2.不推荐进行预防性对侧乳房切除术。; text-align: right; "> 北京市朝阳区桓兴肿瘤医院 桓兴医讯编译组 南南和北北
Contralateral Prophylactic Mastectomy
Ramya Ramaswami, M.B., B.S., M.P.H., Monica Morrow, M.D., and Reshma Jagsi, M.D., D.Phil.
N Engl J Med 2017; 377:1288-1291September 28, 2017DOI: 10.1056/NEJMclde1708293
Comments and Poll open through September 25, 2018
A Woman Considering Contralateral Prophylactic Mastectomy
Ramya Ramaswami, M.B., B.S., M.P.H.
Ms. Markes is a 51-year-old woman who has recently received a diagnosis of breast cancer, and she comes to you to seek your opinion about her surgical options. Three weeks earlier, she had undergone mammography and magnetic resonance imaging to evaluate a mass in the left breast. She has been told that she has a 3-cm triple-negative (i.e., negative for estrogen and progesterone receptors and for overexpression of human epidermal growth factor receptor type 2 [HER2]) invasive ductal carcinoma of the left breast. The breast cancer is at clinical stage IIA or T2N0M0 (i.e., the tumor is >2 cm and<5 cm in the greatest dimension and has not spread to the lymph nodes or to distant sites). Ms. Markes has no history of medical or surgical issues. Menarche was at 11 years of age, and she had an elective termination of pregnancy when she was 22 years old.
Ms. Markes is anxious and fearful, especially since she has a family history of breast cancer. Her sister received a diagnosis of breast cancer at 37 years of age. Ms. Markes tearfully recollects her experiences of caring for her mother, who died of metastatic breast cancer at 55 years of age. Ms. Markes does not know whether any other family members have a history of cancer. She underwent testing for BRCA1 and BRCA2 mutations, and the results were negative. On examination today, you note breast asymmetry and palpate a 3-cm mass in her left breast. There are no palpable lymph nodes. She has participated in many support groups, and after discussion with other women who have undergone breast-cancer surgery, she has been encouraged to consider contralateral prophylactic mastectomy and bilateral breast reconstruction. Ms. Markes asks you whether you would recommend a contralateral prophylactic mastectomy in her case.
Which of the following strategies would you choose for this patient?
1. Recommend contralateral prophylactic mastectomy.
2. Do not recommend contralateral prophylactic mastectomy.