Prophylactic mastectomy: ethical issues.
BACKGROUND
Why in particular should prophylactic mastectomy be seen more as an ethical concern than as a strictly medical question? In this article, four main explanations will be discussed.


RESULTS
First, a risky condition is not a disease and prevention does not improve well-being. The benefits are only statistical and make sense at the population level. Secondly, the cause of the risk is a genetic factor and some might argue about genetic 'exceptionalism'. Thirdly, there is no organ as, connected to femininity, sensuality, sexuality, adulthood and motherhood as the breast. Lastly, making tough and complex choices requires assistance from ethics.


RESULTS
Among ethical principles, western countries often rely on autonomy. The physician has to deliver all the relevant information; based on this 'knowledge' and using their own values, patients will take a decision. AREA OF CONTROVERSY: In 1998 in France, national recommendations set a list of criteria to fulfil, reducing autonomy.


CONCLUSIONS
It might be expected that this tough issue will be solved, thanks to the improvement of prevention and therapeutic efficacy.
Eisinger
Francois
F
INSERM UMR 599 Marseille, France. eisinger@marseille.inserm.fr
D001943:Breast Neoplasms / Q000235:genetics / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D006801:Humans; D007258:Informed Consent / Q000523:psychology*; D008408:Mastectomy / Q000941:ethics*; D026684:Personal Autonomy; D018570:Risk Assessment