Hormone replacement therapy after a diagnosis of breast cancer: cancer recurrence and mortality

OBJECTIVE: To determine whether hormone replacement therapy (HRT) after treatment for breast cancer is associated with increased risk of recurrence and mortality. DESIGN: Retrospective observational study. PARTICIPANTS AND SETTING: Postmenopausal women diagnosed with breast cancer and treated by five Sydney doctors between 1964 and 1999. OUTCOME MEASURES: Times from diagnosis to cancer recurrence or new breast cancer, to death from all causes and to death from primary tumour were compared between women who used HRT for menopausal symptoms after diagnosis and those who did not. Relative risks (RRs) were determined from Cox regression analyses, adjusted for patient and tumour characteristics. RESULTS: 1122 women were followed up for 0-36 years (median, 6.08 years); 154 were lost to follow-up. 286 women used HRT for menopausal symptoms for up to 26 years (median, 1.75 years). Compared with non-users, HRT users had reduced risk of cancer recurrence (adjusted relative risk [RR], 0.62; 95% CI, 0.43-0.87), all-cause mortality (RR, 0.34; 95% CI, 0.19-0.59) and death from primary tumour (RR, 0.40; 95% CI, 0.22-0.72). Continuous combined HRT was associated with a reduced risk of death from primary tumour (RR, 0.32; 95% CI, 0.12-0.88) and all-cause mortality (RR, 0.27; 95% CI, 0.10-0.73). CONCLUSION: HRT use for menopausal symptoms by women treated for primary invasive breast cancer is not associated with an increased risk of breast cancer recurrence or shortened life expectancy.     

Effect of breast self-examination techniques on the risk of death from breast cancer

OBJECTIVE: To measure the effect of breast self-examination (BSE) technique and frequency on the risk of death from breast cancer. DESIGN: Case-control study nested within the Canadian National Breast Screening Study (NBSS). SETTING: The Canadian NBSS, a multicentre randomized controlled trial of screening for breast cancer in Canadian women. SUBJECTS: The case subjects were 163 women who had died from breast cancer and 57 women with distant metastases. Ten control subjects matched by 5-year age group, screening centre, year of enrolment and random allocation group were randomly selected for each case subject. EXPOSURE MEASURES: Self-reported BSE frequency before enrolment in the NBSS, annual self-reports of BSE frequency during the program and annual objective assessments of BSE technique. OUTCOME MEASURES: Odds ratios (ORs) associated with BSE practice were estimated by conditional multiple logistic regression modelling, which permitted control of covariates. RESULTS: Relative to women who, when assessed 2 years before diagnosis, examined their breasts visually, used their finger pads for palpation and examined with their 3 middle fingers, the OR for death from breast cancer or distant metastatic disease for women who omitted 1, 2 or 3 of these components was 2.20 (95% confidence interval [CI] 1.30 to 3.71, p = 0.003). The OR for women who omitted 1 of the 3 components was 1.82 (95% CI 1.00 to 3.29, p = 0.05), for those who omitted 2 of the 3 components, 2.84 (95% CI 1.44 to 5.59, p = 0.003), and for those who omitted all 3 components, 2.95 (95% CI 1.19 to 7.30, p = 0.02). The results remained unchanged after adjustment for potential confounders. CONCLUSION: The results, obtained with the use of prospectively collected data, suggest that the performance of specific BSE components may reduce the risk of death from breast cancer.     

Risks and probabilities of breast cancer: short-term versus lifetime probabilities.

OBJECTIVE: To calculate age-specific short-term and lifetime probabilities of breast cancer among a cohort of Canadian women. DESIGN: Double decrement life table. SETTING: Alberta. SUBJECTS: Women with first invasive breast cancers registered with the Alberta Cancer Registry between 1985 and 1987. MAIN OUTCOME MEASURES: Lifetime probability of breast cancer from birth and for women at various ages; short-term (up to 10 years) probability of breast cancer for women at various ages. RESULTS: The lifetime probability of breast cancer is 10.17% at birth and peaks at 10.34% at age 25 years, after which it decreases owing to a decline in the number of years over which breast cancer risk will be experienced. However, the probability of manifesting breast cancer in the next year increases steadily from the age of 30 onward, reaching 0.36% at 85 years. The probability of manifesting the disease within the next 10 years peaks at 2.97% at age 70 and decreases thereafter, again owing to declining probabilities of surviving the interval. CONCLUSIONS: Given that the incidence of breast cancer among Albertan women during the study period was similar to the national average, we conclude that currently more than 1 in 10 women in Canada can expect to have breast cancer at some point during their life. However, risk varies considerably over a woman's lifetime, with most risk concentrated after age 49. On the basis of the shorter-term age-specific risks that we present, the clinician can put breast cancer risk into perspective for younger women and heighten awareness among women aged 50 years or more.     

Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older

CONTEXT: Postmenopausal women aged 55 years and older have 66% of incident breast tumors and experience 77% of breast cancer mortality, but other age-related health problems may affect tumor prognosis and treatment decisions. OBJECTIVE: To document the comorbidity burden of postmenopausal breast cancer patients and evaluate its relationship with age on disease stage, treatment, and early mortality. DESIGN AND SETTING: Data were collected on breast cancer patients' comorbidities by retrospective hospital medical records review and merged with information on patients' tumor characteristics collected from 6 regional National Cancer Institute Surveillance, Epidemiology, and End Results cancer registries. Patients were followed up until death or for 30 months from breast cancer diagnosis. PARTICIPANTS: Population-based random sample of 1800 postmenopausal breast cancer patients diagnosed in 1992 stratified by 3 age groups: 55 to 64 years, 65 to 74 years, and 75 years and older. MAIN OUTCOME MEASURES: Extent of disease, therapy received, comorbidity, cause of death, and survival. RESULTS: Seventy-three percent (1312 of 1800) of the sample was diagnosed with stage I and II breast cancer, 10% (n = 188) with stage III and IV breast cancer, and 17% (n = 300) did not have a stage assignment. Of the 1017 patients with stage I and stage II node-negative breast cancer, 95% received therapy in agreement with the National Institutes of Health consensus statement recommendation for early-stage breast cancer. Patients in older age groups were less likely to receive therapy consistent with the consensus statement (P<.001), and women aged 70 years and older were significantly less likely to receive axillary lymph node dissection as determined by logistic regression analysis (P<.01). Diabetes, renal failure, stroke, liver disease, a previous malignant tumor, and smoking were significant in predicting early mortality in a statistical model that included age and disease stage. Breast cancer was the underlying cause of death for 135 decedents (51.3%). Heart disease (n = 45, 17.1%) and previous cancers (n = 22, 8.4%) were the next major underlying causes. In the 30-month follow-up period, 263 patients (15%) died. CONCLUSION: Patient care decisions occur in the context of breast cancer and other age-related conditions. Comorbidity in older patients may limit the ability to obtain prognostic information (ie, axillary lymph node dissection), tends to minimize treatment options (eg, breast-conserving therapy), and increases the risk of death from causes other than breast cancer.     

Promotion of breast self-examination in South Australia. A short-term evaluation

In early October 1982, a campaign was launched in South Australia to encourage women to practice breast self-examination. A study of data from the State Cancer Registry was conducted to determine the impact of the campaign on the detection rate, the patient-survival rate and the extent of the tumour at the time of diagnosis. In the three months after the launch, 30% more cancer cases were detected than expected from the numbers presenting during similar periods in previous years. The increase was 53% for women under 50 years of age and 21% for older subjects. There is an indication that tumours diagnosed in the three months after the launch of the campaign were diagnosed earlier than those presenting in corresponding periods in earlier years. The proportion of cases with four or more affected nodes at diagnosis was substantially reduced. The slight differences in tumour diameter and one-year patient survival were also consistent with earlier diagnosis.     

Prospective study of estrogen replacement therapy and risk of breast cancer in postmenopausal women

We prospectively examined the use of estrogen replacement therapy in relation to breast cancer incidence in a cohort of women 30 to 55 years of age in 1976. During 367 187 person-years of follow-up among postmenopausal women, 722 incident cases of breast cancer were documented. Overall, past users of replacement estrogen were not at increased risk (relative risk, 0.98; 95% confidence interval, 0.81 to 1.18), including even those with more than 10 years since last [corrected] use (relative risk after adjustment for established risk factors, 0.70; 95% confidence interval, 0.45 to 1.10). However, the risk of breast cancer was significantly elevated among current users (relative risk, 1.36; 95% confidence interval, 1.11 to 1.67). Among current users, a stronger relationship was observed with increasing age but not with increasing duration of use. These data suggest that long-term past use of estrogen replacement therapy is not related to risk of breast cancer but that current use may modestly increase risk.     

