, Volume 15, Issue 6, pp 1788-1790
Date: 15 Jan 2008

Prophylactic Surgery in the Complex Decision-Making Management of BRCA Mutation Carriers

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To the Editor:

In a recent issue of the journal, Heemskerk-Gerritsen et al.1 provided clinical useful data supporting the efficacy of genetic testing and prophylactic mastectomy (PM) in unaffected and affected breast cancer carriers who had mutations in BRCA1 and BRCA2. No breast cancer occurred among 358 BRCA carriers (unaffected women, n = 177; affected, n = 181) after PM in a median follow-up of 4.5 years. However, is it PM the optimum preventive intervention, just as data on other preventive options, including prophylactic salpingo-oophorectomy chemoprevention and intensified surveillance, have become available?

Given the lack of randomized trials, it is not surprising that the management of BRCA1/2 mutation carriers is debated. In contrast to another recent study2 and data from many other reports, a new study published recently reported no difference in survival between BRCA and non-BRCA mutation carriers.3 If this finding is true, neither genetic testing at diagnosis of a new breas ...