講演情報
[O21-4]当院でのRRSOからみえたHBOC診療の課題
○阿部 彰子1, 野村 秀高1, 伏木 淳1, 尾身 牧子1, 岡本 三四郎1, 谷川 輝美1, 根津 幸穂1, 青木 洋一1, 金子 景香2, 新川 裕美2, 幅野 愛理2, 箕浦 祐子2, 高津 美月2, 植木 有紗2, 金尾 祐之1 (1.がん研究会有明病院 婦人科, 2.がん研究会有明病院 臨床遺伝診療部)
[Introduction] Insurance coverage for HBOC in Japan has resulted in an increased demand for RRSO. We aimed to evaluate the impact of insurance coverage on RRSO. [Subjects] In this retrospective analysis of 200 cases of RRSO performed at our hospital, the annual frequency was compared between pre- and post-insurance groups. [Results] The annual rate of RRSO increased from a mean of 8 (range, 1-20) cases in the pre-insurance group to 41.5 (range, 38－45) cases in post group. Breast cancer (BC) surgery or RRM was performed along with RRSO in 27% of cases overall, with rates of 6.7% and 43.6% in the pre- and post- groups, and with rates in women ＜40 years old of 3.3% and 15.7%, respectively. The rate of individuals at risk for HBOC without cancer was 13.3% and 6.4%, respectively. The following between-group differences were also identified: age at genetic testing, 45 and 47 years for the pre- and post- groups; the periods from cancer diagnosis to genetic testing, 6.47 and 4.01 years; and the periods from HBOC diagnosis to RRSO, 2.56 and 0.64 year. Overall, there was no onset of peritoneal cancer over a median post-RRSO observation period of 20 months; the rate of BC recurrence or secondary cancer at 6% (gBRCA1, 7; gBRCA2, 5), with a rate of mortality of 0.5% at 2.5 years post-RRSO. [Conclusion] Provision of insurance coverage for HBOC increased the frequency of RRSO for BC, per the recommendations for HBOC guidelines. The needs for individuals at risk for HBOC without a cancer diagnosis cannot be met due to current limitations in insurance for this group in Japan.