Which patients are cured of breast cancer?

The clinical and pathological features of 51 patients who survived for more than 20 years after diagnosis of cancer of the breast were compared with those of 176 contemporaries who died within 20 years after diagnosis. Of those who survived, 18 (35%) had had pathologically affected axillary nodes compared with at least 86 (49%) of those who died. Also, 11 (21%) of the survivors had had small tumours compared with 10 (6%) of those who died. Pathological review of tumours in the survivors showed 40 (78%) to have been infiltrating ductal carcinomas, of which 13 (32%) were grade 3 lesions. These differences between the two groups were largely due to the prognostic value of these variables in the first five years after diagnosis. After a patient had survived five years the major prognostic variables were of little value in the prediction of which patients would be cured of breast cancer. Advanced age, which was of little prognostic value in the first five years after diagnosis, was of significant prognostic value in the longer term, partly due to the steep age gradient for mortality from other diseases. Nevertheless, seven of 19 deaths more than 20 years after first treatment were due to breast cancer. Late deaths from breast cancer may, however, have often been the result of metastases from second primaries rather than the late manifestation of micrometastases from the original primary carcinoma. Age, menstrual state, clinical stage, and axillary nodes being affected are thus of some prognostic value in cancer of the breast, but the present inadequacy of knowledge of the behaviour of the disease makes accurate prediction of which patients will be cured impossible.     

Profile of women practicing breast self-examination

The monthly practice of breast self-examination (BSE) can result in the early diagnosis of breast cancer. To explore factors that influence women's habits in the practice of BSE, we interviewed 616 women using an interactive computer program. We found that these women were more likely to practice BSE on a frequent basis if they were living with their sexual partner, had been shown how to perform BSE, and were confident in their examination technique. Women with a maternal history of breast disease were also more likely to practice monthly BSE. Unlike past reports that women with formal education beyond high school practice BSE more frequently than less-educated women, our study showed no association between monthly BSE practice and formal education. Contrary to our hypothesis that BSE practice was associated with the practice of other preventive health activities, our study did not demonstrate such a relationship. These findings suggest that demonstrating BSE at the periodic health examination may help increase the number of women practicing BSE on a frequent basis.     

隐匿性乳腺癌的诊断和治疗

目的 :探讨隐匿性乳腺癌诊断和治疗方法 ,提高诊断准确率和生存率。方法 :回顾性分析 1 7例隐匿性乳腺癌的诊断和治疗经过及随访结果。结果 :1 7例隐匿性乳腺癌首次诊断正确率为 35 .2 9% ( 6/1 7) ,钼靶 X线摄片、增强 CT、MR影像学检查的准确率分别为5 3.85 % ( 7/1 3)、62 .5 0 % ( 5 /8)、60 .0 0 % ( 3/5 ) ,腋下肿块穿刺活检准确率为 1 0 0 % ( 8/8)。 8例患者行乳腺癌改良根治术前行 2～ 4周期化疗 ,8例患者直接行乳腺癌改良根治术 ;1例保守治疗。术后辅助放、化疗和内分泌治疗。生存率 68.75 % ( 1 1 /1 6) ,2例死于其他疾病 ,3例分别于术后 4年、4年、2年死于脑、肺、纵膈转移。 1例保守治疗患者发现后 2年死于脑转移。术前化疗患者生存率 75 .0 0 % ( 6/8)高于直接手术者 62 .5 0 % ( 5 /8)。结论 :提高认识和适宜的影像学检查能提高诊断准确率 ;连续切片和影像学检查有助于原发灶的检出 ,术前化疗加乳癌改良根治术加术后辅助治疗是适宜的治疗方式     

What are the benefits of routine breast cancer follow-up?

