© 2002 by Oxford University Press
Journal of the National Cancer Institute, Vol. 94, No. 4, 307-308,
February 20, 2002
© 2002 Oxford University Press
CORRESPONDENCE |
RESPONSE: Re: Risk-Reduction Mastectomy: Clinical Issues and Research Needs
Affiliations of authors: M. Stefanek, W. Nelson, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD; L. Hartmann, Division of Medical Oncology, Mayo Clinic, Rochester, MN.
Correspondence to: Michael Stefanek, Ph.D., National Cancer Institute, 6130 Executive Blvd., EPN 4066, MSC 7363, Bethesda, MD 20892 (e-mail: ms496r{at}nih.gov).
We thank the authors of this correspondence for their interest in our article and for the additional information that they provide on the topic of risk-reduction mastectomy. Specifically, the issue of women fabricating or inaccurately reporting their family history (e.g., benign breast disease reported as breast cancer) is appreciated. Although this is a rare occurrence (1), this finding, along with the possibility of Munchausen's syndrome (2), certainly warrants careful confirmation of familial cases of breast cancer before surgical intervention.
We are familiar with the work that the authors indicate was neglected in our article (1,3,4). We chose not to include one of these articles (3) because it is essentially a description of a clinical protocol for women at high risk and does not fit our selection criteria. The other articles did include data on the effectiveness of risk-reduction mastectomy (1) and mental health and body image outcomes (4). We did not include the work by Evans et al. (1) because of the limited duration of follow-up of the women after mastectomy and the authors' own acknowledgment that "follow-up of an extended cohort for more than 5 years will be necessary to address the issue of risk reduction" (1). Furthermore, no statistical analysis of the data related to risk reduction as a function of surgery was reported. Although Hopwood et al. (4) found no evidence of substantial emotional distress or body image problems after surgery, their findings were limited by the absence of adequate psychometric data provided on the body image measure used, and missing data. However, it is reassuring that the findings related to both effectiveness of the procedure (1) and mental health and body image sequelae (4) were consistent with the conclusions in our review (5).
Again, we thank the authors for their contributions and urge readers interested in the topic of risk-reduction mastectomy to include articles from this group (1,3,4) as they review this research area.
REFERENCES
1 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]
2 Grenga TE, Dowden RV. Munchausen's syndrome and prophylactic mastectomy. Plast Reconstr Surg 1987;80:119–20.[Medline]
3 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]
4 Hopwood P, Lee A, Shenton A, Baidam 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]
5
Stefanek M, Hartmann L, Nelson W. Risk-reduction mastectomy: clinical issues and research needs. J Natl Cancer Inst 2001;93:1297–306.
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