癌癥專家支持朱莉摘除卵巢決定

Experts Back Angelina Jolie Pitt in Choices for Cancer Prevention

癌癥專家支持朱莉摘除卵巢決定

Cancer experts said Tuesday that the actress and filmmaker Angelina Jolie Pitt was wise to have had her ovaries and fallopian tubes removed last week because she carries a genetic mutation, BRCA1, that significantly increases the risk of ovarian cancer, a disease so difficult to detect that it is often found only at an advanced, untreatable stage.

癌癥專家在周二表示，演員、電影人安吉麗娜·朱莉·皮特(Angelina Jolie Pitt)上周選擇摘除卵巢和輸卵管是一個明智的決定，因為她身上攜帶BRCA1基因突變，這大大增加了患卵巢癌的風險，這種癌癥很難檢測到，通常到了晚期無法治愈的階段才會被發(fā)現(xiàn)。

They also said Ms. Jolie Pitt’s decision to discuss her own choices so frankly will encourage women in similar situations to consider their own options. BRCA mutations cause about 5 to 10 percent of breast cancers and 10 to 15 percent of ovarian cancers among white women in the United States. It is unclear how common the mutations are in other racial and ethnic groups.

他們還表示，朱莉·皮特如此坦誠地講述自己的選擇，將會鼓勵處境相似的女性去權(quán)衡她們的選項。在美國的白人女性中，由BRCA基因突變導致的乳腺癌病例占5%-10%，卵巢癌病例占10%-15%。目前尚不清楚，這種基因突變在其他種族和民族中有多普遍。

“Prophylactic removal of ovaries and fallopian tubes is strongly recommended in women before age 40 in BRCA1 and BRCA2 mutation carriers,” said Dr. Susan Domchek, executive director of the University of Pennsylvania’s Basser Research Center, which specializes in BRCA mutations. “There is no effective screening for ovarian cancer and too many women with advanced stage ovarian cancer die of their disease.”

“強烈建議不滿40歲的BRCA1、BRCA2基因突變攜帶者采取預防性舉措，摘除卵巢和輸卵管，”賓夕法尼亞大學(University of Pennsylvania)巴瑟爾研究中心(Basser Research Center)執(zhí)行主任蘇珊·多姆切克(Susan Domchek)說。“沒有有效檢測卵巢癌的方法，有很多處于卵巢癌晚期的女性死于這種疾病。”該中心專門研究BRCA變異。

Writing for The New York Times’s Op-Ed page, Ms. Jolie Pitt, 39, said she had expected to have her ovaries and fallopian tubes removed, a procedure called a laparoscopic bilateral salpingo-oophorectomy, but that a cancer scare made her decide to undergo the procedure sooner. Her mother, aunt and grandmother died of cancer.

39歲的朱莉·皮特在為《紐約時報》撰寫的觀點文章中寫道，摘除卵巢和輸卵管是她意料中的事，但對癌癥的擔憂促使她決定盡早進行這種叫做“腹腔鏡下雙側(cè)輸卵管卵巢切除術(shù)”的處理。她的母親、姨媽和外祖母均死于癌癥。

“To my relief, I still had the option of removing my ovaries and fallopian tubes and I chose to do it,” she wrote.

她寫道，“讓我釋然的是，自己仍舊可以決定去切除卵巢和輸卵管，而我的決定就是去做手術(shù)。”

Two years ago, she ignited a worldwide discussion about options for women at high risk for breast cancer when she wrote that she had had both breasts removed because BRCA1, the same genetic mutation that prompted her surgery last week, increased her risk of breast cancer.

兩年前，她撰文稱自己切除了雙乳，因為BRCA1加大了她患乳腺癌的風險，此舉在世界范圍內(nèi)引發(fā)了有關乳腺癌發(fā)病率較高的女性應該怎么做的討論。同樣也是BRCA1基因突變促使她上周接受手術(shù)。

Several doctors said that for women in similar situations, they generally recommend that ovaries be removed before breasts, but the cost is that women who do so go into early menopause and can no longer bear children. However, removing the ovaries substantially decreases a woman’s risk of developing breast cancer. Also, breast cancer is generally more detectable and treatable than ovarian cancer.

幾名醫(yī)生表示，對于處境類似的女性，他們通常建議在切除乳房前摘除卵巢，但代價就是做此類手術(shù)的女性將會提早絕經(jīng)，再也不能生孩子了。然而，摘除卵巢會大幅降低女性患乳腺癌的風險。與卵巢癌相比，乳腺癌通常更容易發(fā)現(xiàn)和治療。

“We’re really quite pushy about oophorectomy,” Dr. Domchek said. “And we talk about mastectomy as an option.”

“我們對卵巢切除術(shù)是非常堅持的，”多姆切克表示。“而乳房切除術(shù)我們會作為一個選項來談。”

Experts said that some details mentioned by Ms. Jolie Pitt might not apply to all women with such mutations or might be characterized differently by doctors. For example, Ms. Jolie Pitt wrote that she was advised to have the surgery about 10 years before the age at which her mother was first diagnosed, which was 49. But doctors said a better rule of thumb is between ages 35 and 40, ideally after a woman has finished having children but before her cancer risk rises sharply.

