Department of Breast Oncology, NHO Shikoku Cancer Center, Matsuyama, Japan.
Division of Breast Surgical Oncology, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan.
Jpn J Clin Oncol. 2022 Nov 3;52(11):1265-1269. doi: 10.1093/jjco/hyac120.
Risk-reducing mastectomy is one option for women with hereditary breast and ovarian cancer to reduce the risk of breast cancer.
We analyzed data of the Japanese Organization of Hereditary Breast and Ovarian Cancer on women who were diagnosed as hereditary breast and ovarian cancer by BRCA germline genetic testing between 2010 and 2019 to reveal the rate and likelihood of risk-reducing mastectomy.
There were 412 women with BRCA1, 271 with BRCA2 and 4 with both female pathogenic variants. Ninety (13.1%) received risk-reducing mastectomy. The rates of risk-reducing mastectomy were statistically significantly higher in women with BRCA1 pathogenic variants than BRCA2, in women who had breast cancer than those who did not, in women with a breast cancer family history than in those without, in mothers than in those without children, in women who were receiving surveillance with MRI than those who were not and in women who received risk-reducing salpingo-oophorectomy than in those who did not on univariate analyses. The ages when they received the genetic testing were statistically significantly younger in the women receiving risk-reducing mastectomy than those who did not receive it. The women with BRCA1 pathogenic variants, personal history of breast cancer, mothers, those receiving MRI surveillance and younger women were independently significantly more likely to receive risk-reducing mastectomy based on multivariate analysis.
The rate of risk-reducing mastectomy was not high in Japan; however, risk-reducing surgery was approved by the Japanese National Medical Insurance for hereditary breast and ovarian cancer patients with breast and/or ovarian cancer in 2020, so this rate will increase.
降低风险的乳房切除术是遗传性乳腺癌和卵巢癌女性降低乳腺癌风险的一种选择。
我们分析了日本遗传性乳腺癌和卵巢癌组织中 2010 年至 2019 年间通过 BRCA 种系基因检测诊断为遗传性乳腺癌和卵巢癌的女性的数据，以揭示降低风险的乳房切除术的比率和可能性。
有 412 名女性携带 BRCA1 致病性变异，271 名女性携带 BRCA2 致病性变异，4 名女性同时携带两种女性致病性变异。90 名（13.1%）接受了降低风险的乳房切除术。BRCA1 致病性变异女性接受降低风险的乳房切除术的比率明显高于 BRCA2 致病性变异女性，有乳腺癌的女性明显高于没有乳腺癌的女性，有乳腺癌家族史的女性明显高于没有乳腺癌家族史的女性，有孩子的母亲明显高于没有孩子的母亲，接受 MRI 监测的女性明显高于没有接受 MRI 监测的女性，接受降低风险的输卵管卵巢切除术的女性明显高于没有接受的女性。在单变量分析中，接受降低风险乳房切除术的女性接受基因检测的年龄明显低于未接受者。基于多变量分析，携带 BRCA1 致病性变异、个人乳腺癌病史、母亲、接受 MRI 监测和年轻的女性更有可能接受降低风险的乳房切除术。
在日本，降低风险的乳房切除术的比率并不高；然而，2020 年日本国家医疗保险批准了遗传性乳腺癌和卵巢癌患者有乳腺癌和/或卵巢癌的情况下进行降低风险的手术，因此这一比率将会增加。
