Prophylactic surgery in women with a hereditary predisposition to breast and ovarian cancer.
OBJECTIVE
To review the published literature on the efficacy and adverse effects of prophylactic mastectomy (PM) and prophylactic oophorectomy (PO) in women with a hereditary predisposition to breast and ovarian cancer and to provide management recommendations for these women.


METHODS
Using the terms "prophylactic," "preventive," "bilateral," "mastectomy," "oophorectomy," and "ovariectomy," a MEDLINE search of the English-language literature for articles related to PM and PO was performed. The bibliographies of these articles were reviewed to identify additional relevant references.


RESULTS
There have been no prospective trials of PM or PO for the reduction of breast cancer or ovarian cancer incidence or mortality. Most of the available retrospective studies are composed of women who had surgery for a variety of indications and in whom genetic risk was not well characterized. However, some reports in women at increased risk of breast or ovarian cancer have shown that PM and PO can reduce cancer incidence.


CONCLUSIONS
Interest in and use of PM and PO are high among physicians and high-risk women. PM and PO seem to be associated with considerable reduction in the risk of breast and ovarian cancer, albeit incomplete. The surgical morbidity of PM and PO is low, but the complications of premature menopause may be significant, and few studies address quality-of-life issues in women who have opted for PM and PO. Management recommendations for high-risk individuals are presented on the basis of the available evidence.
Eisen
A
A
Department of Medicine, Biostatistics and Epidemiology, and Genetics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. aeisen@mail.med.upenn.edu
Rebbeck
T R
TR
Wood
W C
WC
Weber
B L
BL
D001943:Breast Neoplasms / Q000235:genetics / Q000517:prevention & control* / Q000601:surgery; D003376:Counseling; D003657:Decision Making; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008408:Mastectomy; D010051:Ovarian Neoplasms / Q000235:genetics / Q000517:prevention & control* / Q000601:surgery; D010052:Ovariectomy; D011788:Quality of Life; D018570:Risk Assessment