, Volume 32, Issue 6, pp 1219-1220
Date: 07 Dec 2007

To the Editor: The Role of Prophylactic Surgery in Cancer Prevention

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In a recent comprehensive review, You, Lakhani, and Wells [1] report on common hereditary cancer syndromes and the role of prophylactic surgery. The authors propose five rational criteria for prophylactic surgery and conclude that only the type 2 multiple endocrine neoplasia (MEN) syndromes meet these criteria. We have some comments on this.

First, according to evidence-based medicine principles the authors are right. But randomized controlled trials (RCTs) to support prophylactic surgery over surveillance for the prevention of hereditary breast, gastric, and colorectal cancer syndromes will never emerge, because it is very difficult to enroll sufficient number of patients in such RCTs, given both the low incidence of the syndromes and current practice guidelines recommendations in favor of prophylactic surgery by international organizations and experts [2, 3].

Second, individuals with inherited pathologic mutations in certain genes, including BRCA1/2, CDH1, and APC and mismatch-repair g ...