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International Variations in Prophylactic Surgery

by Sue Friedman

Presenter: Steven Narod, MD, FRCP, Canada Research Chair in Breast Cancer, Director, Familial Breast Cancer Research Unit, Women’s College Research Institute, Toronto

Dr. Narod introduced data from an ongoing study of 8,058 women from 11 countries, all known BRCA1 or BRCA2 mutation carriers, who are followed with questionnaires every two years. He discussed the risks and benefits of oral contraceptives, fertility treatment, and hormone replacement therapy for BRCA carriers. An in-depth review of this discussion will appear in next quarter’s Joining FORCEs.

Dr. Narod also shared study data regarding international variations of the decision to undergo prophylactic surgeries:

Percentage of previvors choosing prophylactic mastectomy:

  • USA 35%
  • France 25%
  • Canada 22%
  • Austria 21%
  • Italy 13%
  • Norway 5%
  • Israel 4%
  • Poland 4%

According to Dr. Narod, none of the 174 women in the study who chose bilateral mastectomy developed subsequent breast cancer. Of the 1,134 women who did not choose mastectomy, 76 developed breast cancer within a four-year followup period.

Percentage of breast cancer survivors choosing contralateral prophylactic mastectomy (removal of the opposite breast):

  • Israel 52%
  • USA 49%
  • Canada 28%
  • France 20%
  • Austria 16%
  • Italy 6%
  • Poland 4%
  • Norway 0%

Percentage of BRCA carriers choosing prophylactic oophorectomy:

  • Norway 74%
  • France 71%
  • USA 68%
  • Israel 66%
  • Austria 54%
  • Canada 54%
  • Italy 36%
  • Poland 34%

A free webcast is available of this session on our Joining FORCEs Conference webcast page.

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