Risk-reduction mastectomy: Clinical issues and research needs

Risk-reduction mastectomy (RRM), also known as bilateral prophylactic maste ctomy, is a controversial clinical option for women who are at increased ri sk of breast cancer. Highrisk women, including women with a strong family h istory of breast cancer and BRCA1/2 mutation carriers, have several clinica l options: risk-reduction surgery (bilateral mastectomy and bilateral oopho rectomy), surveillance (mammography, clinical breast examination, and breas t self-examination), and chemoprevention (tamoxifen). We review research in a number of areas central to our understanding of RRM, including recent da ta on 1) the effectiveness of RRM in reducing breast cancer risk, 2) the pe rception of RRM among women at increased risk and health-care providers, 3) the decision-making process for follow-up care of women at high risk, and 4) satisfaction and psychological status after surgery. We suggest areas of future research to better guide high-risk women and their health-care prov iders in the decision-making process.