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Volume 345:159-164 July 19, 2001 Number 3 Next

Abstract PDF Editorial by Eisen, A. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Women with a BRCA1 or BRCA2 mutation have a high risk of breast cancer and may choose to undergo prophylactic bilateral total mastectomy. We investigated the efficacy of this procedure in such women.

Methods We conducted a prospective study of 139 women with a pathogenic BRCA1 or BRCA2 mutation who were enrolled in a breast-cancer surveillance program at the Rotterdam Family Cancer Clinic. At the time of enrollment, none of the women had a history of breast cancer. Seventy-six of these women eventually underwent prophylactic mastectomy, and the other 63 remained under regular surveillance. The effect of mastectomy on the incidence of breast cancer was analyzed by the Cox proportional-hazards method in which mastectomy was modeled as a time-dependent covariate.

Results No cases of breast cancer were observed after prophylactic mastectomy after a mean (±SE) follow-up of 2.9±1.4 years, whereas eight breast cancers developed in women under regular surveillance after a mean follow-up of 3.0±1.5 years (P=0.003; hazard ratio, 0; 95 percent confidence interval, 0 to 0.36). The actuarial mean five-year incidence of breast cancer among all women in the surveillance group was 17±7 percent. On the basis of an exponential model, the yearly incidence of breast cancer in this group was 2.5 percent. The observed number of breast cancers in the surveillance group was consistent with the expected number (ratio of observed to expected cases, 1.2; 95 percent confidence interval, 0.4 to 3.7; P=0.80).

Conclusions In women with a BRCA1 or BRCA2 mutation, prophylactic bilateral total mastectomy reduces the incidence of breast cancer at three years of follow-up.

Women with a BRCA1 or BRCA2 mutation have a cumulative lifetime risk of invasive breast cancer (up to the age of 70 years) of 55 to 85 percent and of invasive epithelial ovarian cancer of 15 to 65 percent.^5,6 In these women the risk of breast cancer begins to increase near the age of 25 years, and their overall survival once breast cancer does develop is similar to that of age-matched patients with sporadic cases of breast cancer: in both, the 10-year survival rate is about 50 percent.^7,8

Current risk-reduction strategies for women with a BRCA1 or BRCA2 mutation include regular surveillance; prophylactic mastectomy, oophorectomy, or both; and chemoprevention.^9,10,11 In our experience, 50 percent of women who have a BRCA1 or BRCA2 mutation have chosen to undergo prophylactic bilateral mastectomy.⁴ Until now, however, there have been only retrospective studies of the efficacy of the procedure in women with an increased risk of breast cancer on the basis of the family pedigree and not DNA testing.¹²

We investigated the efficacy of prophylactic mastectomy in women with a proven pathogenic BRCA1 or BRCA2 mutation. Because a randomized trial is impossible for ethical reasons, we performed a prospective cohort study of women at a single institution who chose either prophylactic mastectomy or regular surveillance.

Methods

Study Subjects

Beginning on January 1, 1992, we studied all women with a BRCA1 or BRCA2 mutation who were being monitored for breast cancer because of familial clustering of breast cancer, ovarian cancer, or both at the Daniel den Hoed Cancer Center in Rotterdam, the Netherlands. We included all women who had been given a molecular diagnosis before January 1, 2000. Women with a BRCA1 or BRCA2 mutation in whom breast cancer developed before January 1, 1992, and one woman in whom breast cancer was detected at the first screening were excluded. The date January 1, 1992, was chosen because at that time, a multidisciplinary team at our family cancer clinic took over the care of women at high risk for breast cancer. A total of 139 women fulfilled the criteria. Eventually, 76 of these women chose to undergo prophylactic bilateral mastectomy before the end of the follow-up period (March 1, 2001), whereas the other 63 women chose to remain under regular surveillance. In all but two women prophylactic mastectomy was performed after the molecular diagnosis was established.

Data Collection and Follow-up

Information on vital status and the occurrence of cancer was extracted from the women's medical files. All women were regularly monitored at our clinic until March 1, 2001, and were enrolled in clinical research programs approved by our medical ethics committee (protocol DDHK 91-17, updated in 1995). We obtained pathology reports of all mastectomy specimens and of all breast-biopsy specimens from the women who were being monitored. Information on oophorectomy performed for any reason (mostly at our clinic) was obtained from the women themselves and was verified by a review of all medical records. Premenopausal oophorectomy was defined as bilateral oophorectomy before the age of 56 years and was performed prophylactically in the case of 59 women, for benign disease in the case of 1 woman, for ovarian cancer in the case of 7 women, and for cervical cancer in the case of 1 woman (Table 1). No women were lost to follow-up after prophylactic mastectomy. Of the women in the surveillance group, three died of ovarian cancer and two chose to be monitored at another hospital for practical reasons.

View this table: [in this window] [in a new window]   Table 1. Characteristics of the Women.

 
Surgical Techniques and Surveillance

In all cases a standard, bilateral, simple total mastectomy (including the nipple) was performed by a surgical oncologist at the Daniel den Hoed Cancer Center. In 74 of the 76 women, the breasts were reconstructed with silicone prostheses by a plastic surgeon in the same session, followed later by a nipple reconstruction.

According to national guidelines, regular surveillance for breast cancer consists of a monthly breast self-examination, a clinical breast examination every six months, and yearly mammography. Since 1995, magnetic resonance imaging (MRI) has been an option at our clinic for women with mammographically very dense tissue and those with a BRCA1 or BRCA2 mutation. When indicated, ultrasonography with or without fine-needle aspiration was also performed. The age at entry into the surveillance program was generally 25 years or younger in women with relatives in whom breast cancer had been diagnosed before the age of 30 years.

To rule out overt breast cancer at the time of prophylactic mastectomy, any or all of the following were performed no more than three months before surgery: a physical examination of the breast, mammography, or MRI. After prophylactic mastectomy, the chest wall and regional lymph nodes were examined every six months. In most women, computed tomography of the chest was performed one year after prophylactic mastectomy.

Analysis of BRCA1 and BRCA2 Mutations and Histologic Examination

DNA analysis was performed according to standard procedures.^13,14,15 BRCA1 and BRCA2 linkage analysis was used until 1994 and 1995, respectively, to identify the presence of hereditary breast cancer; from 1994 to 2000 we used direct mutation analysis. All BRCA1 and BRCA2 mutations were pathogenic, since they resulted in a premature truncation of the BRCA1 or BRCA2 protein.

Mastectomy specimens were examined histologically to rule out the presence of occult breast cancer. From each quadrant of the specimen, microscopical sections from three random blocks were examined according to standard procedures.

