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. 1995 Jun;85(6):801–805. doi: 10.2105/ajph.85.6.801

The practice of prophylactic mastectomy: a survey of Maryland surgeons.

F Houn 1, K J Helzlsouer 1, N B Friedman 1, M E Stefanek 1
PMCID: PMC1615504  PMID: 7762713

Abstract

OBJECTIVES. Bilateral prophylactic mastectomy is a drastic breast cancer preventive option for which indications are not standardized and efficacy has not been proven. To estimate the magnitude of this controversial practice, surgeons were surveyed on their recommendations about and performance of prophylactic mastectomy. METHODS. A cross-sectional survey was sent to general surgeons (n = 522), plastic surgeons (n = 80), and gynecologists (n = 801) licensed to practice in Maryland in 1992. Proportions responding were 41.9%, 66.3%, and 54.9%, respectively. In addition, there were 30 respondents who identified "other" as their specialty. The respondents were asked about the role of bilateral prophylactic mastectomy and the number of times they had recommended and performed it in a year. RESULTS. Seven hundred forty-two surgeons responded (51.8%). More plastic surgeons (84.6%) than general surgeons (47.0%) and gynecologists (38.3%) agreed that bilateral prophylactic mastectomy has a role in the care of high-risk women. Eighty-one percent of plastic surgeons had recommended the procedure, compared with 38.8% of general surgeons and 17.7% of gynecologists. CONCLUSIONS. Indications and practice patterns reveal heterogeneity of medical opinion and practice of prophylactic mastectomy. This study raises the need for better evaluation of the efficacy and appropriateness of prophylactic mastectomy.

