定义乳腺癌外科预防的终身风险值
Xia Wei1,2, Lea Mansour2, Samuel Oxley2,3
1Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.
JAMA oncology
|July 24, 2025
概括
降低风险的乳房切除术 (RRM) 对30-55岁的女性具有35%或更高的终身乳腺癌 (BC) 风险具有成本效益. 这一发现可能会扩大RRM访问范围,超出BRCA病原性变体携带者.
科学领域:
- 在瘤学瘤学.
- 卫生经济学 卫生经济学
- 预防医学 预防医学
背景情况:
- 基因检测和风险模型可以确定没有BRCA1/BRCA2/PALB2突变的女性患乳腺癌 (BC) 风险较高.
- 提供降低风险的乳腺切除术 (RRM) 的最佳BC风险值仍未确定.
研究的目的:
- 确定与非手术预防策略相比,RRM具有成本效益的终身BC风险值.
- 为更广泛的人群提供RRM提供临床指南提供信息.
主要方法:
- 一个决策分析的马尔科夫模型评估了RRM与BC查和医疗预防的成本效益.
- 从英国付款人的角度进行了模拟,对整个生命周期进行了模拟.
- 敏感性分析探讨了不同的BC风险 (17%-50%) 和年龄组 (30-60岁).
主要成果:
- 对于30岁的女性来说,RRM在34%的终身BC风险下变得具有成本效益 (使用30,000英/QALY支付意愿).
- 门因年龄而异,RRM对于30-55岁的女性具有≥35%的终身BC风险而具有成本效益.
- 提供RRM给具有≥35%终身BC风险的妇女可以预防每年约11%的英国BC病例.
结论:
- RRM是30-55岁女性的成本有效的BC预防策略,终身风险≥35%.
- 研究结果支持扩大RRM接入到风险模型识别的女性,超出高透基因载体.
- 需要进一步研究RRM在这个人群中的可接受性和长期结果.
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