乳腺癌高危妇女的评估与预防策略

Assessment and prevention of high risk women with breast cancer

乳腺癌是女性最常见的恶性肿瘤之一。流行病学研究发现乳腺癌有许多高危因素 ,其中最主要的因素包括年龄、乳腺癌家庭史和既往某些乳腺疾病史。对于乳腺癌的高危人群开展预防工作是目前的一项重要课题 ,常用的方法包括预防性乳腺切除术、严密监测和化学预防。多项研究表明预防性乳腺切除术不能百分之百起到预防效果 ;乳房切除容易给妇女带来严重的精神创伤 ,因而必须严格掌握手术指证 ,术后也宜首选即刻乳房重建。严密监测应包括定期乳腺X线摄片和临床体检 ,前者已证实具有明显的早期诊断价值 ;有关化学预防试剂的随机对照研究已有初步结果 ,三苯氧胺能显著降低乳腺癌高危人群的乳腺癌发生率 ,相关的其他临床研究还在进行之中。总之乳腺癌高危人群的预防策略应首先基于患者危险性的高低 ,病人对危险性以及各项预防措施的看法应当得到重视 。

Breast cancer is one of the most common malignancies in women. The epidemiological study suggests that the development of female breast cancer is related to dozens of risk factors, among which age,family history of breast cancer and anamnesis of some breast diseases are three most important ones. Therefore, prophylactic measures for high risk women have become a significant subject. Today the preventive methods include prophylactic mastectomy, strict surveillance and chemoprevention. Many researches demonstrated preventive surgery is not absolutely reliable; women without breasts may develop psychosis and for this reason the indication must be defined carefully and a following immediate reconstruction of breast should be considered. The strict surveillance consists of regular mammography and clinical examination. The recent ongoing clinical trials on chemoprevention drugs have preliminary results, NSABP 01 showed that Tamoxifen could effectively reduce the incidence of breast cancer after 7 years follow up. In conclusion, the preventive strategy for high risk women should be based on the graveness of the risks. The patient's attitude for her risk factor and all preventive methods should be recognized by doctors when the choice is made ultimately.