MD Program, University of South Florida Morsani College of Medicine, Tampa, FL.
Center for Evidence-based Medicine and Health Outcomes Research, University of South Florida, Tampa, FL.
Clin Breast Cancer. 2021 Aug;21(4):e427-e433. doi: 10.1016/j.clbc.2021.01.008. Epub 2021 Jan 19.
Carriers of deleterious mutations in breast cancer predisposition genes are presented with critical choices regarding cancer risk management. Risk-reduction mastectomy is a major preventative strategy in this population. Understanding the decision-making process for prophylactic mastectomy is essential in patient-centered care for high-risk carriers and patients with breast cancer. We sought to provide insight into influential factors underlying preventative surgery decisions among individuals with high breast cancer risk.
We conducted a retrospective chart review of pathogenic carriers of high-risk breast cancer genes who presented to the Moffitt GeneHome clinic between March 2017 and June 2020. Associations between preventative mastectomy choice and influence variables were analyzed via unadjusted and adjusted logistic regression models.
Of 258 high-risk mutation carriers, 104 (40.3%) underwent risk-reduction mastectomy. A significantly higher proportion of mastectomy patients reported prior history of breast cancer (68.9% vs. 16.5%; P < .001) and history of other risk-reduction or noncancer-related surgeries (61.7% vs. 25.8%; P < .001). Significant predictors affecting surgery decision included previous breast cancer history (adjusted odds ratio [aOR], 10.48; 95% confidence interval [CI], 5.59-19.63; P < .0001), other risk-reduction or noncancer-related surgical history (aOR, 4.65; 95% CI, 2.28-9.47; P < .0001), and age at presentation to the genetics clinic (< 35 years old: aOR, 2.77; 95% CI, 1.04-7.4; P = .042; 35-55 years old: aOR, 2.48; 95% CI, 1.19-5.18; P = .016).
Preventive mastectomy decisions are highly personal and complex. In our sample, we observed prior history or concurrent breast cancer, history of other risk-reduction surgery or noncancer-related surgery, and younger age at presentation to the GeneHome clinic to be predictive of mastectomy uptake.
携带有害乳腺癌易感基因突变的个体需要在癌症风险管理方面做出关键选择。降低风险的乳房切除术是该人群的主要预防策略。了解预防性乳房切除术决策的决策过程对于高危携带者和乳腺癌患者的以患者为中心的护理至关重要。我们旨在深入了解高乳腺癌风险个体中预防性手术决策的影响因素。
我们对 2017 年 3 月至 2020 年 6 月期间在 Moffitt GeneHome 诊所就诊的高风险乳腺癌基因致病性携带者进行了回顾性图表审查。通过未调整和调整后的逻辑回归模型分析了预防性乳房切除术选择与影响变量之间的关联。
在 258 名高危突变携带者中，有 104 名（40.3%）接受了降低风险的乳房切除术。接受乳房切除术的患者中，有较高比例的患者有乳腺癌病史（68.9%比 16.5%；P<.001）和其他降低风险或非癌症相关手术史（61.7%比 25.8%；P<.001）。影响手术决策的显著预测因素包括既往乳腺癌病史（调整后的优势比[aOR]，10.48；95%置信区间[CI]，5.59-19.63；P<.0001）、其他降低风险或非癌症相关手术史（aOR，4.65；95% CI，2.28-9.47；P<.0001）和遗传学诊所就诊时的年龄（<35 岁：aOR，2.77；95% CI，1.04-7.4；P=.042；35-55 岁：aOR，2.48；95% CI，1.19-5.18；P=.016）。
预防性乳房切除术的决策是高度个人化和复杂的。在我们的样本中，我们观察到既往或同时患有乳腺癌、有其他降低风险的手术或非癌症相关手术史，以及在 GeneHome 诊所就诊时年龄较小，这些因素预测了乳房切除术的采用。
