JHMI Office of Communications and Public Affairs

March 11, 1999

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Vive la Difference? French and American Medical Advice Differs In Telling Ways for Women With Breast Cancer Genes

Vive la difference! may apply to love, but in medical matters it may be another story. In a study reported in this week's Lancet (embargoed for Thursday, March 11, 7 p.m. EST), medical policy analysts at Johns Hopkins and in France reveal just how strong a role culture may play in peoples' medical treatment. Specifically, women at a higher risk of breast or ovarian cancer because of BRCA1 or BRCA2 genes could receive standard care that dramatically differs in France and the United States.

The differences arise in the gray areas, the study says, such as preventive mastectomies. The operation, for example, is optional for high-risk women in both countries, but in France, physicians strongly oppose it for women younger than 30, referring to it in a public consensus statement as "a mutilation." French surgeons are prevented by law from performing the operation unless it's clearly therapeutic; U.S. surgeons, however, need only an informed consent to proceed.

Breast self-exams are de rigeur for high-risk women in this country but "may induce anxiety" in some French women.

These and other differences probably stem from ingrained cultural differences, things like the New World tendency to rugged individualism, as opposed to Europe's more communal spirit, the analysts say.

The Hopkins participants in the study are available for comment.

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