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To the Editor: Dr Schrag and colleagues1 provided information that is critical for making the difficult decision of prophylactic mastectomy in women with breast cancer and BRCA1 or BRCA2 mutations.
However, several issues would further enhance the value of their work. First, the results are stated as the average life expectancy gain, which can be misleading. An increase of 1 year in average life expectancy does not imply that an individual woman can anticipate an extra year of life. Rather, this gain reflects the average benefit in a cohort of women at a defined age and level of risk. It is important to note that the benefit of surgery would be unevenly distributed. In the absence of prophylaxis, a higher percentage of women will experience a recurrence, from which a certain percentage will die. The benefit of prophylaxis is only in this group that would have died. For the majority, who would not have died from recurrence, prophylaxis would not improve life expectancy. It would be helpful to know the percentage that would benefit from each option, as well as the gain in life expectancy in those who did benefit.
Second, the model does not consider quality of life. By ignoring the loss in quality of life due to prophylactic surgery (mastectomy or oophorectomy, or both), the analysis fails to capture an essential component of this decision, thus biasing the result towards prophylactic surgery. A related study2 examined unaffected BRCA carriers and found that incorporating quality of life in the decision would substantially reduce the benefit of prophylactic surgery.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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