Re: Risk-reduction mastectomy: clinical issues and research needs.

In their recent review, Stefanek et al (1) reviewed the available English language literature between 1995 and 2000 relating to risk-reduction mastectomy (RRM). They clearly state that all articles fulfilling their review criteria of effectiveness , perception, decision-making/follow-up, and satisfaction/psychological sequel-ae were included. Our group was a little unsettled that none of our publications in this area that fulfilled the review criteria had been referenced. Furthermore , these articles are included in the appropriate searches on PubMed® and MEDLINE® in the years reviewed (2– 4). We are also concerned that other articles from the same and other Euro-pean journals were not included. This omission therefore raises the following question: How extensive was this re-view? It is scientifically inappropriate to exclude articles within their review criteria. If foreign articles are to be ignored , this should have been clearly stated in the review. Admittedly, our articles were published in journals that are not widely available. If the authors were not able to obtain such references, this fact should have been stated, rather than leaving the readers with the impression that all available literature had been included. In the study period, we reviewed the practice of RRM in 10 European centers with early reports on effectiveness in 174 women (2). We reported on the clinical follow-up and body image of 76 women after RRM (3) and published our detailed protocol, including early evaluation and uptake of the procedure in BRCA1/2 mutation carriers (4). The uptake in our center (50%) is very similar to that reported by the Rotterdam group (5) and, therefore, suggests that RRM appears most acceptable in Northern Europe. These cultural differences were alluded to in the review, which pointed out the low acceptability in France, in particular. The difference between Northern Europe, where subcutaneous mastectomy was relatively rare in the 1970s and 1980s, compared with the United States and the apparent backlash against the procedure in the United States in terms of uptake in mutation carriers could have been developed further. Who is responsible for the back-lash? Is it the U.S. press, clinicians, or advocacy groups? After all, it was the commonplace nature of prophylactic mastectomy that allowed Hartmann et al. (6) to come up with the first good evidence for efficacy. We have also pointed out the important fact that some women are fabricating their family history to obtain RRM (2–4), another detail overlooked by the review. In …