Abstract:
IMPORTANCE:
The prevalence of prophylactic mastectomy is increasing globally despite the aggressiveness of the surgery and its uncertain effectiveness in preventing cancer.
OBJECTIVE:
To estimate the global prevalence of prophylactic mastectomy and assess the predictive factors influencing women’s decisions to undergo this surgery.
DATA SOURCES:
This study searched PubMed, Embase, Web of Science, Scopus, and Cochrane Library databases.
STUDY SELECTION:
Studies were selected for inclusion if they (1) reported real-world data on the number of women who underwent prophylactic mastectomy in relation to the total population and (2) used national or hospital databases.
DATA EXTRACTION AND SYNTHESIS:
The restricted maximum likelihood estimator random-effects model with Freeman-Tukey double arcsine transformation was used for data analysis. A sensitivity analysis, meta regression, and subgroup analysis were conducted.
MAIN OUTCOMES AND MEASURES:
The prevalence of prophylactic mastectomy was evaluated using data from national databases and hospitals.
RESULTS :
Data on 10.7 million women across 23 locations were included, and the overall prevalence of prophylactic mastectomy was 5.04%. The prevalence of prophylactic mastectomy was highest in the Americas (5.19%) and lowest in Asia (1.58%), highlighting differences related to health-care systems, varying cultural perceptions, and the substantial influence of the “Angelina Jolie effect” in Western countries. By analyzing 28 predictive factors, we found that genetic testing, health-care accessibility, insurance support, and psychosocial factors were associated with an increased prevalence of prophylactic mastectomy.
CONCLUSION AND RELEVANCE:
Our findings indicate that the global prevalence of prophylactic mastectomy is increasing. The notably higher rates in the Americas compared with in other regions reflect disparities in health-care systems and inconsistent clinical practices globally. Global efforts, such as developing standardized guidelines, establishing genetic testing criteria, and providing consistent counseling, are key to providing women with reliable information and support for informed decision-making.
Biography:
Huynh Yen Phi is a Ph.D. student at the International PhD Program in Medicine, Taipei Medical University, and a breast surgeon at the Breast Department, University Medical Center, Ho Chi Minh City, Vietnam. Her research focuses on breast cancer, breast cancer surgery, oncoplastic breast surgery, and minimally invasive breast surgery. She is currently conducting a series of studies on the global prevalence, survival, and psychosocial outcomes of prophylactic mastectomy, aiming to provide evidence-based insights to support patient-centered clinical decision-making.
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