嚴(yán)重精神障礙被認(rèn)為影響乳腺癌的診斷和治療，因?yàn)榛颊邔膊〉恼J(rèn)識和了解程度以及與醫(yī)務(wù)人員合作能力下降。
2017年9月20日，歐洲乳腺癌?？茖W(xué)會《乳腺》在線發(fā)表日本鹿兒島大學(xué)的研究報(bào)告，分析了乳腺癌和原有精神障礙（如精神分裂癥、癡呆、智力障礙）患者的臨床特征。
該研究回顧了46例被診斷為乳腺癌伴精神分裂癥、癡呆或智力障礙患者的病歷。3例患者有超過2種精神障礙。1992年9月～2015年1月，所有患者接受根治手術(shù)。將患者的臨床病理資料，與同期727例無精神障礙的乳腺癌患者對照組進(jìn)行比較。
結(jié)果發(fā)現(xiàn)，
精神障礙患者較少意識到自己的乳腺癌，病變常常被其他人發(fā)現(xiàn)，如家屬、護(hù)理人員和醫(yī)務(wù)人員。
乳腺癌伴精神障礙患者與無精神障礙匹配對照者相比，手術(shù)時(shí)T分期和總分期顯著較高、進(jìn)行全乳房切除術(shù)較多、進(jìn)行術(shù)后輔助放化療較少。
組間生物標(biāo)志如雌激素受體、孕激素受體、HER2表達(dá)無顯著差異。
組間無病生存、總生存無顯著差異。
因此，雖然精神障礙患者與無精神障礙患者相比，手術(shù)時(shí)分期較高、全乳房切除術(shù)較多、術(shù)后輔助放化療較少，但是生存結(jié)局相似。
可能原因
Breast. 2017 Sep 20;36:39-43. [Epub ahead of print]
Clinical characteristics of breast cancer patients with mental disorders.
Yoshiaki Shinden, Yuko Kijima, Munetsugu Hirata, Akihiro Nakajo, Kiyonori Tanoue, Takaaki Arigami, Hiroshi Kurahara, Kosei Maemura, Shoji Natsugoe.
Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
BACKGROUND: Severe mental disorders are thought to affect the diagnosis and treatment of breast cancer because of their lower awareness and understanding of the disease and their reduced ability to cooperate with medical staff. We analyzed the clinical features of patients with breast cancer and pre-existing mental disorders such as schizophrenia, dementia, and intellectual disability.
PATIENTS AND METHODS: We reviewed the records of 46 patients who were diagnosed with schizophrenia, dementia, or intellectual disability, before being diagnosed with breast cancer. Three patients had more than 2 mental disorders. All patients underwent curative surgical treatment between September 1992 and January 2015. Patients' clinicopathological information was compared with a control group of 727 breast-cancer patients without mental disorders seen during the same period.
RESULTS: Patients with mental disorders were less likely to be aware of their own breast cancer; the lesions were often found by other people such as family, care staff, and medical staff. Breast cancer patients with mental disorders had significantly more advanced T factors and overall stage at the time of surgery than their counterparts without mental illness, more patients underwent total mastectomy, and fewer patients underwent postoperative adjuvant chemotherapy and radiation. Biological markers such as estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) expression were not significantly different between groups. Disease-free survival and overall survival were not significantly different between groups.
CONCLUSION: Patients with mental disorders receive less postoperative adjuvant chemotherapy; however, their outcomes were not worse than those of patients without mental disorders.
KEYWORDS: Schizophrenia, Dementia, Intellectual disability, Breast cancer
DOI: 10.1016/j.breast.2017.08.010
