Prophylactic Mastectomies: Where’s the Science?

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COMMENT: This amazing abstract deserved to be posted in full. Conventional medicine poo-poos thermography, writing it off as having “no proof of efficacy” and having ” no support in science” despite years of published studies and clinical evidence.  New research points out that aggressive medical procedures, such as prophylactic bilateral mastectomies even in women with BRCA genes, has little foundation in science.  My vote would be for non-invasive, RISK FREE, pain-free and radiation-free prevention rather than radical surgery with little science to support it.                               +++++++++++++++++++++++++++++++++++++++++++++++

ABSTRACT From International Journal of Cancer Published Online: 30 Apr 2007

Mini Review: Effectiveness of preventive interventions in BRCA1/2 gene mutation carriers: A systematic review  by M.J. Bermejo-Pérez  et al  

A systematic review of the literature was conducted to assess the outcomes of preventive interventions (prophylactic mastectomies, intensive cancer screening, and chemoprevention such as Tamoxifen) in women who carry mutations in BRCA1 and BRCA2 genes, in terms of reducing breast and gynecological cancer incidence and/or mortality.

A search for relevant articles published between 1996 and 2005 (inclusive) was run on Medline, Embase and other databases. From the 749 journal articles retrieved from this search strategy, [only] 18 studies were eligible for this review (2 systematic reviews, 10 cohort studies and 6 case-control studies). The critical appraisal of the studies was performed by two independent reviewers with a list of ad hoc selected criteria. The synthesis of results was qualitative.

Mastectomy and prophylactic gynecological surgery (oophorectomy [ovaries removed] or salpingo-oophorectomy [ovaries and tubes removed] )  reduced breast and gynecological cancer incidence in carriers of BRCA mutations, by comparison to surveillance.  However, all the studies presented flaws in internal and external validity, none of these preventive interventions is risk-free, and protection against breast and gynecological cancer, as well as other cancers linked to BRCA mutations, is incomplete.

No studies comparing surveillance programs of varying intensity were found. Exposure to drugs (such as tamoxifen and oral contraceptives) in women carrying BRCA mutations was assessed through a limited number of papers. All of these were case-control studies with prevalent cases and presented major methodological flaws. 

Additional comment: Where’s the science to support this disfiguring, radical procedure?

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