Question: When is a prophylactic mastectomy recommended?
Answer: I personally never recommend a prophylactic mastectomy. The conversations we have with women at high risk lead them to ask the question. I don't want to ever raise it or recommend it so that a woman feels that wise counsel would be to take that recommendation and have a prophylactic mastectomy. If a woman at high risk is being followed in a regular screening program, her risk of dying of breast cancer or of ending up with uncontrolled breast cancer is extremely low. On the other hand, her risk might be quite high of getting breast cancer.
So we need to have a thorough discussion about what developing breast cancer would mean to me -- would mean to her, not to me. How devastating would just that diagnosis be, even if the treatment ends up being quite tolerable? Then, with those discussions, we can enter into a consideration of what is involved in prophylactic mastectomy: the fact that it is not perfect, one can still get breast cancer; the fact that with tamoxifen, for example, we can cut the risk of developing breast cancer roughly in half today. And we expect that over the next ten or 15 years, we will have even better agents for preventing breast cancer.