Abstract
Prophylactic surgery is a major issue for breast/ovarian cancer prone women. Bio-clinical data to help in the decision-making are not sufficient. In this context of uncertainty, physicians' and women's attitudes to prophylactic surgery is information of great value. The physicians' attitudes were assessed by a randomised national sample of practitioners involved in breast and ovarian cancer management. The patients' attitudes were appraised with a pre-consultation self-administered questionnaire presented during a one-year period to all women in five cancer genetic clinics chosen, for their representative geographical locations and their activity level. Consent to prophylactic surgery is higher among physicians than among patients (p < 0.0001). Acceptability of mastectomy is lower than that of oophorectomy in both patients and physicians (p < 0.0001 in both groups). In addition, age at which the intervention is proposed to be performed is a key determinant for both mastectomy and oophorectomy acceptability, in both physicians and patients (p < 0.001 for each comparison). Particularly, the age of 40 years seems to be a critical threshold for the acceptability of prophylactic oophorectomy. In contrast, respondents' age at the time of the survey has no significant effect on the acceptability rate. The higher acceptability rate of prophylactic oophorectomy compared to that of mastectomy observed in the physicians' survey is paradoxical because a more substantial medical impact on life expectancy was expected from the latter. Our results indicate that assumed reduced mortality is not the main criterion steering acceptability. It was anticipated that prophylactic mastectomy should be rarely performed in France.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Burke W, Daly M, Garber J et al. Recommendations for followup care of individuals with an inherited predisposition to cancer. II. BRCA1 and BRCA2. Cancer Genetics Studies Consortium. JAMA 1997; 277: 997-1003.
Eisinger F, Alby N, Bremond A et al. Recommendations for Medical Management of Hereditary Breast and Ovarian Cancer: the French National Ad Hoc Committee. Ann Oncol 1998; 9: 939-50.
Schrag D, Kuntz KM, Garber JE, Weeks JC. Decision analysiseffects of prophylactic mastectomy and oophorectomy on life expectancy among women with BRCA1 or BRCA2 mutations. N Eng J Med 1997; 336: 1465-71.
Grann V, Panageas K, Whang W et al. Decision analysis of prophylactic mastectomy and oophorectomy in BRCA1-positive or BRCA2-positive patients. J Clin Oncol 1998; 16: 979-85.
Hartmann LC, Schaid DJ, Woods JE et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Eng J Med 1999; 340: 77-84.
Struewing JP, Watson P, Easton DF et al. Prophylactic oophorectomy in inherited breast/ovarian cancer families. J Natl Cancer Inst Monogr 1995; 17: 33-5.
Rebbeck TR, Levin AM, Eisen A et al. Breast cancer risk after bilateral prophylactic oophorectomy in BRCA1 mutation carriers. J Natl Cancer Inst 1999; 91: 1475-9.
Easton DF, Ford D, Bishop DT, and the Breast Cancer Linkage Consortium. Breast and ovarian cancer incidence in BRCA1-mutation carriers. Am J Hum Genet 1995; 56: 265-71.
Struewing JP, Hartge P, Wacholder S et al. The risk of cancer associated with specific mutations of BRCA1 and BRCA2 among Ashkenazi Jews. N Eng J Med 1997; 336: 1401-8.
Ford D, Easton D, Stratton M et al. Genetic heterogeneity and penetrance analysis of the BRCA1 and BRCA2 genes in breast cancer families. Am J Hum Genet 1998; 62: 679-89.
Thorlacius S, Struewing JP, Hartge P et al. Population-based study of risk of breast cancer in carriers of BRCA2 mutation [In Process Citation]. Lancet 1998; 352(9137): 1337-9.
Chang J, Yang WT, Choo HF. Mammography in Asian patients with BRCA1 mutations. Lancet 1999; 353(9169): 2070-1.
Den Otter W, Merchant T, Beijerinck D, Koten J. Breast cancer induction due to mammographic screening in hereditary affected women. Anticancer Res 1996; 16: 3173-6.
