In Reply: Ms Miller and Dr Singer are correct that only those women destined to die of contralateral breast cancer would actually live longer as a result of having had prophylactic contralateral mastectomy. Many others would avoid the morbidity of treatment for a second breast cancer. When decisions about cancer prevention strategies need to be made, there is no way to predict whether an individual woman is destined to live out her life cancer-free, develop a cancer that can be cured, or one that ultimately proves fatal. As is the case for many preventive measures, to save a few lives, many individuals must be treated.
Schrag D, Kuntz KM, Garber JE, Weeks JC. Benefit of Prophylactic Mastectomy for Women With BRCA1 or BRCA2 Mutations—Reply. JAMA. 2000;283(23):3071-3072. doi:10.1001/jama.283.23.3068g