The value of follow-up after potentially curative treatment of breast cancer remains controversial. Recurrence-free women (n = 402) attending a breast clinic over a 3 month period were studied. The women attended 423 appointments, 412 of which were routine. Eleven were requested by the patient or general practitioner (interval appointments). All 11 interval and 19 of the routine appointments resulted in investigations for possible recurrence. Three (27%) interval appointments and four (1%) routine appointments resulted in the diagnosis of a recurrence (P < 10(-5). The attitudes of 285 patients to follow-up were investigated by questionnaire. Two hundred and twenty-three (78%) questionnaires were completed. Regular follow-up in the breast clinic was preferred to attendance only when symptomatic by 190 (85%) women and 169 (76%) preferred regular breast clinic visits to general practitioner follow-up. Most women (n = 174) (81%) said they felt reassured and less anxious having attended the breast clinic. Routine follow-up after potentially curative treatment of breast cancer is inefficient in the detection of recurrence. It is, however, highly rated for providing reassurance and reducing anxiety. Reassurance rather than detection of recurrence may be the most important function of the breast cancer follow-up clinic.     

Menopausal estrogen and estrogen-progestin replacement therapy and breast cancer risk

CONTEXT: Whether menopausal hormone replacement therapy using a combined estrogen-progestin regimen increases risk of breast cancer beyond that associated with estrogen alone is unknown. OBJECTIVE: To determine whether increases in risk associated with the estrogen-progestin regimen are greater than those associated with estrogen alone. DESIGN: Cohort study of follow-up data for 1980-1995 from the Breast Cancer Detection Demonstration Project, a nationwide breast cancer screening program. SETTING: Twenty-nine screening centers throughout the United States. PARTICIPANTS: A total of 46355 postmenopausal women (mean age at start of follow-up, 58 years). MAIN OUTCOME MEASURE: Incident breast cancers by recency, duration, and type of hormone use. RESULTS: During follow-up, 2082 cases of breast cancer were identified. Increases in risk with estrogen only and estrogen-progestin only were restricted to use within the previous 4 years (relative risk [RR], 1.2 [95% confidence interval [CI], 1.0-1.4] and 1.4 [95% CI, 1.1-1.8], respectively); the relative risk increased by 0.01 (95% CI, 0.002-0.03) with each year of estrogen-only use and by 0.08 (95% CI, 0.02-0.16) with each year of estrogen-progestin-only use among recent users, after adjustment for mammographic screening, age at menopause, body mass index (BMI), education, and age. The P value associated with the test of homogeneity of these estimates was .02. Among women with a BMI of 24.4 kg/m2 or less, increases in RR with each year of estrogen-only use and estrogen-progestin-only use among recent users were 0.03 (95% CI, 0.01-0.06) and 0.12 (95% CI, 0.02-0.25), respectively. These associations were evident for the majority of invasive tumors with ductal histology and regardless of extent of invasive disease. Risk in heavier women did not increase with use of estrogen only or estrogen-progestin only. CONCLUSION: Our data suggest that the estrogen-progestin regimen increases breast cancer risk beyond that associated with estrogen alone.     

Oral contraceptives and breast cancer. A prospective cohort study

In 1976, information on oral contraceptive (OC) use as well as numerous risk factors for breast cancer was provided by 121,964 married female registered nurses aged 30 to 55 years. Ninety-two percent of women in the cohort completed follow-up questionnaires, and vital records were systematically searched to ascertain deaths among nonrespondents. After four years of follow-up, 592 incident cases of breast cancer were identified. Compared with never users, the age-adjusted relative risk (RR) of breast cancer, regardless of menopausal status, among all women who had ever used OCs was 1.0. Among premenopausal women compared with those who had never used OCs, the RR of breast cancer was 1.5 for current use of OCs in 1976 and 1.0 for past use. Among postmenopausal women, the RR for past use of OCs was 1.0. These estimates were essentially unaltered after controlling for other known risk factors for breast cancer in multiple logistic regression analysis. Furthermore, there was no modification of these effects by family history of breast cancer, age at first use, timing of the first birth, or other breast cancer risk factors. Data on past use of OCs provide substantial reassuring evidence that there is no large excess risk of breast cancer within a few years of cessation of pill use. The observed moderate elevation of breast cancer risk with current use was of borderline statistical significance. However, the observation was based on 29 cases and may reflect the effect of sampling variability, as most other studies have not observed a relationship between current use of OCs and breast cancer in women of this age.     

Cancer of the remaining breast: radiologic contribution to diagnosis.

Between 1953 and 1973 the mean incidence of a first breast cancer in northern Alberta was 0.47 per 1000 women. However, in women who had had a first breast cancer the crude incidence of a second primary cancer in the opposite breast was 1.3%. The rate of discovery of a second primary cancer increased after a multidisciplinary approach was instituted at the follow-up clinics. Mammography has proved to be valuable in diagnosis. By this technique 19 (36.5%) of the 52 cancers occurring in the remaining breast were identified when they were clinically unsuspected.     

