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June 21, 2000

Benefit of Prophylactic Mastectomy for Women With BRCA1 or BRCA2 Mutations

Author Affiliations
  • 1Case Western Reserve University School of Medicine, Cleveland, Ohio
JAMA. 2000;283(23):3070. doi:10.1001/jama.283.23.3068e

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.

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