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2016年6月30日，美国乳腺外科医师学会、外科肿瘤学会（SSO）官方期刊《外科肿瘤学年鉴》在线发表布朗大学沃伦·阿尔珀特医学院妇婴医院乳腺健康中心、纽约圣彼得医院、德克萨斯大学MD安德森癌症中心、马萨诸塞大学医学院、罗德岛妇婴医院的前瞻性匿名调查问卷研究报告，发现女性选择乳腺癌手术时，相信直觉多过专业建议。 共有396位女性返回调查问卷。其中，67.9%行乳房肿块切除术，8.6%行乳房切除术，23.5%行乳房切除再造术，超过77%有伴侣，将近75%的伴侣参加了外科会诊。 令人惊讶的是，多数选择乳房切除术的女性认为自己做出手术决定（56.5%行乳房切除再造术，46.3%行乳房切除术，42.7%乳房肿块切除术）。选择乳房肿块切除术的女性认为她们的外科医师最有影响力（44.2%行乳房肿块切除术，39%行乳房切除术，23.2%行乳房切除再造术）。 此外，乳房切除术与乳房肿块切除术相比，无论是否行再造术，术后患者伴侣对患者胸部视觉满意度均显著下降（91.9%、83.9%、75.9%，P=0.01）。如果患者为乳房肿块切除术候选者，但是选择乳房切除再造术，与选择乳房肿块切除术相比，术后胸部在亲密关系中发挥的作用显著下降（术前91.7%比83.8%，P=0.3；术后42.9%比65.1%，P=0.01）。 因此，当面临决定选择哪种手术切除乳腺癌时，较多女性更相信她们自己的判断，而非外科医师或伴侣的建议。 Ann Surg Oncol. 2016 Jun 30. [Epub ahead of print] Influential Forces in Breast Cancer Surgical Decision Making and the Impact on Body Image and Sexual Function. Kwait RM, Pesek S, Onstad M, Edmonson D, Clark MA, Raker C, Stuckey A, Gass J. Women and Infants Hospital Breast Health Center, Warren Alpert School of Medicine/Brown University, Providence, RI, USA; St. Peter's Hospital, Albany, NY, USA; MD Anderson Cancer Center, Houston, TX, USA; University of Massachusetts Medical School, Worcester, MA, USA; Women and Infants' Hospital of Rhode Island, Providence, RI, USA. BACKGROUND: Shared decision making with one's partner and body image satisfaction may affect surgical choices of breast cancer patients. This study analyzed whether partner opinion was associated with choice of operation and whether comfort level with one's partner was altered postoperatively. METHODS: A prospective anonymous survey was administered to breast cancer patients who underwent breast surgery between 2000 and 2014. Categorical variables were compared by χ 2 or Fisher's exact test. RESULTS: Women who elected to undergo mastectomy with reconstruction (MR) placed greater emphasis on their own decision making than on input from their partner, surgeon, or others (56.5 vs. 8.3 vs. 23.2 vs. 12, respectively), whereas those who chose lumpectomy (L) placed similar weight on surgeon input and self-input (44.2 vs. 42.7 %). Only 7.5 % of all patients identified their partner as the greatest influence on their surgical choice. Preoperatively, the L group was the most comfortable with their partner seeing their chest (91.9 % L vs. 83.9 % MR vs. 75.9 % mastectomy alone (M); p = 0.01), and postoperatively, the comfort levels for all were remarkably decreased. Furthermore, if a patient was a candidate for L but chose MR, the role her chest played in intimacy dropped more compared with those who chose L (83.8 % L vs. 91.7 % MR; p = 0.3 preoperatively to 65.1 % L vs. 42.9 % MR; p = 0.01 postoperatively). CONCLUSIONS: When making surgical decisions, most patients indicate that they value their own opinion over that of others. Mastectomy, regardless of reconstruction, leads to a significant reduction in comfort with one's partner postoperatively compared with lumpectomy. This information may be helpful in counseling couples at the time of consultation for breast cancer treatment. PMID: 27364508 DOI: 10.1245/s10434-016-5365-2
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