Fisher B, Costantino J, Wickerham D et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 1998; 90: 1371-88.
Powles T, Eeles R, Ashley S et al. Interim analysis of the incidence of breast cancer in the Royal Marsden Hospital tamoxifen randomised chemoprevention trial. Lancet 1998; 352(9122): 98-101.
Veronesi U, Maisonneuve P, Costa A et al. Prevention of breast cancer with tamoxifen: preliminary findings from the Italian randomised trial among hysterectomised women. Lancet 1998; 352: 93-7.
Narod SA, Brunet JS, Ghadirian P et al. Tamoxifen and risk of contralateral breast cancer in BRCA1 and BRCA2 mutation carriers: a case-control study. Hereditary Breast Cancer Clinical Study Group. Lancet 2000; 356(9245): 1876-81.
Eisinger F, Charafe-Jauffret E, Jacquemier J et al. Tamoxifen and breast cancer risk in women harboring a BRCA1 germline mutation: computed efficacy, effectiveness and impact [In Process Citation]. Int J Oncol 2001; 18(1): 5-10.
Eisinger F, Julian-Reynier C, Stoppa-Lyonnet D et al. Acceptability of prophylactic mastectomy in cancer-prone women. JAMA 2000; 283: 202-3.
Julian-Reynier C, Eisinger F, Moatti J, Sobol H. Physicians' attitudes towards mammography and prophylactic surgery for hereditary breast/ovarian cancer risk and subsequently published guidelines. Eur J Hum Genet 2000; 8: 204-8.
Julian-Reynier C, Eisinger F, Moatti JP, Sobol H. Re: Randomized trial of a specialist genetic assessment service for familial breast cancer. J Natl Cancer Inst 2001; 93(2): 158-9.
Sobol H, Bignon YJ, Bonaiti C et al. Four years analysis of cancer genetic clinics activity in France from 1994 to 1997: a survey on 801 patients. French Cooperative Network/Groupe Genetique et Cancer de la Federation Nationale des Centres de Lutte Contre le Cancer. Dis Markers 1999; 15(1-3): 15-29.
Mehta C, Patel N. Singly ordered R*C contingency tables. In Mehta C, Ptale N (eds). StatXact 4. Cambridge MA: Cytel software corporation, 1999.
Geller G, Botkin J, Green M et al. Genetic testing for susceptibility to adult-onset cancer. The process and content of informed consent. JAMA 1997; 277: 1467-74.
Geller G, Bernhardt BA, Doksum T et al. Decision-making about breast cancer susceptibility testing: how similar are the attitudes of physicians, nurse practitioners, and at-risk women? J Clin Oncol 1998; 16(8): 2868-76.
Ford D, Easton DF, Bishop DT et al. Risks of cancer in BRCA1-mutation carriers. Lancet 1994; 343: 692-5.
Meijers-Heijboer EJ, Verhoog LC, Brekelmans CT et al. Presymptomatic DNA testing and prophylactic surgery in families with a BRCA1 or BRCA2 mutation. Lancet 2000; 355(9220): 2015-20.
Pennisi VR, Capozzi A. The incidence of obscure carcinoma in subcutaneous mastectomy. Results of a national survey. Plast Reconstr Surg 1975; 56(1): 9-12.
Ziegler L, Kroll S. Primary breast cancer after prophylactic mastectomy. Am J Clin Oncol 1991; 14: 451-4.
Eisinger F, Geller G, Burke W, Holtzman N. Cultural basis for differences between US and French clinical recommendations for women at increased risk of breast and ovarian cancer. Lancet 1999; 353: 919-20.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Eisinger, F., Stoppa-Lyonnet, D., Lasset, C. et al. Comparison of physicians' and cancer prone women's attitudes about breast/ovarian prophylactic surgery. Results from two national surveys. Familial Cancer 1, 157–162 (2001). https://doi.org/10.1023/A:1021113715998
Issue Date:
DOI: https://doi.org/10.1023/A:1021113715998