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Francois Eisinger, MD; Claire Julian-Reynier, MD; Hagay Sobol, MD; Dominique Stoppa-Lyonnet, MD; Christine Lasset, MD; Catherine Nogues, MD
JAMA. 2000;283(2):202-203. doi:10-1001/pubs.JAMA-ISSN-0098-7484-283-2-jbk0112.
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To the Editor: About 7% of breast cancers are associated with a mutation of BRCA1 or BRCA2.1 Preventive management in the population of women with genetically determined breast cancer is challenging because there are limited data about strategies, efficacy, and risk-benefit ratios. Women who test positive for a BRCA1 or BRCA2 mutation face difficult decisions about whether to undergo prophylactic mastectomy. A substantial benefit of prophylactic mastectomy was recently documented in women with a family history of breast cancer.2 However, from a public health point of view, the impact of any treatment depends not only on efficacy but also on availability, affordability, and acceptability of the procedure. On the assumption that availability and affordability could be achieved, we investigated the acceptability of the procedure.

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Figure. Acceptability Reported by Patients and Computed Effectiveness of Prophylactic Mastectomy by Age at Surgery
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The acceptability of prophylactic mastectomy to women potentially at risk was assessed prior to the first cancer genetic consultation. We plotted the rate at which women and physicians said surgery would be acceptable according to age at which the intervention is hypothetically scheduled. Effectiveness (Ef) of the strategy was computed using the following formula: Ef = C (Dfw), where Dfw is the proportion of cancer-prone women still disease free who accept prophylactic mastectomy at a given age based on Breast Cancer Linkage Consortium penetrance data,3 and C is the efficacy of the intervention (90%) as given by Hartmann et al.2

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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