Statistical Analysis

We used a chi-square test and a t-test to compare the characteristics of the group of 76 women who chose to undergo mastectomy with those of the 63 women who opted to continue being monitored. We used a Cox proportional-hazards model to analyze the effect of prophylactic mastectomy on the incidence of breast cancer, with prophylactic mastectomy included as a time-dependent covariate. To adjust for the potential effect of a change in menopausal status, either through premenopausal oophorectomy or through natural menopause (defined as occurring at the age of 56 years), we included menopausal status in the model as a time-dependent covariate. The women were followed from January 1, 1992, or from the time of the first visit after that date at our clinic until the occurrence of breast cancer or death, the end of follow-up at our clinic, or the end of the study (March 1, 2001). We determined the number of woman-years at risk for breast cancer in various age cohorts in the two groups; in this analysis we included in the surveillance-group data the number of years of surveillance in the women in the mastectomy group before prophylactic mastectomy was performed. The numbers of woman-years at risk were used to calculate the numbers of breast cancers expected on the basis of published estimates for women with a BRCA1 mutation.¹⁶ We calculated 95 percent confidence intervals assuming a Poisson distribution. We used the method of Kaplan and Meier to calculate the actuarial probability of breast cancer during the surveillance period. We compared these probabilities with the cumulative incidence, assuming that the model was an exponential one with a constant hazard rate, in order to have more stable estimates with longer follow-up.

A two-sided P value of less than 0.05 was considered to indicate statistical significance. All analyses were performed with the use of SPSS and Stata software.

Results

Characteristics of the Women

Table 1 lists the general characteristics of the women who chose to undergo prophylactic mastectomy and those who opted for surveillance. Significantly more women in the mastectomy group than in the surveillance group had undergone a premenopausal oophorectomy (44 vs. 24 [58 percent vs. 38 percent], P=0.03). All gynecologic cancers occurred before the age of 56 years; the two such cases in the mastectomy group were ovarian cancer, stage IC. There were no significant differences between the two groups with respect to age, average duration of follow-up after entry into the study, follow-up after premenopausal oophorectomy, and type of mutation. The 26 distinct mutations — 23 in BRCA1 and 3 in BRCA2 — were distributed in a similar fashion in the two groups. The 139 women were from a total of 70 families; the number of women from each family ranged from 1 to 5.

The mean (±SE) duration of follow-up was 2.9±1.4 years (219 woman-years) in the mastectomy group and 3.0±1.5 years (190 woman-years) in the surveillance group (Table 1). The total number of woman-years of surveillance increased from 190 to 318 when the 128 woman-years of surveillance before prophylactic mastectomy was added.

Incidence of Breast Cancer

After prophylactic mastectomy no case of invasive breast cancer was observed in any of the 76 women during 219 woman-years at risk (Figure 1). In the surveillance group eight invasive breast cancers were detected during 318 woman-years at risk, for a yearly incidence of 2.5 percent. The ratio of observed cases to expected cases was 1.2 (8 vs. 6.7; 95 percent confidence interval, 0.4 to 3.7; P=0.80). All the affected women were from different families. The actuarial mean five-year incidence of breast cancer in the women in the surveillance group (Figure 1) was 17±7 percent, but the number of women at risk at five years was only eight. To obtain a more stable estimate with longer periods of follow-up, we calculated cumulative incidence probabilities with the use of an exponential model in which the hazard rate was assumed to be constant. According to this model, the yearly incidence of breast cancer was 2.5 percent and the five-year cumulative incidence was 12 percent (95 percent confidence interval, 6 to 23 percent) (Figure 1). Disregarding the years of surveillance before prophylactic mastectomy and thus restricting the actuarial analysis to the 63 women in the surveillance group, we estimated that the five-year risk of breast cancer was 24±9 percent.

View larger version (11K): [in this window] [in a new window]   Figure 1. Actuarial Incidence of Breast Cancer among Women with a BRCA1 or BRCA2 Mutation after Prophylactic Mastectomy or during Surveillance. The surveillance group includes data obtained before prophylactic mastectomy in 76 of the 139 women. The dashed line represents the probability of breast cancer during surveillance, and the dotted lines the 95 percent confidence interval. Values were calculated with the use of an exponential model in which the hazard rate was assumed to be constant.

 
Cox proportional-hazards analysis showed that mastectomy significantly (P=0.003) decreased the incidence of breast cancer (hazard ratio, 0; 95 percent confidence interval, 0 to 0.36). After adjustment for the change in menopausal status, the protective effect of mastectomy remained statistically significant (P=0.01).

Outcome in the Women with Breast Cancer

None of the eight patients in the surveillance group in whom breast cancer developed had been scheduled to undergo prophylactic mastectomy at the time of the diagnosis. The characteristics of the women and the tumors are described in Table 2 and Table 3, respectively. Patients 7 and 8 underwent bilateral oophorectomy 14 and 12 months, respectively, before the diagnosis of breast cancer. Of the eight cancers, four (in Patients 1, 2, 4, and 6) were detected between screening sessions (so-called interval cancers). In these four patients the interval from screening to diagnosis was two to five months. The cancers in the other four patients (Patients 3, 5, 7, and 8) were detected during a screening session. Patient 1 became symptomatic eight weeks after her first clinical breast-cancer screening, the results of which were negative. In four of the eight patients, breast cancer was detected before the molecular diagnosis was made.

View this table: [in this window] [in a new window]   Table 2. Characteristics of the Eight Women in the Surveillance Group in Whom Breast Cancer Developed.

 

View this table: [in this window] [in a new window]   Table 3. Characteristics of the Tumors in the Eight Women in the Surveillance Group in Whom Breast Cancer Developed.

 
Histologic Findings in the Mastectomy Group

Invasive cancer was not detected in any of the specimens obtained at the time of prophylactic mastectomy. One 44-year-old woman with a BRCA1 mutation had lobular carcinoma in situ.

Discussion

In this prospective study we assessed the incidence of breast cancer in 139 women with a BRCA1 or BRCA2 mutation who chose to undergo either prophylactic mastectomy or regular surveillance. Whereas breast cancer developed in 8 of 63 women in the surveillance group, no cases of breast cancer occurred among the 76 women who underwent prophylactic mastectomy. The observed number of breast cancers in the group under surveillance is compatible with the reported incidence of breast cancer in women with a BRCA1 or BRCA2 mutation.¹⁶ As compared with the incidence in the surveillance group, the incidence of breast cancer in the prophylactic-mastectomy group was significantly reduced (P=0.003), but the mean follow-up of three years calls for a cautious interpretation of our results.

