Although the majority of
breast cancers are sporadic, it is estimated that between 5% and 10% of cases are hereditary and
mostly associated with BRCA 1 and BRCA 2 mutations. Women with BRCA 1 or BRCA 2 mutation present up to 95%
increased risk of breast cancer and are advised to take preventive measures.
Surveillance, chemoprevention and prophylactic surgery (mastectomy and
oophorectomy) are risk-reducing strategies. This literature review aims to respond to two major questions: 1) to what extent is the
decision-making for prophylactic mastectomy in women with the BRCA mutation a
more relevant option than other strategies, and 2) what are the major factors
influencing the decision for mastectomy? For this purpose, 27 published
articles were reviewed. Results show: a) the decision for mastectomy is more
frequent in women carrying BRCA 1/2 mutation than in non-carriers; mastectomy being less frequent than oophorectomy; b) the decision-making
is significantly associated with BRCA mutation, parity, age and family history;
c) reasons underlying women decision-making relate to anxiety toward the risk
of cancer, concerns with surgery, body-image and sexuality. It is discussed that, due to the complexity of
the decision-making process, these cases require a careful and meticulous
approach regarding information provided, and in addressing concerns.