BRCA 携带者行双侧输卵管-卵巢切除术降低风险后：绝经激素治疗知识差距，以及医生建议的影响。

BRCA carriers after risk-reducing bilateral salpingo-oophorectomy: menopausal hormone therapy knowledge gaps, and the impact of physicians' recommendations.

机构信息

Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.

Center for Medical Decision Making, Ono Academic College, Kiryat Ono, Israel.

出版信息

Climacteric. 2023 Apr;26(2):154-160. doi: 10.1080/13697137.2023.2173567. Epub 2023 Mar 3.

DOI:10.1080/13697137.2023.2173567

PMID:36866779

Abstract

OBJECTIVE

Female carriers of BRCA1/2 gene mutations are at an increased lifetime risk for breast and ovarian cancers. They are recommended to undergo risk-reducing surgery, including bilateral salpingo-oophorectomy (RR-BSO), upon completion of childbearing. RR-BSO surgery decreases morbidity and mortality but results in early menopause. Menopausal hormone therapy (MHT) is under-utilized despite being shown as safe for carriers. We aim to evaluate the factors associated with decision-making regarding MHT use following RR-BSO in healthy BRCA mutation carriers.

METHODS

Female carriers aged <50 years who underwent RR-BSO and were followed in a multidisciplinary clinic completed online multiple-choice and free-text questionnaires.

RESULTS

A total of 142 women met the inclusion criteria and filled the questionnaire: 83 were MHT users and 59 were non-users. MHT users underwent RR-BSO earlier than non-users (40.82 ± 3.91 vs. 42.88 ± 4.34; < 0.0001). MHT usage was positively associated with MHT explanation (odds ratio 4.318, 95% confidence interval [CI] [1.341-13.902], = 0.014), and knowledge regarding the safety of MHT and its effects on general health (odds ratio 2.001, 95% CI [1.443-2.774], < 0.0001). MHT users and non-users retrospectively evaluated their comprehension of RR-BSO consequences as significantly lower than before surgery ( < 0.001).

CONCLUSION

Post-RR-BSO outcomes, including the effects on women's quality of life and its possible mitigation through MHT use, need to be addressed pre surgery by healthcare providers.

摘要

目的

携带 BRCA1/2 基因突变的女性终生患乳腺癌和卵巢癌的风险增加。建议她们在完成生育后进行降低风险的手术，包括双侧输卵管卵巢切除术（RR-BSO）。RR-BSO 手术降低了发病率和死亡率，但导致早绝经。尽管已经证明对携带者是安全的，但绝经激素治疗（MHT）的应用不足。我们旨在评估与 RR-BSO 后 MHT 使用相关的决策因素，以评估健康的 BRCA 突变携带者。

方法

在多学科诊所接受 RR-BSO 并随访的年龄<50 岁的女性携带者完成了在线多项选择和自由文本问卷。

结果

共有 142 名符合纳入标准并填写问卷的女性：83 名是 MHT 用户，59 名是非用户。MHT 用户比非用户更早进行 RR-BSO（40.82±3.91 与 42.88±4.34； < 0.0001）。MHT 的使用与 MHT 解释呈正相关（优势比 4.318，95%置信区间[CI] [1.341-13.902]， = 0.014），以及对 MHT 的安全性及其对整体健康的影响的知识（优势比 2.001，95%CI [1.443-2.774]， < 0.0001）。MHT 用户和非用户回顾性地评估他们对 RR-BSO 后果的理解明显低于手术前（ < 0.001）。