© 2002 by Oxford University Press
Journal of the National Cancer Institute, Vol. 94, No. 4, 307,
February 20, 2002
© 2002 Oxford University Press
CORRESPONDENCE |
Re: Risk-Reduction Mastectomy: Clinical Issues and Research Needs
Affiliations of authors: D. G. Evans, F. Lalloo, Department of Medical Genetics, St. Mary's Hospital, Manchester, U.K.; A. Howell (Department of Medical Oncology), A. Baildam (Department of Surgery), A. Brain (Department of Plastic Surgery), P. Hopwood (Cancer Research Campaign Psychological Medicine Group), Christie Hospital, Manchester.
Correspondence to: Professor D. Gareth Evans, M.D., F.R.C.P., St. Mary's Hospital (SM2), Hathersage Rd., Manchester, M13 OJH, U.K. (e-mail: Gevans{at}central.cmht.nwest.nhs.uk).
In their recent review, Stefanek et al (1) reviewed the available English language literature between 1995 and 2000 relating to risk-reduction mastectomy (RRM). They clearly state that all articles fulfilling their review criteria of effectiveness, perception, decision-making/follow-up, and satisfaction/psychological sequelae were included. Our group was a little unsettled that none of our publications in this area that fulfilled the review criteria had been referenced. Furthermore, these articles are included in the appropriate searches on PubMedTM and MEDLINETM in the years reviewed (2–4). We are also concerned that other articles from the same and other European journals were not included. This omission therefore raises the following question: How extensive was this review? It is scientifically inappropriate to exclude articles within their review criteria. If foreign articles are to be ignored, this should have been clearly stated in the review. Admittedly, our articles were published in journals that are not widely available. If the authors were not able to obtain such references, this fact should have been stated, rather than leaving the readers with the impression that all available literature had been included.
In the study period, we reviewed the practice of RRM in 10 European centers with early reports on effectiveness in 174 women (2). We reported on the clinical follow-up and body image of 76 women after RRM (3) and published our detailed protocol, including early evaluation and uptake of the procedure in BRCA1/2 mutation carriers (4). The uptake in our center (50%) is very similar to that reported by the Rotterdam group (5) and, therefore, suggests that RRM appears most acceptable in Northern Europe. These cultural differences were alluded to in the review, which pointed out the low acceptability in France, in particular. The difference between Northern Europe, where subcutaneous mastectomy was relatively rare in the 1970s and 1980s, compared with the United States and the apparent backlash against the procedure in the United States in terms of uptake in mutation carriers could have been developed further. Who is responsible for the backlash? Is it the U.S. press, clinicians, or advocacy groups? After all, it was the commonplace nature of prophylactic mastectomy that allowed Hartmann et al. (6) to come up with the first good evidence for efficacy. We have also pointed out the important fact that some women are fabricating their family history to obtain RRM (2–4), another detail overlooked by the review. In a more recent article (outside the review period) (7), we demonstrated that the high uptake of RRM and the relatively low uptake (10%) for chemoprevention trials in women at 40% or greater lifetime risk are likely to be a problem in developing good alternative preventive strategies. It is also important to clarify that the median follow-up period in the Dutch study was 2.8 years, not months as stated. Although this letter may appear a little self-serving, it is important that the Journal's readership be made aware that there is more work in this area than the review would have them to believe.
REFERENCES
1
Stefanek M, Hartmann L, Nelson W. Risk-reduction mastectomy: clinical issues and research needs. J Natl Cancer Inst 2001;93:1297–306.
2 Evans DG, Anderson E, Lalloo F, Vasen H, Beckmann M, Eccles D, et al. Utilisation of prophylactic mastectomy in 10 European centres. Dis Markers 1999;15:148–51.[Medline]
3 Hopwood P, Lee A, Shenton A, Baildam A, Brain A, Lalloo F, et al. Clinical follow-up after bilateral risk reducing ("prophylactic") mastectomy: mental health and body image outcomes. Psychooncology 2000;9:462–72.[CrossRef][Medline]
4 Lalloo F, Baildam A, Brain A, Hopwood P, Evans DG, Howell A. A protocol for preventative mastectomy in women with an increased lifetime risk of breast cancer. Eur J Surg Oncol 2000;26:711–3.[CrossRef][Medline]
5
Meijers-Heijboer H, van Geel B, van Putten WL, Henzen-Logmans SC, Seynaeve C, Menke-Pluymers MB, et al. Breast cancer after prophylactic bilateral mastectomy in women with a BRCA1 or BRCA2 mutation. N Engl J Med 2001;345:159–64.
6
Hartmann LC, Schaid DJ, Woods JE, Crotty TP, Myers JL, Arnold PG, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med 1999;340:77–84.
7 Evans D, Lalloo F, Shenton A, Boggis C, Howell A. Uptake of screening and prevention in women at very high risk of breast cancer [letter]. Lancet 2001;358:889–90.[CrossRef][Medline]
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