乳癌篩檢與存活率--整形乳房植入

[李誠民]

前兩期BMJ有文章報導乳癌早期發現(?)就做乳房切除,並植入整形乳房 (cosmetic breast implants),而近一兩天媒體報導---安捷莉那 潔莉,因乳癌基因篩檢,得知日後有乳癌的機率,是90%;;若做乳房預防性切除,乳癌的發生機率為小於5%;;........
Breast cancer detection and survival among women with cosmetic breast implants: systematic review and meta-analysis of observational studies
BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2399 (Published 30 April 2013)
Cite this as: BMJ 2013;346:f2399

Abstract
Objectives To evaluate whether the stage distribution among women diagnosed as having breast cancer differs between those who have received breast implants for cosmetic purposes and those with no implants and to evaluate whether cosmetic breast augmentation before the detection of breast cancer is a predictor of post-diagnosis survival.
Design Systematic review of observational studies with two meta-analyses.
Data sources Systematic search of the literature published before September 2012 conducted in Medline, Embase, Global health, CINAHL, IPAB, and PsycINFO.
Study selection Eligible publications were those that included women diagnosed as having breast cancer and who had had augmentation mammaplasty for cosmetic purposes.
Results The overall odds ratio of the first meta-analysis based on 12 studies was 1.26 (95% confidence interval 0.99 to 1.60; P=0.058; I2=35.6%) for a non-localized stage of breast cancer at diagnosis comparing women with implants who had breast cancer and women without implants who had breast cancer. The second meta-analysis, based on five studies, evaluated the relation between cosmetic breast implantation and survival. This meta-analysis showed reduced survival after breast cancer among women who had implants compared with those who did not (overall hazard ratio for breast cancer specific mortality 1.38, 95% confidence interval 1.08 to 1.75).
Conclusions The research published to date suggests that cosmetic breast augmentation adversely affects the survival of women who are subsequently diagnosed as having breast cancer. These findings should be interpreted with caution, as some studies included in the meta-analysis on survival did not adjust for potential confounders. Further investigations are warranted regarding diagnosis and prognosis of breast cancer among women with breast implants.
如果換在台灣,Surgeon 要怎樣告訴您的病患?!