Until now, only retrospective studies of the outcome of prophylactic mastectomy (mainly subcutaneous, and thus often incomplete) have been published.¹² Hartmann et al.¹⁷ reported the results of prophylactic bilateral mastectomy in 639 women with a family history of breast cancer; at least 12 of these women had a BRCA1 or BRCA2 mutation.¹⁸ After a median follow-up of 14 years, there was an approximate 90 percent reduction in the risk of breast cancer; the risk of death was also reduced significantly. All seven breast cancers occurred after subcutaneous bilateral mastectomy; there were none after total mastectomy.¹⁷ Moreover, breast cancer did not develop in any of the women with a confirmed BRCA1 or BRCA2 mutation after a median follow-up of 16 years,¹⁸ which leads us to anticipate that prophylactic mastectomy will reduce the long-term risk of breast cancer in the women with a BRCA1 or BRCA2 mutation whom we studied.

It is uncertain whether mammographic surveillance of premenopausal women with a BRCA1 or BRCA2 mutation contributes substantially to early detection of breast cancer.¹⁹ Considering the women's young age in our study cohort and the stage and pathological characteristics of their breast cancers at diagnosis, we estimate that 35 to 50 percent of women under surveillance in whom primary breast cancer develops will die of distant metastasis within 10 to 15 years.^7,8 Assuming that within 10 years breast cancer will develop in approximately 25 percent of the women undergoing regular surveillance, we estimate that 10 to 20 percent of women who choose surveillance will die of breast cancer within 20 years. During the three years of follow-up in our study, there was one death due to breast cancer (Table 2).

Currently, several large, prospective studies are investigating whether MRI screening adds to the efficacy of mammographic screening in women at high risk for breast cancer.^20,21 In our study MRI was performed in six women at the time of diagnosis and detected all six cancers, but mammography was diagnostic in only two of the eight women with breast cancer. In view of the high number of interval cancers (four of eight), the use of high-resolution imaging and more frequent screening might be useful in women with a BRCA1 or BRCA2 mutation.

There is little in the literature on the histologic findings in specimens obtained at the time of prophylactic mastectomy from women with a BRCA1 or BRCA2 mutation. In two studies, in about 35 percent of unaffected high-risk women, proliferative breast disease (marked or atypical hyperplasia) was found in the surgical specimens.^22,23 This abnormality was found in specimens from only 13 percent of women with an average risk of breast cancer.²³ In two women with a strong family history of breast cancer, microcalcifications and invasive breast cancer were detected within one year after the finding of proliferative disease.²³ In contralateral specimens obtained at the time of prophylactic mastectomy from women with prior breast cancer and either a genetic risk or a family history of breast cancer, a higher prevalence of malignant lesions was observed.^9,22 In our study, there was one carcinoma in situ and several prophylactic-mastectomy specimens with various degrees of hyperplasia and atypia. However, we cannot exclude the possibility that small invasive tumors were overlooked.

In our study all eight breast cancers occurred in women with a BRCA1 mutation. This finding may be partly explained by the fact that only about 10 percent of the woman-years of surveillance were accounted for by women with BRCA2 mutations.

Apart from surveillance and prophylactic mastectomy, women with a BRCA1 or BRCA2 mutation may choose to undergo bilateral oophorectomy before menopause, chemoprevention, or both to reduce the risk of breast cancer. Such interventions may reduce the risk of breast cancer by about 50 percent,^24,25,26 but the use of tamoxifen as a preventive agent has been questioned in view of its long-term side effects.²⁷

Prophylactic mastectomy is a highly personal decision. In counseling high-risk women, the protective effect of prophylactic mastectomy must be weighed against possible surgical complications and psychological problems. Up to 30 percent of the women who undergo the procedure will have surgical complications, depending on the type of surgery and the length of follow-up.^12,28 A long-term study of prophylactic mastectomy reported unanticipated repeated operations in 49 percent of women,²⁹ but these results may not be applicable to prophylactic mastectomies as they are currently performed. Psychological studies of women who had undergone a prophylactic mastectomy did not find that, overall, the procedure had detrimental effects on body image and sexuality.^30,31,32,33

In conclusion, our data and those of Hartmann et al.^17,18 indicate that prophylactic bilateral total mastectomy substantially reduces the incidence of breast cancer among women with a BRCA1 or BRCA2 mutation. Nevertheless, longer follow-up and studies of more patients are required to establish the protective effect and determine the long-term complications of this procedure.

Supported in part by a grant from the Dutch Cancer Society (DDHK 95-953) and by a grant from the Dutch Government (ZON 2100.0013).

We are indebted to Madeleine Tilanus-Linthorst and Lia van Zuylen for conducting surveillance; to Rudy Tjong Joe Wai for breast reconstruction in the patients; to Mieke Kriege and Leon Aronson for assistance with data analysis; to Ellen Crepin and Ann Claessens for data collection; to Dicky Halley and Peter Devilee for mutation analysis; and to Petra Bos for assistance with the preparation of the manuscript.

Source Information

From the Departments of Medical Oncology (H.M.-H., C.S., L.C.V., C.T.M.B., J.G.M.K.), Surgery (B.G., M.B.E.M.-P., C.C.M.B.), Statistics (W.L.J.P.), Clinical Genetics (H.M.-H., A.M.W.O., M.F.N.), and Pathology (S.C.H.-L.), Erasmus University Medical Center, Rotterdam, the Netherlands.

Address reprint requests to Dr. Klijn at the Rotterdam Family Cancer Clinic, Department of Medical Oncology, Dr. Daniel den Hoed Kliniek, Erasmus University Medical Center Rotterdam, Groene Hilledijk 301, 3075 EA Rotterdam, the Netherlands, or at bos{at}onch.azr.nl.

