- Email: [email protected]
Has the Angelina Jolie effect led to an increase in risk reducing mastectomy and breast reconstruction in Wales: A retrospective, single centre cohort study
288
Correspondence and communications
Table 2
Results of multicentre audit of nail bed repairs.
Nail bed repair technique Component of operation
Material/technique used
Number of cases (%) n Z 54a
Material used to repair nail bed
Vicryl Rapide suture PDS suture Vicryl suture Tissue glue Replaced Discarded Discarded and nail substitute used Figure-of-eight suture Nothing Tissue glue
24 19 3 2 35 18 1 16 11 8
Fate of nail plate
Method of fixation of nail plate if replaced
(50.0) (39.6) (6.3) (4.2) (64.8) (33.3) (1.9) (45.7) (31.4) (22.9)
Antibiotic usage Point at which antibiotic given
Choice of antibiotic
Number of cases (%) n Z 54
Emergency department
Oral co-amoxiclav No antibiotic Intravenous co-amoxiclav No antibiotic Intravenous flucloxacillin Oral co-amoxiclav No antibiotic
41 13 34 19 1 51 3
Surgery
On discharge a
(75.9) (24.1) (63.0) (35.2) (1.9) (94.4) (5.6)
Six patients were deemed not to require nail bed repair after removing the nail plate.
M.D. Gardiner Imperial College London, London, UK Kennedy Institute of Rheumatology, NDORMS, University of Oxford, UK A. Jain Kennedy Institute of Rheumatology, NDORMS, University of Oxford, UK
Has the Angelina Jolie effect led to an increase in risk reducing mastectomy and breast reconstruction in Wales: A retrospective, single centre cohort study
Imperial College Healthcare NHS Trust, London, UK E-mail address: [email protected] A.V. Greig Department of Plastic Surgery, St Thomas’ Hospital, London, UK On behalf of the Nail bed INJury Analysis (NINJA) Collaborative Groupa ª 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2015.10.025
a Reconstructive Surgery Trials Network Nail bed INJury Analysis (NINJA) Collaborative: Frank Acquaah, Sadia Afzal, Shirwa Sheik Ali, David Beard, Kamal Bisarya, David Bruce, Jonathan Cook, Cushla Cooper, Nicola Farrar, Dominic Furniss, Jenifa Jeyakumar, Max Horwitz, Hawys Lloyd-Hughes, Natalie Pease, Gordon McArthur, Adrian Murphy, Julia Ruston, Hassan Soueid, Makarand Tare, Ricardo Tejero, Evgenia Theodorakopoulou and Claire Zweifel.
Dear Sir, On 14th May 2013, Hollywood actress Angelina Jolie made public her prophylactic double mastectomy and reconstruction because she carries the BRCA gene mutation. Following this publicity, referrals to the All Wales Genetics Service nearly doubled in 2013 compared with 2012.1 This coincided with the issue of newly revised NICE guidance on familial breast cancer that was ratified in June 2013.2 This increase in demand for genetic screening was labelled the Angelina Jolie effect.1 We undertook this study to see whether this Angelina Jolie effect has also led to an increase in patients undergoing risk reducing mastectomy and breast reconstruction at the Welsh Centre for Burns and Plastic Surgery based at Morriston Hospital, Swansea. The data was collected retrospectively of all patients undergoing risk reducing mastectomies and breast reconstruction at the Welsh Centre for Burns and Plastic Surgery between 1st January 2012 e 1st January 2015. The surgery was undertaken by four plastic surgeons with a specialist interest in breast surgery. Demographic details, date and type of surgery were recorded. Both
Correspondence and communications
Figure 1
Risk reducing procedures performed per year.