專家表示，朱莉·皮特提到的一些細節(jié)可能不適用于所有攜帶此類變異的女性，可能不同醫(yī)生也會有不同說法。例如，朱莉·皮特寫道，醫(yī)生建議她比母親第一次確診的年齡——也就是49歲——早10年接受手術(shù)。但醫(yī)生們表示，實際經(jīng)驗證明35至40歲是比較適合的年齡，理想的狀態(tài)就是在生完孩子后，患癌風險急劇增加前。

Ms. Jolie Pitt also said she had a yearly test for the CA-125 protein to monitor the possibility of ovarian cancer. She noted that her doctor said the test missed a high percentage of cancers. Some experts said they had stopped such tests because they miss so many cancers and have not been shown to improve survival rates.

朱莉·皮特還表示，她接受了每年一次的CA-125蛋白質(zhì)檢測，以監(jiān)控是否有卵巢癌的跡象。她說她的醫(yī)生表示，這種檢測會漏過很多癌癥。一些專家表示他們已經(jīng)不再進行此類檢測了，因為漏過的癌癥實在太多，而且沒有證據(jù)證明它們能夠提高生存率。

“We’ve basically said there’s no data to support it and we’re recommending the surgery,” said Dr. Kenneth Offit, chief of the clinical genetics service at Memorial Sloan Kettering Cancer Center.

紀念斯隆-凱特琳癌癥中心(Memorial Sloan Kettering Cancer Center)的臨床遺傳學服務主任肯尼思·奧夫特(Kenneth Offit)說，“從根本上來說，沒有數(shù)據(jù)支持此類檢測，我們建議做手術(shù)。”

He added: “In the end what she did is fine. She got to the right place. She had ovarian surgery done within the window of time.”

他還表示，“最終，她做得很好。她做出了正確的決定，在時間窗口內(nèi)接受了卵巢摘除手術(shù)。”

Ms. Jolie Pitt’s decision not to remove her uterus was consistent with what experts recommended. “There is no research showing that having a BRCA mutation puts women at risk for uterine cancer,” said Dr. Jamie Bakkum-Gamez, a gynecologic oncologist at the Mayo Clinic.

朱莉·皮特不摘除子宮的決定符合專家建議。梅奧診所(Mayo Clinic)的婦產(chǎn)科腫瘤學家杰米·巴庫姆-加梅斯博士(Dr. Jamie Bakkum-Gamez)說，“目前還沒有研究顯示，有一個BRCA基因突變的人有罹患子宮癌的風險。”

Dr. Jamie Bakkum-Gamez and other experts endorsed her decision to take hormone replacement therapy — an estrogen patch and a progesterone intrauterine device — to counteract symptoms of surgery-induced menopause.

杰米·巴庫姆-加梅斯博士和其他專家同意了她的決定：采取激素替代療法——一種雌激素貼片和孕酮宮內(nèi)節(jié)育器——來減少手術(shù)引起的更年期癥狀。

Ms. Jolie Pitt, who has six children, three adopted, wrote that she knows these decisions are “far harder” for women who still want to get pregnant and that she had learned they might have options “to remove their fallopian tubes but keep their ovaries.” Experts cautioned that the evidence is still slim on whether fallopian tube removal is effective at preventing ovarian cancer.

朱莉·皮特有六個孩子，其中三個是領養(yǎng)的。她寫道，她知道對于仍然希望懷孕的女性來說，這些決定會“更加困難”，而且她知道她們可以選擇“摘除輸卵管，但保留卵巢”。專家提醒道，關于摘除輸卵管是否能有效防止卵巢癌，目前證據(jù)仍不充分。

Shira Krance, 35, who has a BRCA2 mutation, had a double mastectomy two years ago and said she has considered whether to have the fallopian tubes removed before her ovaries.

35歲的希拉·克蘭斯(Shira Krance)也有一個BRCA2基因突變，她于兩年前接受了雙側(cè)乳腺切除術(shù)，還說自己曾考慮是否要在摘除卵巢前，先摘除輸卵管。

“Doctors will give you a lot of options, but nobody will tell you what to do,” said Ms. Krance, who lives in Valley Cottage, N.Y., and has two young children. “It’s scary, the idea of not being around when your children grow up. That’s the worst thing and I’m going to do everything I can to avoid that.”

“醫(yī)生會給你提供很多選項，但沒人會告訴你該怎么做，”克蘭斯說。她住在紐約瓦利科塔日，有兩個年幼的孩子。“在孩子成長的時候不能陪伴他們，這種情況很可怕。這是最糟糕的事，我會盡我所能來避免。”

Ethel Zelenske, 62, a BRCA1 carrier who lives in Baltimore, had her tubes and ovaries removed in 2007. A few years later, she was diagnosed with peritoneal cancer, a condition that Dr. Offit said each year occurs in about half of a percent of women who have had their ovaries removed. Ms. Zelenske was treated but had a recurrence of the peritoneal cancer two years ago.

62歲的埃塞爾·澤倫斯克(Ethel Zelenske)是一名BRCA1攜帶者，住在巴爾的摩。2007年，她摘除了自己的輸卵管和卵巢。幾年后，她被診斷出患了腹膜癌。奧夫特說，這種情況每年都會發(fā)生在大約0.5%已摘除卵巢的女性身上。澤倫斯克接受了治療，但兩年前腹膜癌又出現(xiàn)復發(fā)。