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

Houn, Florence; Helzlsouer, Kathy J.; Friedman, Neil B.; Stefanek, Michael

doi:10.2105/ajph.85.6.801

Cited by 47 publications

(31 citation statements)

References 19 publications

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“…The present response rate of 60% is comparable to that obtained in other published medical surveys, which varied between 52% in the case of surgeons questioned on the topic of preventative mastectomy [15], 55% [16]and 64.8% when incentives to participate were offered [17]. Our respondents were more frequently women, and as reported previously [17], they were presumably more concerned about the issues investigated than the non-respondents, which may have overestimated the physicians’ knowledge indicators.…”

Section: Discussionsupporting

confidence: 86%

French Physicians’ Knowledge about Hereditary Breast/Ovarian Cancer: The Need for Continuing Vocational Training in Genetics

Julian‐Reynier

Eisinger²,

Moatti³

et al. 1999

Public Health Genomics

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Objectives: The aim of this study was to determine what medical specialists knew about recent findings in the genetics of breast/ovarian cancer, according to their speciality and the methods they used to keep themselves up to date. Methods: A national random sample of 1,169 surgeons and gynaeco-obstetricians was surveyed using a mailed questionnaire, to which 700 of those contacted responded (60%). Results: Two years after it had been identified, BRCA1 was known by only 54% of the practitioners, whereas BRCA2 was known by 49.1% 1 year after it was first identified. The lifetime breast cancer risk of women in the general population was estimated by 37.6% of the participants to be between 6 and 10%, and 35.7% rated the penetrance of a breast cancer mutated gene at between 70 and 90%. After multivariate adjustment, the overall score for knowledge of hereditary breast/ovarian cancer was mainly determined as follows: by the speciality (p < 0.001), since the gynaeco-obstetricians scored the highest and the general surgeons the lowest; by the size of practice (p < 0.001), since a larger practice was associated with a higher score, and by whether or not the participants were accustomed to reading the international literature (p < 0.01). Conclusions: These results show the need for physicians who are not geneticists to acquire further knowledge about cancer genetics. We discuss the role of international reviews in communicating the latest knowledge available in genetics to specialists working in other medical fields.

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Section: Discussionsupporting

confidence: 86%

French Physicians’ Knowledge about Hereditary Breast/Ovarian Cancer: The Need for Continuing Vocational Training in Genetics

Julian‐Reynier

Eisinger²,

Moatti³

et al. 1999

Public Health Genomics

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“…The response rate of 60% was comparable to those obtained in other published medical surveys, in which the response rates varied between 52% in the case of surgeons questioned on the topic of preventive mastectomy, 8 and 64.8% when monetary incentives were offered. 9 Our respondents were more frequently women, and as reported previously, 9 they presumably felt more closely concerned by the issues investigated than the non-respondents.…”

Section: Discussionsupporting

confidence: 78%

“…11 In another survey in a family risk context, ie when no DNA analysis has been carried out, 81% of the US plastic surgeons questioned declared that they had recommended the procedure, as compared with 38.8% of the general surgeons and 17.7% of the gynaecologists. 8 Our results show that French surgeons seemed to recommend this procedure less frequently in the same family risk context, since only 31.6% had done so (37.9% of the gynaecologist surgeons, and 28.8% of the general surgeons). Gynaecologist surgeons' activities are likely to differ in countries with less breast surgery practice, such as the US and United Kingdom, than in France where they deal with both female genital organs and breasts.…”

