Reviews

Facing mastectomy

Nancy Reagan has had one, so has the "Green Goddess" Diana Moran, and the positive stance to mastectomy taken by these and many other women has done much to allay the understandable fears of those facing surgery. However, healthy women identified by genetic testing and family history as being at high risk of developing breast cancer have scant information to help them decide about prophylactic bilateral mastectomy.

A search via the useful generic site Patient UK (www.patient.co.uk), leading to www.patient.co.uk/selfhelp/cancer.htm and on to specific breast cancer sites such as Cancerbacup (www.cancerbacup.org.uk), is frustrating. A few lines of dry factual information about the reduced risk of breast cancer after bilateral prophylactic mastectomy are all that can be found. This week's prospective study on the psychosocial impact of bilateral prophylactic mastectomy for women with increased risk of breast cancer (p 76) will be a valuable addition to the literature. Its message that surgery reduces psychological morbidity and anxiety and does not have an adverse effect on women's body image or sexual functioning should appear rapidly on breast cancer sites.

Meanwhile, the best site for doctors to direct their patients to is likely to be the US site www.facingourrisk.org. This carries a huge range of links to other resources and contains illuminating in-depth personal accounts and photographs of women who have already made the difficult decision about prophylactic surgery. These bring the reality of decision making alive and illustrate the important point that opting for surgerywhich is performed more frequently in Britain than in the United States, and hardly at all in Franceis a highly personal choice.

Tessa Richards. 

BMJ trichards{at}bmj.com