Once again, many many thanks to all of you who sent such informative and
eloquent responses to me about the client who was advised to have a
bilateral mastectomy to prevent breast cancer.  It turns out that she has
received not two, but three separate opinions from three separate doctors;
one a breast specialist in London who was aghast that she was still nursing
a four year-old and said that this in itself could cause "small cysts" thus
increasing her risk of breast cancer, but suggested the genetic testing
first (her mother and cousin refuse to have the tests).  The second opinion
was from her GP who advised having the bilateral mastectomy and a tubal
ligation all at once (to save time). The third was from her children's paed.

Client is aged 36, her first baby being born 4 years ago. Three female
members of her family have had breast cancer - her mother's sister in her
30s who died, her grandmother over the age of 60 who has survived, and her
own mother, also over the age of 60, also still alive.  Her grandmother did
not breastfeed any of her children.  But her mother did - client was herself
breastfed for 9 months.

I was able to hand her a nice long list of references on the protective
effects of extended breastfeeding, and the general concensus of opinion of
the best brains in the business (thanks, people!)   She has obviously done a
lot to inform herself and sought many opinions from many sources.  I doubt
if she will opt for the surgery, seeing it as unecessary mutilation (as do
we) and being too committed to continuing breastfeeding her children at this
stage. I think she will plan on breast self exam, regular scans and prompt
investigation if anything untoward shows up.

Thank you once again for sharing your wide diversity of knowledge and
experience.

Pamela Morrison IBCLC, Zimbabwe