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.
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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