The prophylactic mastectomy from a medical, individual and social angle

The identification of the two predisposing sing genes, BRCA1 and BRCA2, has ed to a wider individualisation of gene carriers at high risk of breast ca ncer, justifying specific medical interventions. Prophylactic surgery is a major issue in this view. Indeed, based on convergent modelling analyses an d on retrospective analyses, prophylactic mastectomy appears to be a founde d medical option. Other pivotal data to help decision-making are, however, lacking or controversial. In terms of screening, the efficacy of mammograph y is questionable, preventive strategies, like Tamoxifen, are emerging but the magnitude of their impact and their risk level are still controversial. With such an uncertainty, die acceptability of prophylactic surgery by wom en and physicians is an information of great value. For women, various rate s of acceptability have been published in different countries. Among the ca uses of such differences, the emphasis could be put on cultural factors and social rules. Prophylactic mastectomy sends back to how and by whom a deci sion should be made.