Cancer is essentially a genetic disease, and all cancers originate from genetic mutations, but not all genetic mutations are inherited from parents. A variety of environmental factors such as viral infections, chemicals, and radiation can lead to genetic mutations that cause cancer to occur. As humans gain experience in fighting cancer, we find that certain specific types of cancer do have family aggregation. These cancers are called hereditary cancers, in which members of a family have a much higher risk of developing one or more cancers than the general population because they have acquired a genetic mutation that originated in their father’s or mother’s line. Hereditary cancers account for a very low percentage of all cancers; for example, hereditary breast cancer accounts for only 10 percent of all breast cancers. It is such a disease that plagues Angelina Jolie. Jolie’s disease is called Hereditary Breast/Ovarian Cancer Syndrome, and genetic testing of these patients can reveal mutations in the BRCA-1 or BRCA-2 genes, which can be passed on to their children. Jolie’s family includes three female relatives who have died of cancer, including her mother who had breast and eventually ovarian cancer, and Jolie herself who has been tested as a carrier of the BRCA-1 gene mutation. What kind of people need genetic testing? With the advancement of medical science, the prognosis of many types of cancer has improved greatly, but the mortality rate of most cancers is still high, and people’s fear of cancer can be described as “cancer fear”. In her statement after undergoing a bilateral mastectomy, Jolie also said, “”Cancer is still a frightening word that can leave people with a deep sense of powerlessness. But now, you can take a blood test to find out if you are susceptible to breast and ovarian cancer and then take action.” So, is it possible that we can all go for a blood test to find out if we will get cancer and thus prevent it from happening? The American Clinical Cancer Society proposed in 2003 and reiterated in 2010 three principles for genetic testing: the clinical features of the patient or his or her family history suggest a suspicion of hereditary cancer; the results of the test can be interpreted; and the results can help in diagnosis or treatment. This shows that genetic testing is not applicable to the screening of the general population. The incidence of hereditary cancer is very low, and for the general population such testing is a non-starter, with high economic costs and no benefits. There is no guideline on what kind of people need genetic testing for hereditary breast/ovarian cancer syndrome in China, and oncologists mainly refer to the guidelines issued by NCCN, an international authoritative cancer research organization. Simply speaking, breast cancer patients with early onset, specific type, concurrent ovarian cancer or whose relatives have cancer, especially breast and ovarian cancer, should consult their oncologists and their family members whether they need to undergo relevant genetic testing. If a BRCA-1/BRCA-2 mutation is detected, will I definitely get breast cancer or ovarian cancer? First of all, the answer is no. If a BRCA-1/BRCA-2 mutation is detected by genetic testing, further information about the individual and his/her family (including clinical features of the tumor and family genealogy) will be collected by an oncologist and statistical models will be used to calculate the risk for a specific individual. The decision to intervene and the specific interventions will then be based on their risk. Current data show that individuals with BRCA-1/BRCA-2 mutations have a 41%-90% risk of developing breast cancer and an 8%-62% risk of developing ovarian cancer. What should I do as a woman with a BRCA-1/BRCA-2 mutation? Often hereditary breast/ovarian cancer syndromes have an early age of onset, so close breast and ovarian cancer screening is recommended to start early. In the case of breast cancer, monthly breast palpation self-examinations are performed starting at age 18; mammograms are performed every 6 months starting at age 25; and annual mammograms and magnetic resonance imaging (MRI) are performed starting at age 25. However, screening for ovarian cancer is relatively difficult because the ovaries are deep in the pelvis and early ovarian cancer has no obvious symptoms and lacks effective screening tools. Current guidelines recommend transvaginal ultrasound and the tumor marker CA125 every 6 months starting at age 30. In addition to close monitoring, another way to prevent the disease from occurring is to remove the target organ that may be affected. This is exactly what Jolie did when she underwent a preventive bilateral mastectomy in 2013, which sparked global attention and discussion on breast cancer, and again on March 24, 2015 when she announced that she had completed a preventive bilateral ovarian and fallopian tube removal, putting her in the media spotlight. While the media and public praised her determination and bravery, some professionals questioned this approach as being too radical and overly medical. There is controversy over whether to perform prophylactic resection in women with BRCA-1/BRCA-2 mutations, and we discuss the pros and cons of each of these procedures below. The obvious benefit is a substantial reduction in the risk of cancer development. Current data show that for women with intermediate to high risk of BRCA-1/BRCA-2 mutations, prophylactic bilateral mastectomy can reduce the risk of breast cancer by more than 90%; prophylactic bilateral ovarian and fallopian tube resection can reduce the risk of ovarian and fallopian tube cancer by more than 80%. The disadvantages are obvious, as patients need to bear the pain and risks of surgery and the financial pressure of surgery. Therefore, the NCCN believes that the decision to perform prophylactic mastectomy should be made on a case-by-case basis, and that a preoperative consultation with a psychiatrist is required to discuss postoperative psychological and family issues with the patient and to develop a preoperative breast reconstruction plan. Because of the early age of onset of ovarian cancer in women with BRCA-1/BRCA-2 mutations, the current NCCN recommendation for prophylactic bilateral salpingo-oophorectomy is 35 to 40 years of age, taking into account the patient’s reproductive requirements and the age of onset in other patients in the family. However, even though most women no longer have reproductive requirements at this age, the ovaries are still hormone-producing at this time, and the vast majority of patients will experience severe menopausal symptoms after surgery, severely affecting their quality of life, and there is still a lack of clinical research evidence on the safety of exogenous hormone supplementation. In addition, even after prophylactic surgery of the breast and ovarian tubes, cancer cannot be completely eliminated, and the small amount of residual breast tissue and peritoneal tissues with low risk of development may become a breeding ground for future tumors.