Division of Plastic & Reconstructive Surgery, Department of Surgery, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
Department of Surgery, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
Curr Oncol. 2021 Jan 25;28(1):702-715. doi: 10.3390/curroncol28010069.
Breast cancer susceptibility gene (BRCA) mutation carriers have an increased risk of breast cancer. Mitigation of this risk can be achieved via surveillance or prophylactic mastectomy with or without breast reconstruction. Those that choose surgery expect to reduce their chance of developing cancer. The purpose of this study was to determine the incidence of patients developing breast cancer prior to surgery and to identify modifiable contributing factors within the patient journey. This is a historical cohort study of all BRCA mutation carriers identified through the British Columbia Cancer Hereditary Cancer Program between 2000 and 2012. Patients were divided into two groups: surveillance (S) and prophylactic mastectomy with immediate breast reconstruction (PM/IBR). The incidence of cancer, time to PM/IBR and patient journeys were analyzed. A total of 333 women were identified. The time to surgery from mutation disclosure was a median of 31 (5.3, 75.7) months. During this period, 6% of patients developed breast cancer compared with a 14% incidence of breast cancer in patients choosing surveillance. The majority of time to surgery was attributed to the period between mutation disclosure and the decision to proceed with surgery. Strategies to facilitate decision-making as well as wait list prioritization and dedicated operative time should be targeted to this population to decrease the number of women developing an interval cancer prior to surgery.
乳腺癌易感基因 (BRCA) 突变携带者患乳腺癌的风险增加。可以通过监测或预防性乳房切除术（伴或不伴乳房重建）来降低这种风险。选择手术的人期望降低患癌症的几率。本研究旨在确定手术前患者发生乳腺癌的发生率，并确定患者就诊过程中的可改变的促成因素。这是一项对 2000 年至 2012 年间通过不列颠哥伦比亚癌症遗传性癌症计划确定的所有 BRCA 突变携带者进行的历史队列研究。患者分为两组：监测 (S) 和预防性乳房切除术伴即刻乳房重建 (PM/IBR)。分析了癌症的发生率、PM/IBR 的时间和患者就诊过程。共确定了 333 名女性。从突变披露到手术的时间中位数为 31（5.3，75.7）个月。在此期间，选择监测的患者中有 6%发生了乳腺癌，而选择手术的患者中有 14%发生了乳腺癌。手术时间的大部分归因于突变披露和决定进行手术之间的时间段。应针对该人群制定决策促进策略以及等待名单优先级和专门的手术时间，以减少在手术前发生间隔期癌症的女性数量。
