Patient regrets after bilateral prophylactic mastectomy.

BACKGROUND: The discovery of a cadre of breast cancer susceptibility genes has resulted in an increase in the number of women seeking information about prophylactic breast surgery, but virtually no large-scale prospective databases exist to assist women considering prophylactic mastectomy. METHODS: The authors constructed a National Prophylactic Mastectomy Registry comprised of a volunteer population of 817 women from 43 states who have undergone prophylactic mastectomy. RESULTS: In the registry, 370 women had undergone bilateral prophylactic mastectomy. Twenty-one (5%) women expressed regrets about the procedure. The median follow-up was 14.6 years (mean 14.8 years; range 0.2-51 years). Those with regrets were subsetted into those with major (n = 10) or minor (n = 7) regrets. Regrets were more common in those women with whom discussion about prophylactic mastectomy was initiated by a physician (19/255), compared with patients who initiated the discussion themselves (2/108; P < .05). CONCLUSIONS: The overall satisfaction rate of 95% reported here may be explained by the voluntary nature of this registry. The most important factor that predicts an unfavorable outcome following bilateral prophylactic mastectomy is a physician-initiated discussion.

Sensitivity versus cost effectiveness in postoperative follow-up for colorectal cancer.

The incidence of colorectal cancer is increasing. Approximately 20% of patients present with untreatable, disseminated disease. The remaining 80% are generally treated by intended curative resection. Unfortunately, about 40% of the Dukes B2 and C patients will develop recurrent disease. Of these patients, about one third will develop hepatic metastases, one fifth pulmonary metastases, one fifth intra-abdominal metastases, one tenth retroperitoneal metastases, and one twentieth anastomotic recurrences. Rectal cancer patients may have pelvic recurrence rates as high as one third. Unfortunately, only about one fifth of the Dukes B2 and C patients will initially develop recurrences at only one site and are, thus, potentially curable. Indeed, when considering all colorectal cancer patients, resectable recurrences will be detected in the liver in only 2%, regional recurrences in about 10%, in the lungs in 2%, anastomotic recurrences in less than 1%, and in the ovaries in 1%. In general, long-term survival can be achieved in about 30% of these patients with salvage surgery. The goal of intensive follow-up programs has been to identify these sole site recurrences at an earlier, asymptomatic stage and thereby improve survival. Unfortunately this laudable goal has not been achieved. Intensive (and expensive) follow-up programs consistently achieve long-term survival in 0% to 4% of patients. Reliance on symptoms, however, achieves remarkably similar end results.(ABSTRACT TRUNCATED AT 250 WORDS)