Breast cancer risk factors: can we select women for prophylactic mastectomy?

Prophylactic procedures to prevent disease in women at high risk for breast cancer should be considered only when the benefits of prophylaxis outweigh its costs. The rational prophylactic use of mastectomy in these circumstances must await answers to several questions. First, accurate estimates of the true risk associated with these lesions must be obtained, as current estimates are imprecise and potentially biased. Second, large ongoing trials of breast cancer screening and treatment may provide effective methods of distinguishing those women at exceptionally high risk in whom such procedures may be warranted. Finally, the question of conservative surgery as an acceptable treatment for breast cancer must be settled; otherwise, the prophylactic procedure may be more invasive and disfiguring than the treatment of the disease it seeks to prevent.