Would you recommend prophylactic mastectomy if a patient's estimated lifetime risk of breast cancer using the Gail or Clause models approaches that of a person with a germline BRCA1 mutation (eg >65-85%), in the absence of high risk mutations?

It is premature to recommend prophylactic mastectomies to this patient. The recommendation would be for recommendation of expanding genetic testing in the affected mother or sister utlizing a larger panel of breast cancer susceptibility genes, if they are available for testing and amenable to do so....