References

1. Miki Y, Swensen J, Shattuck-Eidens D, et al. A strong candidate for the breast and ovarian cancer susceptibility gene BRCA1. Science 1994;266:66-71. [Free Full Text]
2. Wooster R, Bignell G, Lancaster J, et al. Identification of the breast cancer susceptibility gene BRCA2. Nature 1995;378:789-792. [Erratum, Nature 1996;379:749.] [CrossRef][Medline]
3. Lerman C, Narod S, Shulman K, et al. BRCA1 testing in families with hereditary breast-ovarian cancer: a prospective study of patient decision making and outcomes. JAMA 1996;275:1885-1892. [Abstract]
4. Meijers-Heijboer EJ, Verhoog LC, Brekelmans CTM, et al. Presymptomatic DNA testing and prophylactic surgery in families with a BRCA1 or BRCA2 mutation. Lancet 2000;355:2015-2020. [CrossRef][ISI][Medline]
5. Ford D, Easton DF, Stratton M, et al. Genetic heterogeneity and penetrance analysis of the BRCA1 and BRCA2 genes in breast cancer families. Am J Hum Genet 1998;62:676-689. [CrossRef][ISI][Medline]
6. Struewing JP, Hartge P, Wacholder S, et al. The risk of cancer associated with specific mutations of BRCA1 and BRCA2 among Ashkenazi Jews. N Engl J Med 1997;336:1401-1408. [Free Full Text]
7. Verhoog LC, Brekelmans CTM, Seynaeve C, et al. Survival and tumour characteristics of breast-cancer patients with germline mutations of BRCA1. Lancet 1998;351:316-321. [CrossRef][ISI][Medline]
8. Verhoog LC, Brekelmans CTM, Seynaeve C, et al. Survival in hereditary breast cancer associated with germline mutations of BRCA2. J Clin Oncol 1999;17:3396-3402. [Free Full Text]
9. Klijn JGM, Janin N, Cortes-Funes H, Colomer R. Should prophylactic surgery be used in women with a high risk of breast cancer? Eur J Cancer 1997;33:2149-2159.
10. Burke W, Daly M, Garber J, et al. Recommendations for follow-up care of individuals with an inherited predisposition to cancer. II. BRCA1 and BRCA2. JAMA 1997;77:997-1003. 
11. Bilimoria MM, Morrow M. The women at increased risk for breast cancer: evaluation and management strategies. CA Cancer J Clin 1995;45:263-278. [Abstract]
12. Eisen A, Rebbeck TR, Wood WC, Weber BL. Prophylactic surgery in women with a hereditary predisposition to breast and ovarian cancer. J Clin Oncol 2000;18:1980-1995. [Free Full Text]
13. Hogervorst FBL, Cornelis RS, Bout M, et al. Rapid detection of BRCA1 mutations by the protein truncation test. Nat Genet 1995;10:208-212. [CrossRef][ISI][Medline]
14. Petrij-Bosch A, Peelen T, van Vliet M, et al. BRCA1 genomic deletions are major founder mutations in Dutch breast cancer patients. Nat Genet 1997;17:341-345. [Erratum, Nat Genet 1997;17:503.] [CrossRef][ISI][Medline]
15. Peelen T, van Vliet M, Bosch A, et al. Screening for BRCA2 mutations in 81 Dutch breast-ovarian cancer families. Br J Cancer 2000;82:151-156. [CrossRef][ISI][Medline]
16. Whittemore AS, Gong G, Itnyre J. Prevalence and contribution of BRCA1 mutations in breast cancer and ovarian cancer: results from three U.S. population-based case-control studies of ovarian cancer. Am J Hum Genet 1997;60:496-504. [ISI][Medline]
17. Hartmann LC, Schaid DJ, Woods JE, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med 1999;340:77-84. [Free Full Text]
18. Hartmann LC, Schaid D, Sellers T, et al. Bilateral prophylactic mastectomy (PM) in BRCA1/2 mutation carriers. Proc Am Assoc Cancer Res 2000;41:222. abstract.
19. Brekelmans CTM, Seynaeve C, Bartels CCM, et al. Effectiveness of breast cancer surveillance in BRCA1/2 gene mutation carriers and women with high familial risk. J Clin Oncol 2001;19:924-930. [Free Full Text]
20. Kuhl CK, Schmutzler RK, Leutner C, et al. Breast MR imaging screening in 192 women proved or suspected to be carriers of a breast cancer susceptibility gene: preliminary results. Radiology 2000;215:267-279. [Free Full Text]
21. Kriege M, Brekelmans C, Boetes C, et al. MRI screening for breast cancer in women with high familial risk. Eur J Cancer 2000;36:Suppl 5:S137-S137.abstract 
22. Khurana KK, Loosmann A, Numann PJ, Khan SA. Prophylactic mastectomy: pathologic findings in high-risk patients. Arch Pathol Lab Med 2000;124:378-381. [Medline]
23. Skolnick MH, Cannon-Albright LA, Goldgar DE, et al. Inheritance of proliferative breast disease in breast cancer kindreds. Science 1990;250:1715-1720. [Free Full Text]
24. Rebbeck TR, Levin AM, Eisen A, et al. Breast cancer risk after bilateral prophylactic oophorectomy in BRCA1 mutation carriers. J Natl Cancer Inst 1999;91:1475-1479. [Free Full Text]
25. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 1998;90:1371-1388. [Free Full Text]
26. Narod SA, Brunet J-S, Ghadirian P, et al. Tamoxifen and risk of contralateral breast cancer in BRCA1 and BRCA2 mutation carriers: a case-control study. Lancet 2000;356:1876-1881. [CrossRef][ISI][Medline]
27. Berman L, Beelen MLR, Gallee MPW, Hollema H, Benraadt J, van Leeuwen FE. Risk and prognosis of endometrial cancer after tamoxifen for breast cancer. Lancet 2000;356:881-887. [CrossRef][ISI][Medline]
28. Gabriel SE, Woods JE, O'Fallon WM, Beard CM, Kurland LT, Melton LJ III. Complications leading to surgery after breast implantation. N Engl J Med 1997;336:677-682. [Free Full Text]
29. Zion SM, Slezak JM, Schaid DJ, et al. Surgical morbidities following bilateral prophylactic mastectomy. Prog Proc Am Soc Clin Oncol 2000;19:441a. abstract.
30. Stefanek ME, Helzlsouer KJ, Wilcox PM, Houn F. Predictors of and satisfaction with bilateral prophylactic mastectomy. Prev Med 1995;24:412-419. [CrossRef][ISI][Medline]
31. Borgen PI, Hill ADK, Tran KN, et al. Patient regrets after bilateral prophylactic mastectomy. Ann Surg Oncol 1998;5:603-606. [Abstract]
32. Frost MH, Schaid DJ, Sellers TA, et al. Long-term satisfaction and psychological and social function following bilateral prophylactic mastectomy. JAMA 2000;284:319-324. [Free Full Text]
33. Hatcher MB, Fallowfield L, A'Hern R. The psychosocial impact of bilateral prophylactic mastectomy: prospective study using questionnaires and semistructured interviews. BMJ 2001;322:1-7. [Free Full Text]

Abstract PDF Editorial by Eisen, A. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