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Selected References

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  1. Ariyan S. Prophylactic mastectomy for precancerous and high-risk lesions of the breast. Can J Surg. 1985 May;28(3):262-4, 266. [PubMed] [Google Scholar]
  2. Belanger D., Moore M., Tannock I. How American oncologists treat breast cancer: an assessment of the influence of clinical trials. J Clin Oncol. 1991 Jan;9(1):7–16. doi: 10.1200/JCO.1991.9.1.7. [DOI] [PubMed] [Google Scholar]
  3. Biesecker B. B., Boehnke M., Calzone K., Markel D. S., Garber J. E., Collins F. S., Weber B. L. Genetic counseling for families with inherited susceptibility to breast and ovarian cancer. JAMA. 1993 Apr 21;269(15):1970–1974. [PubMed] [Google Scholar]
  4. Claus E. B., Risch N. J., Thompson W. D. Age at onset as an indicator of familial risk of breast cancer. Am J Epidemiol. 1990 Jun;131(6):961–972. doi: 10.1093/oxfordjournals.aje.a115616. [DOI] [PubMed] [Google Scholar]
  5. Farrow D. C., Hunt W. C., Samet J. M. Geographic variation in the treatment of localized breast cancer. N Engl J Med. 1992 Apr 23;326(17):1097–1101. doi: 10.1056/NEJM199204233261701. [DOI] [PubMed] [Google Scholar]
  6. Gail M. H., Brinton L. A., Byar D. P., Corle D. K., Green S. B., Schairer C., Mulvihill J. J. Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst. 1989 Dec 20;81(24):1879–1886. doi: 10.1093/jnci/81.24.1879. [DOI] [PubMed] [Google Scholar]
  7. Jacobs I., Oram D. Prevention of ovarian cancer: a survey of the practice of prophylactic oophorectomy by fellows and members of the Royal College of Obstetricians and Gynaecologists. Br J Obstet Gynaecol. 1989 May;96(5):510–515. doi: 10.1111/j.1471-0528.1989.tb03248.x. [DOI] [PubMed] [Google Scholar]
  8. Jarrett J. R. Aesthetic refinements in prophylactic mastectomy with immediate reconstruction. Aesthetic Plast Surg. 1990 Spring;14(2):87–92. doi: 10.1007/BF01578331. [DOI] [PubMed] [Google Scholar]
  9. King M. C., Rowell S., Love S. M. Inherited breast and ovarian cancer. What are the risks? What are the choices? JAMA. 1993 Apr 21;269(15):1975–1980. [PubMed] [Google Scholar]
  10. Leis H. P., Jr Selective, elective, prophylactic contralateral mastectomy. Cancer. 1971 Oct;28(4):956–961. doi: 10.1002/1097-0142(1971)28:4<956::aid-cncr2820280419>3.0.co;2-t. [DOI] [PubMed] [Google Scholar]
  11. Miki Y., Swensen J., Shattuck-Eidens D., Futreal P. A., Harshman K., Tavtigian S., Liu Q., Cochran C., Bennett L. M., Ding W. A strong candidate for the breast and ovarian cancer susceptibility gene BRCA1. Science. 1994 Oct 7;266(5182):66–71. doi: 10.1126/science.7545954. [DOI] [PubMed] [Google Scholar]
  12. Miller A. B., Baines C. J., To T., Wall C. Canadian National Breast Screening Study: 1. Breast cancer detection and death rates among women aged 40 to 49 years. CMAJ. 1992 Nov 15;147(10):1459–1476. [PMC free article] [PubMed] [Google Scholar]
  13. Moore M. J., O'Sullivan B., Tannock I. F. How expert physicians would wish to be treated if they had genitourinary cancer. J Clin Oncol. 1988 Nov;6(11):1736–1745. doi: 10.1200/JCO.1988.6.11.1736. [DOI] [PubMed] [Google Scholar]
  14. Nattinger A. B., Gottlieb M. S., Veum J., Yahnke D., Goodwin J. S. Geographic variation in the use of breast-conserving treatment for breast cancer. N Engl J Med. 1992 Apr 23;326(17):1102–1107. doi: 10.1056/NEJM199204233261702. [DOI] [PubMed] [Google Scholar]
  15. Nelson H., Miller S. H., Buck D., Demuth R. J., Fletcher W. S., Buehler P. Effectiveness of prophylactic mastectomy in the prevention of breast tumors in C3H mice. Plast Reconstr Surg. 1989 Apr;83(4):662–669. doi: 10.1097/00006534-198904000-00011. [DOI] [PubMed] [Google Scholar]
  16. Pennisi V. R., Capozzi A. Subcutaneous mastectomy data: a final statistical analysis of 1500 patients. Aesthetic Plast Surg. 1989 Winter;13(1):15–21. doi: 10.1007/BF01570320. [DOI] [PubMed] [Google Scholar]
  17. Schechter M. T. Breast cancer risk factors: can we select women for prophylactic mastectomy? Can J Surg. 1985 May;28(3):242-4, 247. [PubMed] [Google Scholar]
  18. Snyderman R. K. Prophylactic mastectomy: pros and cons. Cancer. 1984 Feb 1;53(3 Suppl):803–808. doi: 10.1002/1097-0142(19840201)53:3+<803::aid-cncr2820531332>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
  19. Temple W. J., Lindsay R. L., Magi E., Urbanski S. J. Technical considerations for prophylactic mastectomy in patients at high risk for breast cancer. Am J Surg. 1991 Apr;161(4):413–415. doi: 10.1016/0002-9610(91)91100-w. [DOI] [PubMed] [Google Scholar]
  20. Wapnir I. L., Rabinowitz B., Greco R. S. A reappraisal of prophylactic mastectomy. Surg Gynecol Obstet. 1990 Aug;171(2):171–184. [PubMed] [Google Scholar]
  21. Wong J. H., Jackson C. F., Swanson J. S., Palmquist M. A., Oyama A. A., Miller S. H., Fletcher W. S. Analysis of the risk reduction of prophylactic partial mastectomy in Sprague-Dawley rats with 7,12-dimethylbenzanthracene-induced breast cancer. Surgery. 1986 Jan;99(1):67–71. [PubMed] [Google Scholar]
  22. Ziegler L. D., Kroll S. S. Primary breast cancer after prophylactic mastectomy. Am J Clin Oncol. 1991 Oct;14(5):451–454. doi: 10.1097/00000421-199110000-00018. [DOI] [PubMed] [Google Scholar]

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