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British Medical Bulletin Advance Access originally published online on April 4, 2007
British Medical Bulletin 2007 81-82(1):7-19; doi:10.1093/bmb/ldm003
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© The Author 2007. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Prophylactic mastectomy: ethical issues

Francois Eisinger*,{dagger},{ddagger}

{dagger} Department of Oncogenetics Prevention and Screening, Paoli-Calmettes Institute, France
{ddagger} INSERM UMR 599, ERMES, Marseille, France

* Correspondence to: Francois Eisinger, 232 Bd St Marguerite, 13009 Marseille, France. E-mail: eisinger{at}marseille.inserm.fr

Introduction: Why in particular should prophylactic mastectomy be seen more as an ethical concern than as a strictly medical question? In this article, four main explanations will be discussed.

Main points: First, a risky condition is not a disease and prevention does not improve well-being. The benefits are only statistical and make sense at the population level. Secondly, the cause of the risk is a genetic factor and some might argue about genetic ‘exceptionalism’. Thirdly, there is no organ as, connected to femininity, sensuality, sexuality, adulthood and motherhood as the breast. Lastly, making tough and complex choices requires assistance from ethics.

Areas of agreement: Among ethical principles, western countries often rely on autonomy. The physician has to deliver all the relevant information; based on this ‘knowledge’ and using their own values, patients will take a decision.

Area of controversy: In 1998 in France, national recommendations set a list of criteria to fulfil, reducing autonomy.

Emerging areas for developing research: It might be expected that this tough issue will be solved, thanks to the improvement of prevention and therapeutic efficacy.

Keywords: genes BRCA1 • genes BRCA2 • risk management • personal autonomy

Accepted for publication February 6, 2007.


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