© 2003 by Oxford University Press
Journal of the National Cancer Institute, Vol. 95, No. 13, 941-947,
July 2, 2003
© 2003 Oxford University Press
COMMENTARY |
Potential for Bias in Studies on Efficacy of Prophylactic Surgery for BRCA1 and BRCA2 Mutation
Affiliations of authors: H. M. Klaren, L. J. van’t Veer (Department of Pathology), F. E. van Leeuwen, M. A. Rookus (Department of Epidemiology), The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Correspondence to: Matti A. Rookus, Ph.D., Department of Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands (e-mail: m.rookus@nki.nl).
| The first 150 words of the full text of this article appear below. |
Women who carry a germline mutation in the BRCA1 or BRCA2 (BRCA1/2) gene have a 50%–80% lifetime risk of developing breast cancer and a 10%–40% lifetime risk of developing ovarian cancer (1–4). These high-risk women are being offered various preventive measures, including surveillance, chemoprevention, and prophylactic surgery to reduce their risk of cancer. During a prophylactic bilateral mastectomy or a prophylactic bilateral salpingo-oophorectomy, healthy breast or ovarian tissue, respectively, is removed to prevent the development of a malignancy. However, these procedures do not completely eradicate cancer risk because, often, not all tissue at risk is taken away (5–9). Because of the invasive and irreversible nature of prophylactic surgery, knowledge of its efficacy and the extent of risk reduction are crucial for women considering the procedure.
Several groups have investigated the efficacy of bilateral prophylactic surgery in women with a family history of
ILLUSTRATION OF DECISION-MAKING PROCESS WITHIN A FAMILY
BIASES ASSOCIATED WITH SELECTION OF STUDY SUBJECTS
Confounding by Indication
Breast Cancer Risk Reduction After Prophylactic Bilateral Salpingo-Oophorectomy: Survival Bias From Competing Risk of Ovarian Cancer
Tumors Diagnosed at Prophylactic Surgery: Detection Bias
BIASES ASSOCIATED WITH START OF FOLLOW-UP
Date of Ascertainment of the Family
Date of BRCA Mutation Test Result: Cancer-Induced Testing Bias
Date of Prophylactic Surgery: Familial-Event Bias
CONFOUNDING
Efficacy of Prophylactic Bilateral Mastectomy: Confounding Effect of Salpingo-Oophorectomy
Confounding by Other Risk Factors of Breast and Ovarian Cancer
CONCLUSIONS
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