Impact of news of celebrity illness on breast cancer screening: Kylie Minogue's breast cancer diagnosis

OBJECTIVES: To describe the main media narratives in the reportage of singer Kylie Minogue's illness with breast cancer; and to assess the impact of this coverage on bookings for screening for breast cancer by mammography in four Australian states. SETTING: Government sponsored BreastScreen programs in Queensland, Victoria, Tasmania and Western Australia. MAIN OUTCOME MEASURES: Narratives on breast cancer in television news programs 17-27 May 2005; initial and re-screening bookings for mammograms. PARTICIPANTS: Women aged > or = 40 years who booked for mammograms in BreastScreen programs in the 19 weeks before, the 2 weeks during, and the 6 weeks after the publicity. RESULTS: There was a 20-fold increase in news coverage of breast cancer, which emphasised that young women do get breast cancer and that early detection was critical. Overall screening bookings rose 40% in the 2 weeks of the publicity, with a 101% increase in non-screened women in the eligible age-group 40-69 years. Six weeks after the publicity, bookings remained more than a third higher in non-screened women. CONCLUSIONS: News coverage of Kylie Minogue's breast cancer diagnosis caused an unprecedented increase in bookings for mammography. Health advocates should develop anticipatory strategies for responding to news coverage of celebrity illness.     

Variation in breast cancer surgery in Ontario.

OBJECTIVES: To analyse the extent of variation by county and hospital in the use of breast-conserving surgery in the initial management of breast cancer and to assess some factors that might explain the observed variation. DESIGN: Population-based retrospective cohort study. SETTING: Ontario. PATIENTS: All women with breast cancer newly diagnosed from Jan. 1, 1989, to Dec. 31, 1991. MAIN OUTCOME MEASURE: Proportion of women undergoing unilateral breast cancer surgery who had breast-conserving surgery in each hospital and county. RESULTS: Of the 14,570 women with newly diagnosed breast cancer 12,815 (88.0%) underwent unilateral breast cancer surgery. The mean proportion of breast-conserving procedures by county was 52% and ranged from 11% to 84%. The proportion of breast-conserving procedures in individual hospitals with one or more cases of breast cancer per month ranged from 6% to 84%. The variations in the rates between hospitals was greater than that expected by chance alone (p < 0.0001). CONCLUSIONS: There was marked variation at the hospital and county level in the use of breast-conserving surgery in the initial management of breast cancer. This variation was strongly associated with the hospital where the surgery was performed.     

Implementing clinical practice guidelines: a community-based audit of breast cancer treatment. Australian Capital Territory and South Eastern New South Wales Breast Cancer Treatment Group

OBJECTIVE: To improve breast cancer management by facilitating implementation of treatment guidelines. DESIGN: A prospective, longitudinal study (developed by clinicians and consumers) of all patients with newly diagnosed breast cancer. Four locally agreed breast cancer management guidelines were established (based on 1995 National Health and Medical Research Council guidelines) as practice indicators. SETTING: Breast cancer treatment facilities and medical practices in the Australian Capital Territory and South Eastern New South Wales, May 1997 to July 1998. MAIN OUTCOME MEASURES: Actual treatment received by patients for primary breast cancer during the study period. RESULTS: During the 14 months of the study, 19 clinicians registered 221 new patients with a proven diagnosis of breast cancer. Of 191 women with localised invasive breast cancer, 112 (59%) had tumours 2 cm or less in diameter. Axillary surgery in 173 (91%) of these women showed 107 (56%) had no axillary lymph node involvement. Of 87 women treated with breast-conserving surgery for locally invasive cancer, 85 (98%) also received postoperative radiotherapy. Some form of systemic adjuvant therapy was indicated in 99 women (axillary nodes positive or tumours > 2 cm diameter) and this treatment was received by 95 (96%). All 27 women aged under 50 years with node-positive disease received adjuvant chemotherapy. CONCLUSIONS: Enhancing uptake of breast cancer management guidelines is feasible at a regional level with an audit program and broad support among clinicians and consumers.     

