Do you think it is OK for a woman to have her breasts removed if she is at high risk of breast cancer? Both of my grandmothers, three great-aunts and two aunts have had breast cancer. I am very concerned.

H.B.

Current thoughts on prophylactic mastectomy -- removal of the breasts to prevent cancer -- suggest that women with two first-degree relatives with breast cancer may benefit from having their breasts removed. First-degree relatives include mother, sister or daughter. Unless there is a positive BRCA mutation in the family and tests show you carry that mutation, prophylactic mastectomy is not recommended if more distant relatives (such as grandmothers and aunts) are the only ones affected.

The BRCA mutations are errors in specific genes that increase the odds of breast and ovarian cancers. This mutation can be tested for in families plagued with these cancers. The testing needs to involve affected family members, so if all the relatives with breast cancer are already dead, this testing would not be available to the surviving members of your family. If several of the relatives who have had cancer are still alive, their blood can be tested. If a BRCA mutation is present, that same mutation can be looked for in other family members not yet diagnosed with cancer. If a woman has a BRCA mutation, her risk of developing breast cancer is higher, but not all women with a BRCA mutation will develop breast or ovarian cancer -- nor does a negative result guarantee that one will not get cancer.

If your family is interested in having such testing done, you and other interested members should undergo extensive genetic counseling. This is available through regional cancer centers that offer the BRCA testing.