Physicians' attitudes towards mammography and prophylactic surgery for hereditary breast/ovarian cancer risk and subsequently published guidelines

After a BRCA mutation has been identified in the context of hereditary brea st/ovarian cancer (HBOC), mammographic screening and prophylactic surgery a re two of the main options available to those responsible for the clinical management of healthy women. The aim of this study was to describe the atti tudes of specialists towards the clinical management of women with an HBOC risk: this information was collected prior to the publication of the recent French guidelines. A random national sample of 1169 French surgeons, gynae cologists and obstetricians was surveyed using a mailed questionnaire, to w hich 700 of these physicians (60%) responded. When dealing with a BRCA muta ted woman, 88.6% of the respondents said they would recommend mammographic screening, but only 27.1% would recommend that it should be carried out ann ually from the age of 30 years onwards, as recommended in the French guidel ines; 10.9% would find it acceptable to propose prophylactic mastectomy fro m the age of 30 years, and 22.9% would find it acceptable to propose prophy lactic oophorectomy from the age of 35 years. The specialists who agreed wi th recommending breast/ovarian cancer genetic testing also had more positiv e attitudes towards prophylactic mastectomy (adj OR = 3.4, 95% CI = 1.4-8.2 ), as did those who had previously recommended prophylactic mastectomy when gene testing was not yet available (adj OR = 2.06, 95% CI = 1.23-3.44). Th e respondents' attitudes towards prophylactic oophorectomy and mastectomy w ere significantly associated (adj OR = 3.9; 95% CI = 2.3-6.5). Previous rec ommendation of prophylactic mastectomy was associated (P < 0.01) with a hig her level of knowledge of breast/ovarian cancer genetics and with medical p ractice in this field. French physicians' attitudes towards mammographic sc reening and prophylactic surgery were not in complete agreement with the su bsequently published French guidelines, the impact of which has now to be c onsidered. Constantly evolving knowledge about the efficacy of preventive i ntervention will give practitioners new elements to integrate into their co unselling.