The decision to proceed with prophylactic surgery is a very complex and personal one. The high-risk woman herself must take the lead. As physicians, our role is to provide her with the best long-term data, both positive and negative, regarding all the available options. You mentioned that prophylactic mastectomy is an option for high-risk women. These are women whose family history suggests an inherited predisposition to breast cancer.
Prophylactic mastectomy sounds like drastic treatment.
For families with thyroid cancer, prophylactic thyroidectomy is performed. For families with inherited colon cancer, prophylactic colectomy is performed in young individuals. Clearly, the ideal would be to have another, non-surgical intervention that was highly effective. Unfortunately the process of carcinogenesis, or cancer development, is extremely complex and can occur via a number of biologic pathways. Thus, removing the tissue at risk remains an option for select individuals at high-risk.