Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
Am J Surg. 2021 Jun;221(6):1172-1176. doi: 10.1016/j.amjsurg.2021.03.040. Epub 2021 Mar 24.
Contralateral prophylactic mastectomy (CPM) is not recommended for average-risk women with breast cancer due to lack of evidence for survival benefit, yet recent studies demonstrate increasing CPM rates.
We identified patients with breast cancer treated with unilateral mastectomy (UM) with or without CPM. Rates of malignancy in CPM specimens and factors in CPM rates were assessed.
From 2013 to 2017, 1353 patients had UM and 355 had CPM. Our institution's occult malignancy detection rate was 5.04%. CPM rates decreased from 31.6% to 17.3% (p < 0.001) over 5 years. Compared to patients receiving UM only, patients receiving CPMs had significantly higher reconstruction rates (p < 0.001), which did not significantly change over time (p = 0.551) and tended to be younger (p < 0.001).
Patients having UM have low risk of contralateral malignancy. CPM is associated with younger age and breast reconstruction, suggesting factors to identify for patient and provider education.
由于缺乏生存获益的证据，不建议将对侧预防性乳房切除术 (CPM) 用于乳腺癌的低危女性，但最近的研究表明 CPM 率不断增加。
我们确定了接受单侧乳房切除术 (UM) 治疗且伴或不伴 CPM 的乳腺癌患者。评估 CPM 标本中恶性肿瘤的发生率和 CPM 率的影响因素。
2013 年至 2017 年，1353 例患者接受 UM，355 例患者接受 CPM。我们机构的隐匿性恶性肿瘤检出率为 5.04%。5 年内，CPM 率从 31.6%降至 17.3%（p<0.001）。与仅接受 UM 的患者相比，接受 CPM 的患者的重建率明显更高（p<0.001），但随着时间的推移并没有显著变化（p=0.551），且往往更年轻（p<0.001）。
接受 UM 的患者发生对侧恶性肿瘤的风险较低。CPM 与年龄较小和乳房重建有关，提示需要识别这些因素，以便对患者和医务人员进行教育。