Section: Discussionmentioning

confidence: 65%

Physicians' attitudes towards mammography and prophylactic surgery for hereditary breast/ovarian cancer risk and subsequently published guidelines

et al. 2000

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After a BRCA mutation has been identified in the context of hereditary breast/ovarian cancer (HBOC), mammographic screening and prophylactic surgery are two of the main options available to those responsible for the clinical management of healthy women. The aim of this study was to describe the attitudes of specialists towards the clinical management of women with an HBOC risk: this information was collected prior to the publication of the recent French guidelines. A random national sample of 1169 French surgeons, gynaecologists and obstetricians was surveyed using a mailed questionnaire, to which 700 of these physicians (60%) responded. When dealing with a BRCA mutated woman, 88.6% of the respondents said they would recommend mammographic screening, but only 27.1% would recommend that it should be carried out annually from the age of 30 years onwards, as recommended in the French guidelines; 10.9% would find it acceptable to propose prophylactic mastectomy from the age of 30 years, and 22.9% would find it acceptable to propose prophylactic oophorectomy from the age of 35 years. The specialists who agreed with recommending breast/ovarian cancer genetic testing also had more positive attitudes towards prophylactic mastectomy (adj OR = 3.4, 95% CI = 1.4-8.2), as did those who had previously recommended prophylactic mastectomy when gene testing was not yet available (adj OR = 2.06, 95% CI = 1.23-3.44). The respondents' attitudes towards prophylactic oophorectomy and mastectomy were significantly associated (adj OR = 3.9; 95% CI = 2.3-6.5). Previous recommendation of prophylactic mastectomy was associated (P < 0.01) with a higher level of knowledge of breast/ovarian cancer genetics and with medical practice in this field. French physicians' attitudes towards mammographic screening and prophylactic surgery were not in complete agreement with the subsequently published French guidelines, the impact of which has now to be considered. Constantly evolving knowledge about the efficacy of preventive intervention will give practitioners new elements to integrate into their counselling.

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“…The responses regarding skepticism are also consistent with the finding that the plastic surgery literature contains the majority of articles on SSM because SSM was first described by plastic surgeons. 1 Published articles have assessed specialty differences and practice patterns 12,13 for varying procedures and fields, although none exist for SSM to date. Most of these assessments deal with one country's or region's attitudes without global comparisons.…”

Section: Discussionmentioning

confidence: 99%

Skin‐sparing mastectomy

Bleicher

Hansen

Giuliano

2003

Cancer

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BACKGROUNDSkin‐sparing mastectomy (SSM) is a variation of modified radical mastectomy (MRM) optimized for reconstruction. The authors attempted to determine SSM attitudes and biases within different specialties and countries throughout the world.METHODSThe authors polled 11,485 individuals via e‐mail, including members of surgical, medical, and breast oncology societies, about SSM. Respondents were directed to a survey website where data were directly entered into a database.RESULTSAmong 1027 respondents, 19 said their knowledge was insufficient to attempt the survey. Surveys were completed by 1008 respondents (8.8%) from 52 countries, comprising 436 (43.3%) surgeons, 376 (37.3%) medical oncologists, 146 (14.5%) radiation oncologists, and 50 (5.0%) individuals from other fields. Of the respondents, 61.9% stated that SSMs are performed at their institution. However 19.1% of these believed that SSM leaves the nipple and areola intact. This perception was higher outside the U.S. (P < 0.0001). Despite knowledge by 77.8% that SSM does not have a higher local disease recurrence rate than MRM, 25.3% of these individuals did not believe the literature. This was most prevalent among radiation oncologists (48.5%), as was the belief that SSM is contraindicated in patients with ductal carcinoma in situ and invasive breast carcinoma (23.3%).CONCLUSIONSDespite a developing body of literature, there was variation in opinion among specialties and a lack of understanding of SSM. Many physicians were not familiar with the literature. Among those who were, skepticism was highest among radiation oncologists. Although these results were indicative of only those responding, education about SSM is needed across specialties and in other countries if the procedure is to be widely accepted. Cancer 2003. © 2003 American Cancer Society.

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

Cited by 47 publications

References 19 publications

French Physicians’ Knowledge about Hereditary Breast/Ovarian Cancer: The Need for Continuing Vocational Training in Genetics

French Physicians’ Knowledge about Hereditary Breast/Ovarian Cancer: The Need for Continuing Vocational Training in Genetics

Physicians' attitudes towards mammography and prophylactic surgery for hereditary breast/ovarian cancer risk and subsequently published guidelines

Skin‐sparing mastectomy

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