。: 决策特征、个人价值观、寻求安心的愿望以及获得乳房对称性的愿望是推动女性决定接受 CPM 的重要因素。此外，许多患者缺乏关于不同类型的乳房手术如何影响结果的知识。为了改善共同决策过程，应该采用逐步的方法来解决可能存在的误解，并澄清该手术的真正风险/益处。应该对每一位考虑接受 CPM 的新诊断为乳腺癌的患者做出明确的建议（赞成/反对）。非常需要用于协助患者和外科医生进行此过程的沟通工具。
