Despite advances in genetics of familial breast and ovarian cancer, the clinical management of women with established mutations in BRCA1 or BRCA2 genes remains controversial. For women who decide for prophylactic surgery and not for a conservative approach, it is highly debated whether they are benefited more by a prophylactic mastectomy rather than a prophylactic oophorectomy. Although BRCA-mutation carriers are at substantially higher risk for developing breast cancer rather than ovarian cancer, a medical decision-making is a major challenge. Penetrance estimates of breast and ovarian cancer considerably vary and substantially differ between BRCA1 and BRCA2 mutation carriers. This variation is important in decision-making. Here we balance risks and benefits of these two surgical procedures regarding cancer risk estimates, effectiveness, morbidity and quality of life.

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