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    北京市朝阳区桓兴肿瘤医院

    中国医学科学院肿瘤医院紧密型医联体

    肿瘤专科医协体

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    桓兴医讯 预防性对侧乳房切除术

    作者:南南和北北 来源:北京市朝阳区桓兴肿瘤医院
    字号: + - 14
    小标题
    预防性对侧乳房切除术
    病历简要
    一名考虑进行预防性对侧乳房切除术的女性
    Markes女士51岁,最近诊断出乳腺癌,向你咨询她的手术选择。3周前,她对左乳肿块进行了乳腺钼靶和乳腺核磁检查,被告知左乳患有3cm的三阴性(即雌激素受体、孕激素受体、人表皮生长因子受体2[HER2]过表达阴性)侵袭性导管癌,乳腺癌临床分期为IIA期或T2N0M0(即肿瘤最大径>2cm但<5cm,未波及淋巴结或远处部位)。Markes女士既往无疾病史或外科手术史,11岁初潮,22岁时有过一次选择性终止妊娠。
    Markes女士感到担忧害怕,特别是她有乳腺癌家族史。她的姐姐37岁时诊断出乳腺癌,Markes含泪回忆自己照顾母亲的经历,母亲55岁死于转移性乳腺癌,Markes不知道家庭其他成员是否有癌症史。她进行了BRCA1和BRCA2的基因突变检查,结果为阴性。今天为检查日,你注意到乳房不对称、左乳可触及一3cm肿块,未触及淋巴结。她已参加了很多支持小组,与其它做了乳腺癌手术的女性进行过探讨,建议她考虑进行预防性对侧乳腺切除术及双乳重建。Markes问你,像她这样的病例,你是否推荐预防性对侧乳腺切除术。
    治疗选择
    你会为这位病人选择下面的哪个策略?
    1.推荐进行预防性对侧乳房切除术。
    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
    2017年11月20日 星期一



    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
    Case Vignette
    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.
    Treatment Options
    Which of the following strategies would you choose for this patient?
    1. Recommend contralateral prophylactic mastectomy.
    2. Do not recommend contralateral prophylactic mastectomy.
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