289 annually to nearly 40% in 2014. In regards to the bilateral risk reducing mastectomies the number has increased over the period of study with just 1 case in 2012 and 4 cases in both 2013 and 2014 as shown in Figure 2. The highest numbers of procedures were performed in early 2014 which may be explained by the average 6e8 month wait for being seen by genetic testing services and receiving results. This study is limited by the lack of genetic screening information from patients electing to have risk reducing procedures. Overall this shows, despite small numbers that the number of risk reducing procedures has increased since the widespread publicity of Angelina Jolie and the publication of the revised NICE guidance led to increased demand for genetic screening. Further data from 2015 onwards is needed to assess whether this increase has been sustained in the long term.
Conflict of interest Nil.
Funding Nil.
References Figure 2 year.
Bilateral risk reducing procedures performed each
bilateral and unilateral risk reducing procedures were considered. The data was entered and analysed in Microsoft Excel sheet. The total number of mastectomies performed over the 3 year period was 264. 31% (n Z 82) of these were risk reducing procedures. 11% (n Z 9) were bilateral risk reducing mastectomies with the remainder (n Z 63) being unilateral in patients with a history of breast cancer in the contralateral breast. All patients undergoing risk reducing mastectomy had immediate reconstruction. Seventeen patients had prophylactic mastectomy and reconstruction in 2012, 32 in 2013 and 33 in 2014. Figure 1 illustrates the increasing trend of risk reducing procedures each year. The total nearly doubled between 2012 and 2013 and this increase appears to have been sustained. Risk reducing mastectomies have also become an increasing part of the workload of the plastic surgeons involved, with risk reducing procedures constituting just 20% of the reconstructive breast surgery workload in 2012, but rising
1. Evans DG, Barwell J, Eccles DM, et al. The Angelina Jolie effect: how high celebrity profile can have a major impact on provision of cancer related services. Breast Cancer Res 2014;16:442. 2. NICE. Familial breast cancer. Classification and care of people at risk of familial breast cancer and management of breast cancer and related risks in people with a family history of breast cancer. NICE clinical guideline 164. 2013. guidance.nice. org.uk/cg164.
Cathy M. Malcolm Muhammad Umair Javed Dai Nguyen Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, SA6 6NL, United Kingdom E-mail address: [email protected] Crown Copyright ª 2015 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2015.10.018
Correspondence and communications
Table 2
Results of multicentre audit of nail bed repairs.
Nail bed repair technique Component of operation
Material/technique used
Number of cases (%) n Z 54a
Material used to repair nail bed
Vicryl Rapide suture PDS suture Vicryl suture Tissue glue Replaced Discarded Discarded and nail substitute used Figure-of-eight suture Nothing Tissue glue
24 19 3 2 35 18 1 16 11 8
Fate of nail plate
Method of fixation of nail plate if replaced
(50.0) (39.6) (6.3) (4.2) (64.8) (33.3) (1.9) (45.7) (31.4) (22.9)
Antibiotic usage Point at which antibiotic given
Choice of antibiotic
Number of cases (%) n Z 54
Emergency department
Oral co-amoxiclav No antibiotic Intravenous co-amoxiclav No antibiotic Intravenous flucloxacillin Oral co-amoxiclav No antibiotic
41 13 34 19 1 51 3
Surgery
On discharge a
(75.9) (24.1) (63.0) (35.2) (1.9) (94.4) (5.6)
Six patients were deemed not to require nail bed repair after removing the nail plate.
M.D. Gardiner Imperial College London, London, UK Kennedy Institute of Rheumatology, NDORMS, University of Oxford, UK A. Jain Kennedy Institute of Rheumatology, NDORMS, University of Oxford, UK
Has the Angelina Jolie effect led to an increase in risk reducing mastectomy and breast reconstruction in Wales: A retrospective, single centre cohort study
Imperial College Healthcare NHS Trust, London, UK E-mail address: [email protected] A.V. Greig Department of Plastic Surgery, St Thomas’ Hospital, London, UK On behalf of the Nail bed INJury Analysis (NINJA) Collaborative Groupa ª 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2015.10.025
a Reconstructive Surgery Trials Network Nail bed INJury Analysis (NINJA) Collaborative: Frank Acquaah, Sadia Afzal, Shirwa Sheik Ali, David Beard, Kamal Bisarya, David Bruce, Jonathan Cook, Cushla Cooper, Nicola Farrar, Dominic Furniss, Jenifa Jeyakumar, Max Horwitz, Hawys Lloyd-Hughes, Natalie Pease, Gordon McArthur, Adrian Murphy, Julia Ruston, Hassan Soueid, Makarand Tare, Ricardo Tejero, Evgenia Theodorakopoulou and Claire Zweifel.