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• Offit, K. (2006). BRCA Mutation Frequency and Penetrance: New Data, Old Debate. JNCI J Natl Cancer Inst 98: 1675-1677 [Full Text]  
• Vogel, V. G. (2006). Identifying and Screening Patients at Risk of Second Cancers. Cancer Epidemiol. Biomarkers Prev. 15: 2027-2032 [Abstract] [Full Text]  
• Guillem, J. G., Wood, W. C., Moley, J. F., Berchuck, A., Karlan, B. Y., Mutch, D. G., Gagel, R. F., Weitzel, J., Morrow, M., Weber, B. L., Giardiello, F., Rodriguez-Bigas, M. A., Church, J., Gruber, S., Offit, K. (2006). ASCO/SSO Review of Current Role of Risk-Reducing Surgery in Common Hereditary Cancer Syndromes. JCO 24: 4642-4660 [Abstract] [Full Text]  
• Guillem, J. G., Wood, W. C., Moley, J. F., Berchuck, A., Karlan, B. Y., Mutch, D. G., Gagel, R. F., Weitzel, J., Morrow, M., Weber, B. L., Giardiello, F., Rodriguez-Bigas, M. A., Church, J., Gruber, S., Offit, K. (2006). ASCO/SSO Review of Current Role of Risk-Reducing Surgery in Common Hereditary Cancer Syndromes. Ann. Surg. Oncol. 13: 1296-1321 [Abstract] [Full Text]  
• Pierce, L. J., Levin, A. M., Rebbeck, T. R., Ben-David, M. A., Friedman, E., Solin, L. J., Harris, E. E., Gaffney, D. K., Haffty, B. G., Dawson, L. A., Narod, S. A., Olivotto, I. A., Eisen, A., Whelan, T. J., Olopade, O. I., Isaacs, C., Merajver, S. D., Wong, J. S., Garber, J. E., Weber, B. L. (2006). Ten-Year Multi-Institutional Results of Breast-Conserving Surgery and Radiotherapy in BRCA1/2-Associated Stage I/II Breast Cancer. JCO 24: 2437-2443 [Abstract] [Full Text]  
• Plevritis, S. K., Kurian, A. W., Sigal, B. M., Daniel, B. L., Ikeda, D. M., Stockdale, F. E., Garber, A. M. (2006). Cost-effectiveness of screening BRCA1/2 mutation carriers with breast magnetic resonance imaging.. JAMA 295: 2374-2384 [Abstract] [Full Text]  
• Hall, M. J., Olopade, O. I. (2006). Disparities in Genetic Testing: Thinking Outside the BRCA Box. JCO 24: 2197-2203 [Abstract] [Full Text]  
• Walsh, T., Casadei, S., Coats, K. H., Swisher, E., Stray, S. M., Higgins, J., Roach, K. C., Mandell, J., Lee, M. K., Ciernikova, S., Foretova, L., Soucek, P., King, M.-C. (2006). Spectrum of Mutations in BRCA1, BRCA2, CHEK2, and TP53 in Families at High Risk of Breast Cancer. JAMA 295: 1379-1388 [Abstract] [Full Text]  
• Anderson, K., Jacobson, J. S., Heitjan, D. F., Zivin, J. G., Hershman, D., Neugut, A. I., Grann, V. R. (2006). Cost-effectiveness of preventive strategies for women with a BRCA1 or a BRCA2 mutation.. ANN INTERN MED 144: 397-406 [Abstract] [Full Text]  
• Kuhl, C. K., Schrading, S., Leutner, C. C., Morakkabati-Spitz, N., Wardelmann, E., Fimmers, R., Kuhn, W., Schild, H. H. (2005). Mammography, Breast Ultrasound, and Magnetic Resonance Imaging for Surveillance of Women at High Familial Risk for Breast Cancer. JCO 23: 8469-8476 [Abstract] [Full Text]  
• Frost, M. H., Slezak, J. M., Tran, N. V., Williams, C. I., Johnson, J. L., Woods, J. E., Petty, P. M., Donohue, J. H., Grant, C. S., Sloan, J. A., Sellers, T. A., Hartmann, L. C. (2005). Satisfaction After Contralateral Prophylactic Mastectomy: The Significance of Mastectomy Type, Reconstructive Complications, and Body Appearance. JCO 23: 7849-7856 [Abstract] [Full Text]  
• Barton, M. B., West, C. N., Liu, I.-L. A., Harris, E. L., Rolnick, S. J., Elmore, J. G., Herrinton, L. J., Greene, S. M., Nekhlyudov, L., Fletcher, S. W., Geiger, A. M. (2005). Complications Following Bilateral Prophylactic Mastectomy. J Natl Cancer Inst Monogr 2005: 61-66 [Abstract] [Full Text]  
• Nanda, R., Schumm, L. P., Cummings, S., Fackenthal, J. D., Sveen, L., Ademuyiwa, F., Cobleigh, M., Esserman, L., Lindor, N. M., Neuhausen, S. L., Olopade, O. I. (2005). Genetic Testing in an Ethnically Diverse Cohort of High-Risk Women: A Comparative Analysis of BRCA1 and BRCA2 Mutations in American Families of European and African Ancestry. JAMA 294: 1925-1933 [Abstract] [Full Text]  
• U.S. Preventive Services Task Force*, (2005). Genetic Risk Assessment and BRCA Mutation Testing for Breast and Ovarian Cancer Susceptibility: Recommendation Statement. ANN INTERN MED 143: 355-361 [Abstract] [Full Text]  
• Nelson, H. D., Huffman, L. H., Fu, R., Harris, E. L. (2005). Genetic Risk Assessment and BRCA Mutation Testing for Breast and Ovarian Cancer Susceptibility: Systematic Evidence Review for the U.S. Preventive Services Task Force. ANN INTERN MED 143: 362-379 [Abstract] [Full Text]  
• Herrinton, L. J., Barlow, W. E., Yu, O., Geiger, A. M., Elmore, J. G., Barton, M. B., Harris, E. L., Rolnick, S., Pardee, R., Husson, G., Macedo, A., Fletcher, S. W. (2005). Efficacy of Prophylactic Mastectomy in Women With Unilateral Breast Cancer: A Cancer Research Network Project. JCO 23: 4275-4286 [Abstract] [Full Text]  
• Simeone, A.-M., Deng, C.-X., Kelloff, G. J., Steele, V. E., Johnson, M. M., Tari, A. M. (2005). N-(4-Hydroxyphenyl)retinamide is more potent than other phenylretinamides in inhibiting the growth of BRCA1-mutated breast cancer cells. Carcinogenesis 26: 1000-1007 [Abstract] [Full Text]  
