Bancroft et al. describe the successful establishment of a novel specialist clinic for BRCA1/2 mutation carriers. (1) The authors should be applauded for the introduction of this specialized, multi-disciplinary clinic. However, although their study provides elaborate data on numbers of patients followed in this clinic, it remains unclear what the information provision and guidance for decision-making in the multi- disciplinary team consisted of. This is of special importance with respect to the counselling of BRCA1/2 carriers whether or not to undergo prophylactic mastectomy. In the article of Bancroft the effect of prophylactic mastectomy is emphasized. In contrast with surveillance for ovarian cancer that appeared to be ineffective, either annual mammography plus MRI screening or prophylactic mastectomy seem to offer comparable results with respect to survival (2); in our opinion there is no need to direct patients towards a decision for prophylactic mastectomy. Of note, although the rate of false-positive MRI results in this population is high, the impact of a false-positive MRI on the choice for prophylactic mastectomy is limited and is determined by the woman's preference before the establishment of a BRCA mutation. (3) In our multidisciplinary clinic for BRCA1/2 carriers, which we started in 1999, 27% had an initial preference for prophylactic mastectomy. After a median observation period of 2 years, 30% had undergone prophylactic mastectomy. (4) We believe that a careful counselling of the pros and cons of prophylactic mastectomy and an open discussion on real and perceived risk reduction by prophylactic mastectomy is crucial. For carriers of a BRCA1/2 mutation and their family members such counselling may be the surplus value of a specialized multidisciplinary clinic.

References 1. Bancroft EK, Locke I, Ardern-Jones A et al. The carrier clinic: an evaluation of a novel clinic dedicated to the follow-up of BRCA1 and BRCA2 carriers--implications for oncogenetics practice. J Med Genet. 2010;47:486 -491. 2. Kurian AW, Sigal BM, Plevritis SK. Survival analysis of cancer risk reduction strategies for BRCA1/2 mutation carriers. J Clin Oncol. 2010;28:222-231. 3. Hoogerbrugge N, Kamm YJ, Bult P et al. The impact of a false-positive MRI on the choice for mastectomy in BRCA mutation carriers is limited. Ann Oncol. 2008;19:655-659. 4. Landsbergen KM, Prins JB, Kamm YJ et al. Female BRCA mutation carriers with a preference for prophylactic mastectomy are more likely to participate an educational-support group and to proceed with the preferred intervention within 2 years. Fam Cancer. 2010;9:213-220.

Conflict of Interest:

None declared