保留乳房的乳腺癌切除术可以用于治疗遗传性乳腺癌

根据2004年11月22日《癌症》在线期刊上发表的研究结果：女性遗传性乳腺癌患者接受保留乳房的乳腺癌切除术，手术过的乳房癌症复发的风险不会增加。

保留乳房的乳腺癌切除术(Breast-conserving therapy, BCT)，包括乳房局部病灶切除术和放疗，用于治疗非遗传性或者散发性早期乳腺癌已经被证明是安全有效的。但是使用BCT治疗BRCA1和BRCA2基因突变的女性乳腺癌患者则仍然存在争议。这是因为有资料认为手术过的乳房癌症复发的风险增加，未治疗的乳房会生成新的肿瘤，这些资料充满矛盾。在一项新研究中，对87例诊断为乳腺癌而且有BRCA突变的女性使用BCT治疗后远期的癌症风险进行了评估。

研究者发现：与年轻无基因突变的女性乳腺癌患者相比，手术过的乳房癌症复发风险并没有增加。在明确诊断后的10年，13.6％有基因突变的女性出现肿瘤复发，与以前使用BCT治疗的非遗传性乳腺癌女性相似。但是超过半数的女性患者在诊断后的10年内发生肿瘤相关性事件，37.6％的患者未手术治疗的乳房生成新的癌症。

“保留乳房的乳腺癌切除术对BRCA突变女性患者是一种合理的治疗选择，单侧乳房切除术的手术指征对遗传性和非遗传性乳腺癌患者是相同的，”作者总结说。但是，作者提醒“应当对双侧乳房切除术进行论证，以确保控制对侧乳房发生癌症的风险。”该项研究由Mark Robson医学博士和Memorial Solan-Kettering癌症中心(New York, NY, USA)的同事完成的。

Breast-Conserving Therapy for Hereditary Disease
 
Women with hereditary breast cancer treated with breast-conserving therapy have no increased risk for recurrence in the treated breast, according to a study published in the November 22, 2004, online issue of Cancer.

Breast-conserving therapy (BCT), consisting of lumpectomy and radiation, has been demonstrated in the past to be a safe, effective treatment for nonhereditary or sporadic forms of early breast cancer. However, the use of BCT for women with mutations in BRCA1 and BRCA2 genes has been controversial because of conflicting data about the increased risk of recurrence in the treated breast and the development of tumors in the untreated breast. In the new study, 87 women diagnosed with breast cancer and BRCA mutations were treated with BCT to evaluate their long-term cancer risks.

Investigators found no increase in the risk of cancer recurrence in the treated breast, compared to young women without mutations. Ten years after diagnosis, 13.6% of the women with a genetic mutation had experienced a recurrence similar to previously found rates for women with nonhereditary cancers treated with BCT. However, more than half of the women suffered a cancer-related event within 10 years of their diagnosis, including 37.6% who experienced a new cancer in the untreated breast.

“Breast-conserving treatment is a reasonable option for [women with BRCA mutations], and the indications for unilateral mastectomy should be the same for both hereditary and nonhereditary breast cancer,” concluded the authors. However, they caution that “discussion of bilateral mastectomy is warranted by the significant contralateral breast cancer risk.” The study was conducted by Mark Robson, M.D., and colleagues from Memorial Sloan-Kettering Cancer Center (New York, NY, USA).