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Cultural basis for differences between US and French clinical recommendations for women at increased risk of breast and ovarian cancer

1999; Elsevier BV; Volume: 353; Issue: 9156 Linguagem: Inglês

10.1016/s0140-6736(98)07516-3

1474-547X

François Eisinger, Gail Geller, Wylie Burke, Holtzman Na,

Global Cancer Incidence and Screening

Two recent consensus statements, one from the USA 1 Burke W Daly M Garber J et al. Recommendations for follow-up care of individuals with an inherited predisposition to cancer—II BRCAI and BRCA2: Cancer Genetics Studies Consortium.. JAMA. 1997; 277: 997-1003 Crossref PubMed Google Scholar and one from France, 2 Eisinger F Alby N Bremond A et al. Recommendations for medical management of hereditary breast and ovarian cancer: the French National Ad Hoc Committee.. Ann Oncol. 1998; 9: 939-950 Crossref PubMed Scopus (126) Google Scholar made recommendations about clinical management of women with an inherited predisposition to breast cancer and ovarian cancer due primarily to the presence of BRCA1 or BRCA2 susceptibility-conferring alleles. The groups formulating these statements had the difficult task of making recommendations despite inadequate or equivocal evidence on risk reduction strategies. The two sets of recommendations are similar for the most part, but they diverge in some areas of clinical uncertainty (panel). We believe that the divergence in three areas—breast self-examination, lifestyle, and prophylactic surgery—partly reflects the cultural context in which physicians and patients make decisions and health policies are formulated. Tabled 1 Intervention USA1 Burke W Daly M Garber J et al. Recommendations for follow-up care of individuals with an inherited predisposition to cancer—II BRCAI and BRCA2: Cancer Genetics Studies Consortium.. JAMA. 1997; 277: 997-1003 Crossref PubMed Google Scholar France2 Eisinger F Alby N Bremond A et al. Recommendations for medical management of hereditary breast and ovarian cancer: the French National Ad Hoc Committee.. Ann Oncol. 1998; 9: 939-950 Crossref PubMed Scopus (126) Google Scholar Breast self-examination Recommended Not recommended (training on request) Breast examination by a physician Recommended, by age 25–35, once or twice a year Recommended by age 20, two to three times a year Mammography Suggested by age 25–35 Recommended by age 30 Clinical examination for ovarian cancer Not considered Recommended Ovarian cancer screening by ultrasonography Recommended Recommended Ovarian cancer screening with CA125 Recommended Research only Prostate cancer screening in male relative No position No position Colorectal cancer screening Same as in general population No position Prophylactic mastectomy Informed consent sufficient Informed consent insufficient Prophylactic oophorectomy Informed consent sufficient Informed consent insufficient Hormone replacement therapy No position No contraindication Hormonal contraception No position No contraindication Chemoprevention (tamoxifen) No position Research only Diet Counselling No position Tobacco Counselling No position Open table in a new tab