Arslan Bilal, Tazeoğlu Deniz, Dağ Ahmet, Berkeşoğlu Mustafa, Özdemir Asena Ayça
Department of General Surgery, Mersin University Faculty of Medicine, Mersin, Turkey.
Department of Biostatistics, Mersin University Faculty of Medicine, Mersin, Turkey.
Turk J Surg. 2021 Dec 31;37(4):347-354. doi: 10.47717/turkjsurg.2021.4963. eCollection 2021 Dec.
Prophylactic contralateral/bilateral mastectomy (PCM/PBM), as a risk-reducing mastectomy procedure, has a few evidence-based indica- tions; however, there is an increasing trend in the total number of operations globally. Worldwide famous actress Angelina Jolie was detected to have BRCA-1 mutation and underwent a prophylactic bilateral mastectomy in 2013. The procedure was perceived as 'lifesaving' worldwide, which eventually led to a significant increase in BRCA gene mutation analysis and PCM/PBM. In this study, it was aimed to evaluate our risk-reducing PCM/PBM results.
Twenty-seven patients underwent risk-reducing PCM/PBM between 2010-2018, but only 22 patients were included into the study. A retrospective analysis was carried out on demographics, family history, preoperative diagnoses, pathological findings, mastectomy details, reconstructive procedures, neoadjuvant chemotherapy, BRCA analysis, educational status, and mastectomy indications.
Surgical indications or major reasons for surgery were as follows: BRCA-1 mutation (n= 5), BRCA-2 mutation (n= 3), malignant-like areas in magnetic resonance imaging (n= 2), lobular carcinoma in situ (n= 3) and intense anxiety (n= 9). Eighteen patients (82%) underwent an additional re- constructive procedure via implantation or autologous tissue and four patients (18%) underwent mastectomy only. PCM/PBM by years was as: 2010 (n= 1), 2011 (n= 0), 2012 (n= 1), 2013 (n= 2), 2014 (n= 1), 2015 (n= 2), 2016 (n= 3), 2017 (n= 4), 2018 (n= 8), which represents the recently increasing trend.
Risk-reducing PCM/PBM was performed in 59.1% of the patients (n= 13) for a significant medical reason, whereas for distress about a relapse or a new disease on the contralateral breast on the remaining 40.9% of the patients (n= 9). Evidence in the literature shows that risk-reducing mastectomy does not affect survival, although it lowers breast cancer incidence. Close surveillance, cancer screening, and chemoprevention methods should have priority.
预防性对侧/双侧乳房切除术（PCM/PBM）作为一种降低风险的乳房切除手术，有一些循证医学指征；然而，全球范围内手术总数呈上升趋势。全球著名女演员安吉丽娜·朱莉被检测出携带BRCA-1基因突变，并于2013年接受了预防性双侧乳房切除术。该手术在全球被视为“挽救生命”，最终导致BRCA基因突变分析和PCM/PBM显著增加。本研究旨在评估我们进行的降低风险的PCM/PBM结果。
2010年至2018年期间，27例患者接受了降低风险的PCM/PBM，但仅22例患者纳入本研究。对患者的人口统计学、家族史、术前诊断、病理结果、乳房切除细节、重建手术、新辅助化疗、BRCA分析、教育状况和乳房切除指征进行回顾性分析。
手术指征或主要手术原因如下：BRCA-1基因突变（n = 5）、BRCA-2基因突变（n = 3）、磁共振成像显示恶性样区域（n = 2）、小叶原位癌（n = 3）和严重焦虑（n = 9）。18例患者（82%）通过植入或自体组织进行了额外的重建手术，4例患者（18%）仅接受了乳房切除术。按年份统计的PCM/PBM情况如下：2010年（n = 1）、2011年（n = 0）、2012年（n = 1）、2013年（n = 2）、2014年（n = 1）、2015年（n = 2）、2016年（n = 3）、2017年（n = 4）、2018年（n = 8），呈现出近期上升趋势。
59.1%的患者（n = 13）因重大医学原因接受了降低风险的PCM/PBM，而其余40.9%的患者（n = 9）是因为对侧乳房复发或新发疾病的担忧。文献证据表明，降低风险的乳房切除术虽可降低乳腺癌发病率，但不影响生存率。应优先考虑密切监测、癌症筛查和化学预防方法。
