Do all BRCA1/2 carriers with breast cancer benefit from bilateral mastectomy?

Surgical management of hereditary breast cancer is influenced by several variables pertaining tumor biology as well as patients’ physical and psychological characteristics. The prevalence of BRCA1/2 mutations among breast cancer patients is low, but many carriers are not diagnosed according current criteria of access to genetic testing. This is becoming even more relevant as specific drugs for carriers have now been included in the armamentarium of medical oncologists. Indeed, the whole therapeutic strategy, including pros and cons of radiotherapy, is influenced by BRCA1/2 status. Although no major differences have been reported between the outcome of BRCA1/2 negative vs. BRCA1/2 positive patients, the latter carry a substantially higher cumulative risk of metachronous breast and ovarian cancers. It is then mandatory that the complex interplay between clinical, biological and treatment variables be fully taken into account when cancer develops in these women.