育龄期乳腺癌患者子代健康担忧与遗传风险认知对生育意愿的影响

doi:10.20223/j.cnki.1000-8535.2025.12.019

摘要/Abstract

摘要： 目的了解育龄期乳腺癌患者对子代健康和遗传风险担忧现状及其对癌症诊断前后生育意愿改变的影响。方法于2019年11月—2020年9月,采用中文版癌症后生育忧虑量表（RCAC）-子女健康亚量表对广州市某三甲医院的230例育龄期乳腺癌患者进行调查,应用SPSS 26.0及PSM插件对结果进行统计分析。在进行子女健康亚量表得分低分组和中高分组患者的生育意愿改变率的比较时,应用倾向性评分匹配法控制混杂因素。结果育龄期乳腺癌患者对子代健康和遗传风险担忧得分为（11.40±2.99）分;匹配前后不同子女健康亚量表得分分组的患者在癌症诊断前后生育意愿改变率的差异均不具有统计学意义（P>0.05）。结论育龄期乳腺癌患者对子代健康和遗传风险的担忧虽然没有显著影响其生育意愿的改变,但其对子代健康和遗传风险担忧处于较高水平,临床医护人员应提高对这一现象的重视,可通过多渠道科普相关知识,开展遗传咨询服务以减轻患者的担忧。

关键词: 生育意愿, 乳腺癌, 遗传风险, 倾向性评分匹配

Abstract: Objective To explore the current status of childbearing age breast cancer patients' concerns about their children's health and genetic risk and its influence on the change of fertility intention before and after cancer diagnosis．Methods From November 2019 to September 2020,the Chinese version of the Reproductive Concern After Cancer Scale（RCAC）- Children's Health Sub-scale was used to interview 230 patients with breast cancer of childbearing age in a tertiary hospital in Guangzhou,and SPSS 26.0 and PSM plug-in were used to analyze the results statistically．The propensity score matching method was used to control confounding factors when comparing the change rate of fertility intention of patients with low scores and those with medium and high scores in the children health subscale．Results The score of concern for the health and genetic risk of children in breast cancer patients of childbearing age was（11.40±2.99）．There was no statistically significant difference in the change rate of fertility intention before and after cancer diagnosis among patients with different subscale scores of children's health．Conclusions Despite not significantly impacting fertility intentions,the notably high level of concern regarding children's health and genetic risks among childbearing-age breast cancer patients necessitates increased clinical awareness． It is recommended that healthcare professionals address this through multi-channel education and genetically focused counseling within a collaborative model to mitigate patient distress．

Key words: fertility intention, breast cancer, genetic risk, propensity score matching

高红丽, 于雅. 育龄期乳腺癌患者子代健康担忧与遗传风险认知对生育意愿的影响[J]. 广州医药, 2025, 56(12): 1754-1760.

GAO Hongli, YU Ya. The influence of health concerns for offspring and genetic risk perception on fertility intentions among women of childbearing age with breast cancer[J]. Guangzhou Medical Journal, 2025, 56(12): 1754-1760.

