2016 年 7 月，美国乳腺外科医生协会发布了指南，不鼓励对患有单侧乳腺癌的平均风险女性进行对侧预防性乳房切除术。我们将这些纳入结构化患者咨询的实践中，旨在评估这一举措对对侧预防性乳房切除术率的影响。我们评估了 2011 年 1 月至 2022 年 11 月在我们机构接受乳房切除术的单侧乳腺癌女性患者。与对侧预防性乳房切除术相关的变量并酌情使用 Wilcoxon 秩和检验或 χ2 分析来分析随时间变化的趋势。 在 3,208 名患者中（中位年龄 54 岁），1,366 名患者（43%）接受了单侧乳房切除术，1,842 名患者（57%）还同时接受了对侧预防性治疗乳房切除术。在所有患者中，与 2015 年至 2016 年 (62%) 相比，2017 年至 2019 年实施后对侧预防性乳房切除术率显着下降 (55%) (P = .01)，但从 2020 年至 2022 年有所增加 (61%)。总体即刻乳房重建率为 70%（接受对侧预防性乳房切除术的患者为 81%，未接受对侧预防性乳房切除术的患者为 56%，P < .001）。年龄较小、白种人、突变状态和早期阶段也与对侧预防性乳房切除术相关。基因检测从指南前的 27% 增加到 2020 年至 2022 年的 74%，携带致病性变异的患者比例也是如此（指南前为 4%，2020 年至 2022 年为 11%，P < .001），其中 91%进行了对侧预防性乳房切除术。在无致病性变异的测试患者和未测试的患者中，对侧预防性乳房切除术率在指南前后分别从 78% 下降至 67% 和 48% 至 38%，P < .001。特定患者咨询的实施是有效的降低对侧预防性乳房切除术率。虽然认识到患者的选择在对侧预防性乳房切除术的决定中起着重要作用，但仍需要进一步的教育工作来影响对侧预防性乳房切除术的发生率，特别是在基因检测阴性的情况下。版权所有 © 2023 Elsevier Inc. 保留所有权利。

In July 2016, the American Society of Breast Surgeons published guidelines discouraging contralateral prophylactic mastectomy for average-risk women with unilateral breast cancer. We incorporated these into practice with structured patient counseling and aimed to assess the effect of this initiative on contralateral prophylactic mastectomy rates.We evaluated female patients with unilateral breast cancer undergoing mastectomy at our institution from January 2011 to November 2022. Variables associated with contralateral prophylactic mastectomy and trends over time were analyzed using the Wilcoxon rank sum test or χ2 analysis as appropriate.Among 3,208 patients, (median age 54 years) 1,366 (43%) had a unilateral mastectomy, and 1,842 (57%) also had a concomitant contralateral prophylactic mastectomy. Across all patients, contralateral prophylactic mastectomy rates significantly decreased post-implementation from 2017 to 2019 (55%) vs 2015 to 2016 (62%) (P = .01) but increased from 2020 to 2022 (61%). Immediate breast reconstruction rate was 70% overall (81% with contralateral prophylactic mastectomy and 56% without contralateral prophylactic mastectomy, P < .001). Younger age, White race, mutation status, and earlier stage were also associated with contralateral prophylactic mastectomy. Genetic testing increased from 27% pre-guideline to 74% 2020 to 2022, as did the proportion of patients with a pathogenic variant (4% pre-guideline vs 11% from 2020-2022, P < .001), of whom 91% had a contralateral prophylactic mastectomy. Among tested patients without a pathogenic variant and patients not tested, contralateral prophylactic mastectomy rates declined from 78% to 67% and 48% to 38% pre -and post-guidelines, respectively, P < .001.Implementation of specific patient counseling was effective in decreasing contralateral prophylactic mastectomy rates. While recognizing that patient choice plays a significant role in the decision for contralateral prophylactic mastectomy, further educational efforts are warranted to affect contralateral prophylactic mastectomy rates, particularly in the setting of negative genetic testing.Copyright © 2023 Elsevier Inc. All rights reserved.