Reviewer's report 
 Time to Decide: Risk-Reducing Mastectomy and BRCA1/2 Gene Mutation Carriers Title: 
 1  23 November 2006 Version: Date: 
 Nina Hallowell Reviewer: 
Reviewer's report: 
General 
This is an interesting ppaer which looks at the decsion-making about prophylatic mastectomy because of a 
family history of cancer. THis type of risk-reducing surgery raises many issues for high risk women and the authors demonstrate the difficulties women face when charged with making this decision. My main issue 
with the paper is that it is overly descriptive and misses the opportunity to add some flesh on the theoretical 
debates in this area. The paper is beautifully written and makes some interesting policy related points about 
provising support to women in the longer term. 
------------------------------------------------------------------------------- Major Compulsory Revisions (that the author must respond to before a decision on publication can be 
reached) 
I would have liked to see more primary data in the paper. At the moment it reports three descriptive case 
studies which are based upon open-ended responses to questions in telephone interviews ( I assume, see 
below). Although the case studies are very interesting in themselves, I would have liked to have heard what 
the women said about their decisions. Indeed, it is not very clear what data the case studies are based on 
either the forced choice questionnaire responses or open-ednded responses in interviews. 
I would have liked to have seen some discussion about the counsellors/health care professionals' need to 
promote autonomous decsion-making about surgery in this instance and the women's potential feelings about needing guidance and support. Why are HCPs backing off here, should they behave like this when 
they are more than happy to give advice in other areas of medicine? In an old study of genetic counselling 
for HBOC I observed that HCPs do talk about proph mastectomy very differently compared to other types of 
risk management. Hallowell N (1999) Advising on the management of genetic risk: offering choice or 
prescribing action? Health, Risk and Society 1:267-280 
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Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
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Discretionary Revisions (which the author can choose to ignore) 
P15ff In supporting their comments about cultural differences the authors might like to refer to rence to 
Kathy Davis' work on plastic surgery in the netherlands. I Reshaping the Female Body. New 
York:Routledge, 1995. 
There is also published work undertaken by Julien Reynier et al which compares attitudes to Proph surgery 
in quebec and france. 
 Unable to decide on acceptance or rejection until the authors have responded to the major What next?: 
compulsory revisions 
 An article of importance in its field Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
'I declare that I have no competing interests'