双侧原发性乳腺癌16例临床病理分析

目的 探讨双侧原发性乳腺癌的临床病理特征及其防治.方法 回顾性分析2001年1月至2009年12月江苏省肿瘤医院收治的确诊为双侧原发性乳腺癌16例的临床病理资料.结果 16例均为女性,占同期收治乳腺癌的0.47%,发病年龄41～69岁,中位年龄53岁.同时性双侧乳腺癌7例,发病年龄41～54岁,中位年龄47岁,5例为绝经前患者.异时性双侧乳腺癌9例,第2癌的发病年龄43～69岁,中位年龄58岁,1例为绝经前患者.异时性双侧乳腺癌第1癌与第2癌间隔14个月至196个月不等,中位间隔时间52个月.结论 同时性双侧原发性乳腺癌较异时性双侧乳腺癌发病年龄早,多见于绝经前.异时性双侧乳腺癌发生间隔时间不定,一侧发生乳腺癌后宜积极随访对侧乳腺,对雌激素受体阳性的患者应坚持内分泌治疗.     

Age as a factor in breast cancer knowledge, attitudes and screening behaviour.

OBJECTIVE: To determine whether there are age-related differences in knowledge, attitudes and behaviour with respect to breast cancer and whether the differences reflect the age-specific Canadian recommendations on breast cancer screening. DESIGN: Telephone survey. SETTING: Two cities and five towns and their surrounding areas in Alberta. PARTICIPANTS: The age-specific, randomly selected sample comprised 1284 women aged 40 to 75 years who did not have breast cancer. Of the 1741 eligible women who were contacted, 1350 (78%) agreed to participate; 66 were excluded because of age ineligibility or a history of breast cancer. MAIN OUTCOME MEASURE: Frequency of knowledge, attitudes and behaviour with respect to breast cancer, by age group. RESULTS: Knowledge of breast cancer risk factors was generally low and decreased with age. Few women were aware of the Canadian recommendations on breast self-examination, physical examination of the breasts by a health care practitioner and mammographic screening. Older women believed they were less susceptible to breast cancer than younger women and were less likely to have positive attitudes toward screening. Self-examination was performed 9 to 15 times per year by 424 women (33%), and 810 (63%) had been examined by a health care professional in the past year. Although 664 (52%) had undergone mammography, the proportion decreased with age after age 59. The main barriers to mammography were lack of physician referral and the woman's belief that the procedure is unnecessary if she is healthy. CONCLUSIONS: Education is needed to increase breast cancer knowledge, promote the Canadian recommendations for early detection of breast cancer and decrease negative beliefs about the disease. Changes in the behaviour of women and physicians are needed to increase the use of breast self-examination, clinical breast examination by a health care professional and mammographic screening. Reaching women in the upper range (60 to 69 years) of the target group for mammographic screening should be a focus in promoting early detection of breast cancer.     

隐匿性乳腺癌的诊治分析(附14例报告)

目的探讨隐匿性乳腺癌的诊断、治疗方法.方法回顾性分析1995年1月～2004年6月该科收治的14例隐匿性乳腺癌的诊断和治疗经过及随访结果.结果所有病例均为女性,占同期乳癌的0.86%,14例患者均行乳腺钼靶摄片,异常者6例,双乳B超,3例考虑乳癌.13例行改良根治术,1例保乳根治术.随访至今,2例死亡,12例生存,其中1例带瘤生存,最长1例存活5 a.结论临床对女性腋窝肿块应高度警惕隐性乳癌可能,提高认识,影像学检查及连续切片、免疫组化有助于乳腺原发灶检出.治疗予改良根治术或结合病情及自身愿望保留乳房手术综合化放疗.     

妊娠合并卵巢子宫内膜异位囊肿53例临床疗效分析

目的探讨妊娠合并卵巢子宫内膜异位囊肿的临床特点及诊治方案。方法回顾性分析53例均经病理证实妊娠合并卵巢子宫内膜异位囊肿患者的临床资料。结果术前诊断15例(28.30%),剖宫产术中诊断38例(71.70%);10例孕期囊肿直径无变化,5例明显缩小;6例发生并发症,5例异位囊肿破裂,1例异位囊肿扭转;8例行单侧附件切除,余45例行囊肿剥除、粘连分解及病灶电灼术。术后复发4例。结论妊娠合并卵巢子宫内膜异位囊肿早期诊断困难,并发症隐匿,应密切观察囊肿的变化,先行保守治疗,必要时手术,术后应定期随访。