University of Birmingham, Birmingham, B15 2TT, UK.
University Hospital Birmingham NHS Trust, Mindelsohn Way, Birmingham, B15 2TH, UK.
Sci Rep. 2021 Feb 2;11(1):2847. doi: 10.1038/s41598-021-82654-x.
Contralateral risk-reducing mastectomy (CRRM) rates have tripled over the last 2 decades. Reasons for this are multi-factorial, with those harbouring a pathogenic variant in the BRCA1/2 gene having the greatest survival benefit. On May 14th, 2013, Angelina Jolie shared the news of her bilateral risk-reducing mastectomy (BRRM), on the basis of her BRCA1 pathogenic variant status. We evaluated the impact of this news on rates of CRRM in women with increased risk for developing breast cancer after being diagnosed with unilateral breast cancer. The prospective cohort study included all women with at least a moderate lifetime risk of developing breast cancer who attended our family history clinic (1987-2019) and were subsequently diagnosed with unilateral breast cancer. Rates of CRRM were then compared between patients diagnosed with breast cancer before and after Angelina Jolie's announcement (pre- vs. post-AJ). Of 386 breast cancer patients, with a mean age at diagnosis of 48 ± 8 years, 268 (69.4%) were diagnosed in the pre-AJ period, and 118 (30.6%) in the post-AJ period. Of these, 123 (31.9%) underwent CRRM, a median 42 (interquartile range: 11-54) days after the index cancer surgery. Rates of CRRM doubled following AJ's news, from 23.9% pre-AJ to 50.0% post AJ (p < 0.001). Rates of CRRM were found to decrease with increasing age at breast cancer (p < 0.001) and tumour TNM stage (p = 0.040), and to increase with the estimated lifetime risk of breast cancer (p < 0.001) and tumour grade (p = 0.015) on univariable analysis. After adjusting for these factors, the step-change increase in CRRM rates post-AJ remained significant (odds ratio: 9.61, p < 0.001). The AJ effect appears to have been associated with higher rates of CRRM amongst breast cancer patients with increased cancer risk. CRRM rates were highest amongst younger women and those with the highest lifetime risk profile. Clinicians need to be aware of how media news can impact on the delivery of cancer related services. Communicating objective assessment of risk is important when counselling women on the merits of risk-reducing surgery.
过去 20 年来，对侧预防性乳房切除术（CRRM）的比率增加了两倍。其原因是多方面的，携带 BRCA1/2 基因突变的患者具有最大的生存获益。2013 年 5 月 14 日，安吉丽娜·朱莉（Angelina Jolie）根据其 BRCA1 致病性变异状态，分享了她接受双侧预防性乳房切除术（BRRM）的消息。我们评估了这一消息对单侧乳腺癌确诊后乳腺癌风险增加的女性进行 CRRM 的比率的影响。这项前瞻性队列研究纳入了所有至少有中度终生乳腺癌发病风险并在我们的家族史诊所就诊（1987-2019 年）且随后被诊断为单侧乳腺癌的女性。然后比较了安吉丽娜·朱莉（Angelina Jolie）发布消息前后（AJ 前 vs. AJ 后）诊断为乳腺癌的患者的 CRRM 率。在 386 名乳腺癌患者中，平均发病年龄为 48±8 岁，268 名（69.4%）患者在 AJ 前期间被诊断，118 名（30.6%）在 AJ 后期间被诊断。其中，123 名（31.9%）接受了 CRRM，在指数癌症手术后中位数 42（四分位距：11-54）天。AJ 消息发布后，CRRM 的比率翻了一番，从 AJ 前的 23.9%增加到 AJ 后的 50.0%（p<0.001）。CRRM 的比率随着乳腺癌发病年龄的增加而降低（p<0.001）和肿瘤 TNM 分期（p=0.040），随着估计的终生乳腺癌风险（p<0.001）和肿瘤分级（p=0.015）的增加而增加。在调整这些因素后，AJ 后 CRRM 比率的显著变化仍然显著（比值比：9.61，p<0.001）。AJ 效应似乎与风险增加的乳腺癌患者中 CRRM 比率较高有关。CRRM 比率在年轻女性和终生风险最高的女性中最高。临床医生需要意识到媒体新闻如何影响癌症相关服务的提供。在为接受风险降低手术的女性提供咨询时，对风险进行客观评估非常重要。
