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JNCI Journal of the National Cancer Institute 2001 93(5):339; doi:10.1093/jnci/93.5.339
© 2001 by Oxford University Press
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Journal of the National Cancer Institute, Vol. 93, No. 5, 339, March 7, 2001
© 2001 Oxford University Press

NEWS

French National Ad Hoc Committee Strongly Resists Prophylactic Mastectomy

Laura Newman

In America, where individual choice is a strong value, prophylactic mastectomy is considered an "option." Not so in France, where, according to a recent survey, few physicians and patients accept the procedure, and where under French law, individuals do not always have the final say over their bodies.

The French National Ad Hoc Committee on Hereditary, Breast, and Ovarian Cancer has gone further than any other health authority in weighing in against prophylactic mastectomy. "Interestingly, despite a probable higher efficacy, prophylactic mastectomy is only envisaged, but it is never recommended, while prophylactic oophorectomy is sometimes recommended," said Francois Eisinger, M.D., Ad Hoc Committee chair and physician at the Institute Paoli Calmettes, INSERM Research Unit in Marseille.



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  		Dr. Francois Eisinger

 
The committee termed prophylactic surgery "a mutilation" and set rigorous standards that that must be satisfied before such surgery is even contemplated, according to Eisinger. The criteria include making a multidisciplinary decision about prophylactic mastectomy; determining that the patient’s life expectancy is not significantly compromised by another illness; and proposing both a pre- and post-surgery psychological consultation.

"This consultation takes on extreme importance with the probability of having a deleterious mutation," said Eisinger. Also, a 6-month period of reflection is required before proceeding with prophylactic surgery. The committee also "strongly opposed performing the surgery in women under age 30."

Although Eisinger acknowledged that Americans may view this as paternalistic, it is not really "clinical practice that rules, but the French society, through the law process that gives limit to the autonomy of individuals."


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F. Eisinger, L. Huiart, and H. Sobol
The Choice of Bilateral Prophylactic Mastectomy
J. Clin. Oncol., February 20, 2005; 23(6): 1330 - 1331.
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