癌症专家支持朱莉摘除卵巢决定

Experts Back Angelina Jolie Pitt in Choices for Cancer Prevention

癌症专家支持朱莉摘除卵巢决定

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.

癌症专家在周二表示，演员、电影人安吉丽娜·朱莉·皮特(Angelina Jolie Pitt)上周选择摘除卵巢和输卵管是一个明智的决定，因为她身上携带BRCA1基因突变，这大大增加了患卵巢癌的风险，这种癌症很难检测到，通常到了晚期无法治愈的阶段才会被发现。

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.

他们还表示，朱莉·皮特如此坦诚地讲述自己的选择，将会鼓励处境相似的女性去权衡她们的选项。在美国的白人女性中，由BRCA基因突变导致的乳腺癌病例占5%-10%，卵巢癌病例占10%-15%。目前尚不清楚，这种基因突变在其他种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.”

“强烈建议不满40岁的BRCA1、BRCA2基因突变携带者采取预防性举措，摘除卵巢和输卵管，”宾夕法尼亚大学(University of Pennsylvania)巴瑟尔研究中心(Basser Research Center)执行主任苏珊·多姆切克(Susan Domchek)说。“没有有效检测卵巢癌的方法，有很多处于卵巢癌晚期的女性死于这种疾病。”该中心专门研究BRCA变异。

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岁的朱莉·皮特在为《纽约时报》撰写的观点文章中写道，摘除卵巢和输卵管是她意料中的事，但对癌症的担忧促使她决定尽早进行这种叫做“腹腔镜下双侧输卵管卵巢切除术”的处理。她的母亲、姨妈和外祖母均死于癌症。

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

她写道，“让我释然的是，自己仍旧可以决定去切除卵巢和输卵管，而我的决定就是去做手术。”

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.

两年前，她撰文称自己切除了双乳，因为BRCA1加大了她患乳腺癌的风险，此举在世界范围内引发了有关乳腺癌发病率较高的女性应该怎么做的讨论。同样也是BRCA1基因突变促使她上周接受手术。

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.

几名医生表示，对于处境类似的女性，他们通常建议在切除乳房前摘除卵巢，但代价就是做此类手术的女性将会提早绝经，再也不能生孩子了。然而，摘除卵巢会大幅降低女性患乳腺癌的风险。与卵巢癌相比，乳腺癌通常更容易发现和治疗。

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

“我们对卵巢切除术是非常坚持的，”多姆切克表示。“而乳房切除术我们会作为一个选项来谈。”

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.

专家表示，朱莉·皮特提到的一些细节可能不适用于所有携带此类变异的女性，可能不同医生也会有不同说法。例如，朱莉·皮特写道，医生建议她比母亲第一次确诊的年龄——也就是49岁——早10年接受手术。但医生们表示，实际经验证明35至40岁是比较适合的年龄，理想的状态就是在生完孩子后，患癌风险急剧增加前。

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·皮特还表示，她接受了每年一次的CA-125蛋白质检测，以监控是否有卵巢癌的迹象。她说她的医生表示，这种检测会漏过很多癌症。一些专家表示他们已经不再进行此类检测了，因为漏过的癌症实在太多，而且没有证据证明它们能够提高生存率。

“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.

纪念斯隆-凯特琳癌症中心(Memorial Sloan Kettering Cancer Center)的临床遗传学服务主任肯尼思·奥夫特(Kenneth Offit)说，“从根本上来说，没有数据支持此类检测，我们建议做手术。”

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.”

他还表示，“最终，她做得很好。她做出了正确的决定，在时间窗口内接受了卵巢摘除手术。”

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·皮特不摘除子宫的决定符合专家建议。梅奥诊所(Mayo Clinic)的妇产科肿瘤学家杰米·巴库姆-加梅斯博士(Dr. Jamie Bakkum-Gamez)说，“目前还没有研究显示，有一个BRCA基因突变的人有罹患子宫癌的风险。”

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·巴库姆-加梅斯博士和其他专家同意了她的决定：采取激素替代疗法——一种雌激素贴片和孕酮宫内节育器——来减少手术引起的更年期症状。

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·皮特有六个孩子，其中三个是领养的。她写道，她知道对于仍然希望怀孕的女性来说，这些决定会“更加困难”，而且她知道她们可以选择“摘除输卵管，但保留卵巢”。专家提醒道，关于摘除输卵管是否能有效防止卵巢癌，目前证据仍不充分。

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岁的希拉·克兰斯(Shira Krance)也有一个BRCA2基因突变，她于两年前接受了双侧乳腺切除术，还说自己曾考虑是否要在摘除卵巢前，先摘除输卵管。

“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.”

“医生会给你提供很多选项，但没人会告诉你该怎么做，”克兰斯说。她住在纽约瓦利科塔日，有两个年幼的孩子。“在孩子成长的时候不能陪伴他们，这种情况很可怕。这是最糟糕的事，我会尽我所能来避免。”

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岁的埃塞尔·泽伦斯克(Ethel Zelenske)是一名BRCA1携带者，住在巴尔的摩。2007年，她摘除了自己的输卵管和卵巢。几年后，她被诊断出患了腹膜癌。奥夫特说，这种情况每年都会发生在大约0.5%已摘除卵巢的女性身上。泽伦斯克接受了治疗，但两年前腹膜癌又出现复发。