• Hall, M., Olopade, O. I. (2005). Confronting Genetic Testing Disparities: Knowledge Is Power. JAMA 293: 1783-1785 [Full Text]  
• Geiger, A. M., Yu, O., Herrinton, L. J., Barlow, W. E., Harris, E. L., Rolnick, S., Barton, M. B., Elmore, J. G., Fletcher, S. W. (2005). A Population-Based Study of Bilateral Prophylactic Mastectomy Efficacy in Women at Elevated Risk for Breast Cancer in Community Practices. Arch Intern Med 165: 516-520 [Abstract] [Full Text]  
• Narod, S. A., Offit, K. (2005). Prevention and Management of Hereditary Breast Cancer. JCO 23: 1656-1663 [Full Text]  
• Shaag, A., Walsh, T., Renbaum, P., Kirchhoff, T., Nafa, K., Shiovitz, S., Mandell, J. B., Welcsh, P., Lee, M. K., Ellis, N., Offit, K., Levy-Lahad, E., King, M.-C. (2005). Functional and genomic approaches reveal an ancient CHEK2 allele associated with breast cancer in the Ashkenazi Jewish population. Hum Mol Genet 14: 555-563 [Abstract] [Full Text]  
• Garber, J. E., Offit, K. (2005). Hereditary Cancer Predisposition Syndromes. JCO 23: 276-292 [Abstract] [Full Text]  
• Bertagnolli, M. M. (2005). Surgical Prevention of Cancer. JCO 23: 324-332 [Abstract] [Full Text]  
• Stearns, V., Gallagher, A., Kleer, C. G., Singh, B., Freedman, M., Haddad, B. R., Isaacs, C., Warren, R., Brown, M., Cullen, J., Trock, B., Hayes, D. F. (2004). A Pilot Study to Establish a Clinical Model to Perform Phase II Studies of Breast Cancer Chemopreventive Agents in Women at High Risk with Biomarkers as Surrogate Endpoints for Activity. Clin. Cancer Res. 10: 8332-8340 [Abstract] [Full Text]  
• Wainberg, S., Husted, J. (2004). Utilization of Screening and Preventive Surgery Among Unaffected Carriers of a BRCA1 or BRCA2 Gene Mutation. Cancer Epidemiol. Biomarkers Prev. 13: 1989-1995 [Abstract] [Full Text]  
• Agnantis, N. J., Paraskevaidis, E., Roukos, D. (2004). Editorial: Preventing Breast, Ovarian Cancer in BRCA Carriers: Rational of Prophylactic Surgery and Promises of Surveillance. Ann. Surg. Oncol. 11: 1030-1034 [Full Text]  
• Oloparde, O. I. (2004). Genetics in Clinical Cancer Care: A Promise Unfulfilled among Minority Populations. Cancer Epidemiol. Biomarkers Prev. 13: 1683-1686 [Full Text]  
• Becker, S., Cazares, L. H., Watson, P., Lynch, H., Semmes, O. J., Drake, R. R., Laronga, C. (2004). Surfaced-Enhanced Laser Desorption/Ionization Time-of-Flight (SELDI-TOF) Differentiation of Serum Protein Profiles of BRCA-1 and Sporadic Breast Cancer. Ann. Surg. Oncol. 11: 907-914 [Abstract] [Full Text]  
• Meric-Bernstam, F. (2004). Serum Proteomics for BRCA1-associated Breast Cancer. Ann. Surg. Oncol. 11: 883-884 [Full Text]  
• Robson, M. E., Offit, K. (2004). Breast MRI for Women With Hereditary Cancer Risk. JAMA 292: 1368-1370 [Full Text]  
• Wacholder, S. (2004). Bias in Intervention Studies That Enroll Patients From High-Risk Clinics. JNCI J Natl Cancer Inst 96: 1204-1207 [Abstract] [Full Text]  
• Kriege, M., Brekelmans, C. T.M., Boetes, C., Besnard, P. E., Zonderland, H. M., Obdeijn, I. M., Manoliu, R. A., Kok, T., Peterse, H., Tilanus-Linthorst, M. M.A., Muller, S. H., Meijer, S., Oosterwijk, J. C., Beex, L. V.A.M., Tollenaar, R. A.E.M., de Koning, H. J., Rutgers, E. J.T., Klijn, J. G.M., the Magnetic Resonance Imaging Screening Study Gro, (2004). Efficacy of MRI and Mammography for Breast-Cancer Screening in Women with a Familial or Genetic Predisposition. NEJM 351: 427-437 [Abstract] [Full Text]  
• Liberman, L. (2004). Breast Cancer Screening with MRI -- What Are the Data for Patients at High Risk?. NEJM 351: 497-500 [Full Text]  
• Balmana, J, Stoffel, E M, Emmons, K M, Garber, J E, Syngal, S (2004). Comparison of motivations and concerns for genetic testing in hereditary colorectal and breast cancer syndromes. J. Med. Genet. 41: e44-e44 [Full Text]  
• Hartmann, L. C., Degnim, A., Schaid, D. J. (2004). Prophylactic Mastectomy for BRCA1/2 Carriers: Progress and More Questions. JCO 22: 981-983 [Full Text]  
• Rebbeck, T. R., Friebel, T., Lynch, H. T., Neuhausen, S. L., van 't Veer, L., Garber, J. E., Evans, G. R., Narod, S. A., Isaacs, C., Matloff, E., Daly, M. B., Olopade, O. I., Weber, B. L. (2004). Bilateral Prophylactic Mastectomy Reduces Breast Cancer Risk in BRCA1 and BRCA2 Mutation Carriers: The PROSE Study Group. JCO 22: 1055-1062 [Abstract] [Full Text]  
• Armstrong, K., Schwartz, J. S., Randall, T., Rubin, S. C., Weber, B. (2004). Hormone Replacement Therapy and Life Expectancy After Prophylactic Oophorectomy in Women With BRCA1/2 Mutations: A Decision Analysis. JCO 22: 1045-1054 [Abstract] [Full Text]  
• Adem, C., Jenkins, R. B., Capron, F., Stoppa-Lyonnet, D. (2004). High-Risk Lesions in High-Risk Women: A High-Risk Formalin-Based Biology!. JCO 22: 1159-1161 [Full Text]  
• Hoogerbrugge, N., Bult, P., Brunner, H. (2004). In Reply:. JCO 22: 1161-1162 [Full Text]  
• Sermijn, E, Goelen, G, Teugels, E, Kaufman, L, Bonduelle, M, Neyns, B, Poppe, B, De Paepe, A, De Greve, J (2004). The impact of proband mediated information dissemination in families with a BRCA1/2 gene mutation. J. Med. Genet. 41: e23-23 [Full Text]  