参考文献

[1] HU L,XU B,CHAU P H,et al.Reproductive concerns among young adult women with breast cancer:A systematic review and meta-analysis[J].Psychooncology,2024,33(8):e9304.
[2] 王松梅,赵亚杰,候莹鸽,等.青年女性癌症患者生育信息需求及支持的研究进展[J].中华护理杂志,2022,57(14):1777-1782.
[3] 沈淑洁,刘洪秀,李龙田,等.育龄期癌症患者生育忧虑评估工具的系统评价[J].中华护理教育,2025,22(2):238-246.
[4] CHEN L,SHEN J,JIANG H,et al.Incidence and influencing factors of fertility concerns in breast cancer in young women:A systematic review and meta-analysis[J].Front Oncol,2023(13):1273529.
[5] AHN J,HAN J.The lived experiences of pregnancy planning after breast cancer in women of childbearing age:A phenomenological study[J].Asia Pac J Oncol Nurs,2023,10(9):100276.
[6] QIU J,TANG L,LI P,et al.Psychological and reproductive decision-making experiences of young women after breast cancer diagnosis:A qualitative study[J].Support Care Cancer,2023,31(7):423.
[7] 白冰,毛旭,郭思彤,等.年轻乳腺癌患者生育意愿的研究进展[J].护理学杂志,2025,40(6):120-124.
[8] 赵守军,张勇,汪萱怡,等.均衡组间差异的有效方法:倾向评分[J].中华流行病学杂志,2003(6):92-95.
[9] WORLD HEALTH ORGANIZATION.Women of reproductive age(15-49 years)population(thousands)[EB/OL].[2025-07-22].https://www.who.int/data/gho/indicator-metadata-registry/imr-details/women-of-reproductive-age-(15-49-years)-population-
[10] AUSTIN P C.An introduction to propensity score methods for reducing the effects of confounding in observational studies[J].Multivariate Behav Res,2011,46(3):399-424.
[11] BROOKHART M A,STÜRMER T,GLYNN R J,et al.Confounding control in healthcare database research:Challenges and potential approaches[J].Med Care,2010,48(6 Suppl):S114-S120.
[12] GORMAN J R,SU H I,PIERCE J P,et al.A multidimensional scale to measure the reproductive concerns of young adult female cancer survivors[J].J Cancer Surviv,2014,8(2):218-228.
[13] 乔婷婷,陈丹丹,郑蔚,等.癌症后生育忧虑量表的汉化及信效度研究[J].中华护理杂志,2016,51(12):1509-1514.
[14] GORMAN J R,SU H I,ROBERTS S C,et al.Experiencing reproductive concerns as a female cancer survivor is associated with depression[J].Cancer,2015,121(6):935-942.
[15] 徐黄菲,卜庆云,白银洁,等.年轻乳腺癌患者生育忧虑的潜在剖面分析[J].护理管理杂志,2024,24(5):455-460.
[16] CAPPELLI M,SURH L,HUMPHREYS L,et al.Psychological and social determinants of women's decisions to undergo genetic counseling and testing for breast cancer[J].Clin Genet,1999,55(6):419-430.
[17] RIDDLE L,JOSEPH G,CARUNCHO M,et al.The role of polygenic risk scores in breast cancer risk perception and decision-making[J].J Community Genet,2023,14(5):489-501.
[18] 张钰佳,马力.乳腺癌外科治疗领域新技术的进展和争议[J].中国癌症杂志,2025,35(4):339-345.
[19] 何丹,成炜,刘铭.肿瘤可塑性与药物治疗抵抗[J].广州医药,2024,55(3):213-220,230.
[20] 荆凤,蒋凌云,况艺,等.女性乳腺癌易感基因突变携带者乳腺癌风险管理的证据总结[J].中国护理管理,2024,24(9):1358-1363.
[21] OKTAY K,HARVEY B E,PARTRIDGE A H,et al.Fertility preservation in patients with cancer:ASCO clinical practice guideline update[J].J Clin Oncol,2018,36(19):1994-2001.
[22] PINAR C,ALMELING R,GADARIAN S K.Does genetic risk for common adult diseases influence reproductive plans? Evidence from a national survey experiment in the United States[J].Soc Sci Med,2018(218):62-68.
[23] 唐一丹,魏清风,朱龙双,等.育龄期乳腺癌患者生育忧虑非药物干预的最佳证据总结[J].护理学杂志,2025,40(7):25-30.
[24] ZHANG Z,ZHANG Y,DENG C,et al.Exploration of the fertility decision-making experiences of women of reproductive age with cancer:A qualitative systematic review[J].Res Nurs Health,2025,48(2):133-145.
[25] 乔婷婷,颜萍,由淑萍,等.年轻女性癌症患者生育忧虑与抑郁的相关性研究——以乌鲁木齐市某三级甲等医院为例[J].现代预防医学,2019,46(17):3134-3138.
[26] HOWARD-ANDERSON J,GANZ P A,BOWER J E,et al.Quality of life,fertility concerns,and behavioral health outcomes in younger breast cancer survivors:A systematic review[J].J Natl Cancer Inst,2012,104(5):386-405.
[27] DONG Y,YUE Z,ZHUANG H,et al.The experiences of reproductive concerns in cancer survivors:A systematic review and meta-synthesis of qualitative studies[J].Cancer Med,2023,12(24):22224-22251.
[28] WIKLANDER M,STRANDQUIST J,OBOL C M,et al.Feasibility of a self-help web-based intervention targeting young cancer patients with sexual problems and fertility distress[J].Support Care Cancer,2017,25(12):3675-3682.
[29] BARJASTEH S,FARNAM F,ELSOUS A,et al.Overcoming reproductive and psychological concerns of breast cancer survivors:A randomized controlled trial[J].J Family Reprod Health,2022,16(1):52-60.
[30] MORAND M,ROTH M,PETERSON S K,et al.Factors impacting adolescent and young adult cancer patients' decision to pursue genetic counseling and testing[J].Support Care Cancer,2022,30(6):5481-5489.
[31] AUSTIN S,HANSON E N,DELACROIX E,et al.Impact of barriers and motivators on intention and confidence to undergo hereditary cancer genetic testing[J].J Genet Couns,2025,34(1):e1926.
[32] SUN S,LI S T,NGEOW J.Factors shaping at-risk individuals' decisions to undergo genetic testing for cancer in Asia[J].Health Soc Care Community,2020,28(5):1569-1577.
[33] RESTA R,BIESECHER B B,BENNETT R L,et al.A new definition of genetic counseling:National society of genetic counselors' task force report.[J].J Genet Couns,2006,15(2):77-83.
[34] CIUCĂ A,CLANCY T,PINTEA S,et al.The efficacy of genetic counseling for familial colorectal cancer:A meta-analysis[J].J Genet Couns,2025,34(3):e70046.
[35] JOHNSEN K B,STRØMSVIK N.Need for specially designed educational support groups:Young women's experiences of being identified with BRCA pathogenic variants[J].J Genet Couns,2025,34(2):e1980.