How Big Is Big Enough? Thinking About Contralateral Prophylactic Mastectomy
Menée à l'aide d'un modèle mathématique, cette étude évalue le bénéfice, en termes de survie à 20 ans, d'une mastectomie controlatérale prophylactique chez les femmes atteintes d'un cancer du sein de stade I ou II sans mutation des gènes BRCA
When evaluating the benefit of a therapy, we must consider the effects of uncertainty and the magnitude of the gain or loss, having decided on a metric for outcome differences. With two alternatives (A and B) under consideration, there are three possible conclusions: Option A is substantially better; option B is substantially better; and the options are more or less equal—that is, the decision is a close call or toss up (1). When considered to sufficient precision, it would be unusual for two strategies to be exactly equivalent. Thus, the boundary between a close call and a clear benefit or harm is dependent on the purpose of the comparison, the perspective of the analysis (who the decision maker is), and the preferences of the decision maker. In recent decades, such comparisons have been sharpened by developing models of the choice and the prognoses using decision analysis that explicitly reveals the underlying assumptions and perspectives. Prognosis and its uncertainty can be summarized by probabilities or probability distributions. The relative value of possible outcomes can be …