• Thull, D. L., Vogel, V. G. (2004). Recognition and Management of Hereditary Breast Cancer Syndromes. The Oncologist 9: 13-24 [Abstract] [Full Text]  
• Peshkin, B. N., Isaacs, C., Finch, C., Kent, S., Schwartz, M. D. (2003). Tamoxifen As Chemoprevention in BRCA1 and BRCA2 Mutation Carriers With Breast Cancer: A Pilot Survey of Physicians. JCO 21: 4322-4328 [Abstract] [Full Text]  
• Weitzel, J. N., McCaffrey, S. M., Nedelcu, R., MacDonald, D. J., Blazer, K. R., Cullinane, C. A. (2003). Effect of Genetic Cancer Risk Assessment on Surgical Decisions at Breast Cancer Diagnosis. Arch Surg 138: 1323-1328 [Abstract] [Full Text]  
• King, M.-C., Marks, J. H., Mandell, J. B. (2003). Breast and Ovarian Cancer Risks Due to Inherited Mutations in BRCA1 and BRCA2. Science 302: 643-646 [Abstract] [Full Text]  
• Mincey, B. A. (2003). Genetics and the Management of Women at High Risk for Breast Cancer. The Oncologist 8: 466-473 [Abstract] [Full Text]  
• Ryan, P. D., Haber, D. A., Shannon, K. M., Smith, B. L., Fan, M. J. (2003). Case 28-2003 - A 51-Year-Old Premenopausal Woman with Newly Diagnosed Breast Cancer and a Strong Family History of Breast Cancer. NEJM 349: 1076-1082 [Full Text]  
• Hirsch, A. (2003). Integrative Tumor Board: Recurrent Breast Cancer or New Primary?. Integr Cancer Ther 2: 272-276  
• Col, N. F. (2003). The Use of Gene Tests to Detect Hereditary Predisposition to Chronic Disease: Is Cost-Effectiveness Analysis Relevant?. Med Decis Making 23: 441-448 [Abstract]  
• Gray, S., Olopade, O. I. (2003). Direct-to-Consumer Marketing of Genetic Tests for Cancer: Buyer Beware. JCO 21: 3191-3193 [Full Text]  
• Friedenson, B., Piver, M. S., Weber, B. L., Wooster, R. (2003). Breast-Cancer Genomics. NEJM 349: 910-911 [Full Text]  
• Klaren, H. M., van't Veer, L. J., van Leeuwen, F. E., Rookus, M. A. (2003). Potential for Bias in Studies on Efficacy of Prophylactic Surgery for BRCA1 and BRCA2 Mutation. JNCI J Natl Cancer Inst 95: 941-947 [Full Text]  
• Wooster, R., Weber, B. L. (2003). Breast and Ovarian Cancer. NEJM 348: 2339-2347 [Full Text]  
• Meijers-Heijboer, H., Brekelmans, C. T.M., Menke-Pluymers, M., Seynaeve, C., Baalbergen, A., Burger, C., Crepin, E., van den Ouweland, A. W.M., van Geel, B., Klijn, J. G.M. (2003). Use of Genetic Testing and Prophylactic Mastectomy and Oophorectomy in Women With Breast or Ovarian Cancer From Families With a BRCA1 or BRCA2 Mutation. JCO 21: 1675-1681 [Abstract] [Full Text]  
• Kattlove, H., Winn, R. J. (2003). Ongoing Care of Patients After Primary Treatment for Their Cancer. CA Cancer J Clin 53: 172-196 [Abstract] [Full Text]  
• Daly, P. A., Nolan, C., Green, A., Ormiston, W., Cody, N., McDevitt, T., O'hIci, B., Byrne, D., McDermott, E., Carney, D. N., O'Higgins, N., Barton, D. E. (2003). Predictive testing for BRCA1 and 2 mutations: a male contribution. Ann Oncol 14: 549-553 [Abstract] [Full Text]  
• Domchek, S. M., Eisen, A., Calzone, K., Stopfer, J., Blackwood, A., Weber, B. L. (2003). Application of Breast Cancer Risk Prediction Models in Clinical Practice. JCO 21: 593-601 [Abstract] [Full Text]  
• Lynch, H. T., Snyder, C. L., Lynch, J. F., Riley, B. D., Rubinstein, W. S. (2003). Hereditary Breast-Ovarian Cancer at the Bedside: Role of the Medical Oncologist. JCO 21: 740-753 [Abstract] [Full Text]  
• Pichert, G., Bolliger, B., Buser, K., Pagani, O. (2003). Evidence-based management options for women at increased breast/ovarian cancer risk. Ann Oncol 14: 9-19 [Abstract] [Full Text]  
• Hoogerbrugge, N., Bult, P., de Widt-Levert, L.M., Beex, L.V., Kiemeney, L.A., Ligtenberg, M.J.L., Massuger, L.F., Boetes, C., Manders, P., Brunner, H.G. (2003). High Prevalence of Premalignant Lesions in Prophylactically Removed Breasts From Women at Hereditary Risk for Breast Cancer. JCO 21: 41-45 [Abstract] [Full Text]  
• Narod, S. A., Dube, M.-P., Klijn, J., Lubinski, J., Lynch, H. T., Ghadirian, P., Provencher, D., Heimdal, K., Moller, P., Robson, M., Offit, K., Isaacs, C., Weber, B., Friedman, E., Gershoni-Baruch, R., Rennert, G., Pasini, B., Wagner, T., Daly, M., Garber, J. E., Neuhausen, S. L., Ainsworth, P., Olsson, H., Evans, G., Osborne, M., Couch, F., Foulkes, W. D., Warner, E., Kim-Sing, C., Olopade, O., Tung, N., Saal, H. M., Weitzel, J., Merajver, S., Gauthier-Villars, M., Jernstrom, H., Sun, P., Brunet, J.-S. (2002). Oral Contraceptives and the Risk of Breast Cancer in BRCA1 and BRCA2 Mutation Carriers. JNCI J Natl Cancer Inst 94: 1773-1779 [Abstract] [Full Text]  
• Roukos, D. H., Agnanti, N. J., Paraskevaidis, E., Kappas, A. M. (2002). Approaching the Dilemma Between Prophylactic Bilateral Mastectomy or Oophorectomy for Breast and Ovarian Cancer Prevention in Carriers of BRCA1 or BRCA2 Mutations. Ann. Surg. Oncol. 9: 941-943 [Full Text]  
• Evans, D G R, Lalloo, F (2002). Risk assessment and management of high risk familial breast cancer. J. Med. Genet. 39: 865-871 [Abstract] [Full Text]  
