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Why Are There So Many Mastectomies in the United States?
Annual Review of Medicine ( IF 10.5 ) Pub Date : 2017-01-18 00:00:00 , DOI: 10.1146/annurev-med-043015-075227
Anita Mamtani 1 , Monica Morrow 1
Affiliation  

Breast-conserving therapy (BCT) and mastectomy result in equivalent long-term survival. Locoregional recurrence rates after BCT have decreased over time and are now similar to those after mastectomy. Contralateral breast cancer rates are declining as well owing to the widespread use of adjuvant systemic therapy. Despite these improved outcomes, increasing rates of bilateral mastectomy for unilateral cancer have been observed in the United States. Medical indications for mastectomy are well defined and present in a minority of patients, and women at increased risk for contralateral cancer are a small proportion of the breast cancer population. Evidence indicates that increasing use of mastectomy is a patient-driven trend that is most pronounced among younger, educated, and well-insured women, and reflects fear of recurrence and in some cases misunderstanding of future cancer risks. Although satisfaction levels are generally high among patients choosing contralateral prophylactic mastectomy, complications and procedure extent may be underestimated. Improved communication strategies are essential to facilitate this complex decision-making process.

中文翻译:


为什么在美国有这么多的直肠切除术?

保乳疗法(BCT)和乳房切除术可带来相当的长期生存率。BCT后局部复发率随时间下降,现在与乳房切除术后相似。由于辅助性全身治疗的广泛使用,对侧乳腺癌的发病率也在下降。尽管取得了这些改善的结果,但在美国已观察到双侧乳房切除术治疗单侧癌症的比率增加。乳房切除术的医学适应症已明确定义,并存在于少数患者中,对侧癌风险增加的妇女在乳腺癌人群中所占比例很小。有证据表明,越来越多地使用乳房切除术是一种由患者驱动的趋势,在年轻,受过良好教育和保险状况良好的女性中最为明显,并反映出对复发的恐惧,在某些情况下还反映了对未来癌症风险的误解。尽管在选择对侧预防性乳房切除术的患者中满意度通常很高,但是并发症和手术范围可能会被低估。改进的沟通策略对于促进这一复杂的决策过程至关重要。

更新日期:2017-01-18
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