Dear Sir, On 14th May 2013, Hollywood actress Angelina Jolie made public her prophylactic double mastectomy and reconstruction because she carries the BRCA gene mutation. Following this publicity, referrals to the All Wales Genetics Service nearly doubled in 2013 compared with 2012.1 This coincided with the issue of newly revised NICE guidance on familial breast cancer that was ratified in June 2013.2 This increase in demand for genetic screening was labelled the Angelina Jolie effect.1 We undertook this study to see whether this Angelina Jolie effect has also led to an increase in patients undergoing risk reducing mastectomy and breast reconstruction at the Welsh Centre for Burns and Plastic Surgery based at Morriston Hospital, Swansea. The data was collected retrospectively of all patients undergoing risk reducing mastectomies and breast reconstruction at the Welsh Centre for Burns and Plastic Surgery between 1st January 2012 e 1st January 2015. The surgery was undertaken by four plastic surgeons with a specialist interest in breast surgery. Demographic details, date and type of surgery were recorded. Both
Correspondence and communications
Figure 1
Risk reducing procedures performed per year.
289 annually to nearly 40% in 2014. In regards to the bilateral risk reducing mastectomies the number has increased over the period of study with just 1 case in 2012 and 4 cases in both 2013 and 2014 as shown in Figure 2. The highest numbers of procedures were performed in early 2014 which may be explained by the average 6e8 month wait for being seen by genetic testing services and receiving results. This study is limited by the lack of genetic screening information from patients electing to have risk reducing procedures. Overall this shows, despite small numbers that the number of risk reducing procedures has increased since the widespread publicity of Angelina Jolie and the publication of the revised NICE guidance led to increased demand for genetic screening. Further data from 2015 onwards is needed to assess whether this increase has been sustained in the long term.
Conflict of interest Nil.
Funding Nil.
References Figure 2 year.
Bilateral risk reducing procedures performed each
bilateral and unilateral risk reducing procedures were considered. The data was entered and analysed in Microsoft Excel sheet. The total number of mastectomies performed over the 3 year period was 264. 31% (n Z 82) of these were risk reducing procedures. 11% (n Z 9) were bilateral risk reducing mastectomies with the remainder (n Z 63) being unilateral in patients with a history of breast cancer in the contralateral breast. All patients undergoing risk reducing mastectomy had immediate reconstruction. Seventeen patients had prophylactic mastectomy and reconstruction in 2012, 32 in 2013 and 33 in 2014. Figure 1 illustrates the increasing trend of risk reducing procedures each year. The total nearly doubled between 2012 and 2013 and this increase appears to have been sustained. Risk reducing mastectomies have also become an increasing part of the workload of the plastic surgeons involved, with risk reducing procedures constituting just 20% of the reconstructive breast surgery workload in 2012, but rising
1. Evans DG, Barwell J, Eccles DM, et al. The Angelina Jolie effect: how high celebrity profile can have a major impact on provision of cancer related services. Breast Cancer Res 2014;16:442. 2. NICE. Familial breast cancer. Classification and care of people at risk of familial breast cancer and management of breast cancer and related risks in people with a family history of breast cancer. NICE clinical guideline 164. 2013. guidance.nice. org.uk/cg164.
Cathy M. Malcolm Muhammad Umair Javed Dai Nguyen Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, SA6 6NL, United Kingdom E-mail address: [email protected] Crown Copyright ª 2015 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2015.10.018