• Wagner, A, Tops, C, Wijnen, J T, Zwinderman, K, van der Meer, C, Kets, M, Niermeijer, M F, Klijn, J G M, Tibben, A, Vasen, H F A, Meijers-Heijboer, H (2002). Genetic testing in hereditary non-polyposis colorectal cancer families with a MSH2, MLH1, or MSH6 mutation. J. Med. Genet. 39: 833-837 [Full Text]  
• Zhuang, S. H., Leonard, G. D., Swain, S. M., Peshkin, B. N., DeMarco, T. A., Schwartz, M. D., Anderson, W. F., Brawley, O. W., Chang, S., Whitfield, G. A., Kauff, N. D., Robson, M. E., Offit, K., Rebbeck, T. R., Weber, B. L. (2002). Oophorectomy in Carriers of BRCA Mutations. NEJM 347: 1037-1040 [Full Text]  
• Lippman, S. M., Hong, W. K. (2002). Cancer Prevention Science and Practice. Cancer Res. 62: 5119-5125 [Full Text]  
• UDAGAWA, T., FERNANDEZ, A., ACHILLES, E.-G., FOLKMAN, J., D'AMATO, R. J. (2002). Persistence of microscopic human cancers in mice: alterations in the angiogenic balance accompanies loss of tumor dormancy. FASEB J. 16: 1361-1370 [Abstract] [Full Text]  
• Roukos, D. H., Kappas, A. M., Tsianos, E. (2002). Role of Surgery in the Prophylaxis of Hereditary Cancer Syndromes. Ann. Surg. Oncol. 9: 607-609 [Full Text]  
• Euhus, D. M., Smith, K. C., Robinson, L., Stucky, A., Olopade, O. I., Cummings, S., Garber, J. E., Chittenden, A., Mills, G. B., Rieger, P., Esserman, L., Crawford, B., Hughes, K. S., Roche, C. A., Ganz, P. A., Seldon, J., Fabian, C. J., Klemp, J., Tomlinson, G. (2002). Pretest Prediction of BRCA1 or BRCA2 Mutation by Risk Counselors and the Computer Model BRCAPRO. JNCI J Natl Cancer Inst 94: 844-851 [Abstract] [Full Text]  
• Kauff, N. D., Satagopan, J. M., Robson, M. E., Scheuer, L., Hensley, M., Hudis, C. A., Ellis, N. A., Boyd, J., Borgen, P. I., Barakat, R. R., Norton, L., Castiel, M., Nafa, K., Offit, K. (2002). Risk-Reducing Salpingo-oophorectomy in Women with a BRCA1 or BRCA2 Mutation. NEJM 346: 1609-1615 [Abstract] [Full Text]  
• Haber, D. (2002). Prophylactic Oophorectomy to Reduce the Risk of Ovarian and Breast Cancer in Carriers of BRCA Mutations. NEJM 346: 1660-1662 [Full Text]  
• van Roosmalen, M. S., Verhoef, L. C.G., Stalmeier, P. F.M., Hoogerbrugge, N., van Daal, W. A.J. (2002). Decision Analysis of Prophylactic Surgery or Screening for BRCA1 Mutation Carriers: A More Prominent Role For Oophorectomy. JCO 20: 2092-2100 [Abstract] [Full Text]  
• Liede, A., Karlan, B. Y., Baldwin, R. L., Platt, L. D., Kuperstein, G., Narod, S. A. (2002). Cancer Incidence in a Population of Jewish Women at Risk of Ovarian Cancer. JCO 20: 1570-1577 [Abstract] [Full Text]  
• DeMichele, A., Weber, B. L. (2002). Risk Management in BRCA1 and BRCA2 Mutation Carriers: Lessons Learned, Challenges Posed. JCO 20: 1164-1166 [Full Text]  
• Scheuer, L., Kauff, N., Robson, M., Kelly, B., Barakat, R., Satagopan, J., Ellis, N., Hensley, M., Boyd, J., Borgen, P., Norton, L., Offit, K. (2002). Outcome of Preventive Surgery and Screening for Breast and Ovarian Cancer in BRCA Mutation Carriers. JCO 20: 1260-1268 [Abstract] [Full Text]  
• Evans, D. G., Howell, A., Baildam, A., Brain, A., Lalloo, F., Hopwood, P. (2002). Re: Risk-Reduction Mastectomy: Clinical Issues and Research Needs. JNCI J Natl Cancer Inst 94: 307-307 [Full Text]  
• Morrow, M., Gradishar, W. (2002). Recent developments: Breast cancer. BMJ 324: 410-414 [Full Text]  
• Stefanek, M., Hartmann, L., Nelson, W. (2002). RESPONSE: Re: Risk-Reduction Mastectomy: Clinical Issues and Research Needs. JNCI J Natl Cancer Inst 94: 143-144 [Full Text]  
• Suh, N., Glasebrook, A. L., Palkowitz, A. D., Bryant, H. U., Burris, L. L., Starling, J. J., Pearce, H. L., Williams, C., Peer, C., Wang, Y., Sporn, M. B. (2001). Arzoxifene, a New Selective Estrogen Receptor Modulator for Chemoprevention of Experimental Breast Cancer. Cancer Res. 61: 8412-8415 [Abstract] [Full Text]  
• Narod, S., Offit, K., Robson, M., Schrag, D., Riggs, T., Stoutjesdijk, M. J., Barentsz, J. O., Klijn, J. G.M., Meijers-Heijboer, H. (2001). Prophylactic Mastectomy in Carriers of BRCA Mutations. NEJM 345: 1498-1500 [Full Text]  
• King, M.-C., Wieand, S., Hale, K., Lee, M., Walsh, T., Owens, K., Tait, J., Ford, L., Dunn, B. K., Costantino, J., Wickerham, L., Wolmark, N., Fisher, B. (2001). Tamoxifen and Breast Cancer Incidence Among Women With Inherited Mutations in BRCA1 and BRCA2: National Surgical Adjuvant Breast and Bowel Project (NSABP-P1) Breast Cancer Prevention Trial. JAMA 286: 2251-2256 [Abstract] [Full Text]  
• Lynch, H. T., Lynch, J. F., Rubinstein, W. S. (2001). Prophylactic Mastectomy: Obstacles and Benefits. JNCI J Natl Cancer Inst 93: 1586-1587 [Full Text]  
• Hartmann, L. C., Sellers, T. A., Schaid, D. J., Frank, T. S., Soderberg, C. L., Sitta, D. L., Frost, M. H., Grant, C. S., Donohue, J. H., Woods, J. E., McDonnell, S. K., Vockley, C. W., Deffenbaugh, A., Couch, F. J., Jenkins, R. B. (2001). Efficacy of Bilateral Prophylactic Mastectomy in BRCA1 and BRCA2 Gene Mutation Carriers. JNCI J Natl Cancer Inst 93: 1633-1637 [Abstract] [Full Text]  
• Stefanek, M., Hartmann, L., Nelson, W. (2001). Risk-Reduction Mastectomy: Clinical Issues and Research Needs. JNCI J Natl Cancer Inst 93: 1297-1297 [Abstract] [Full Text]