If someone in your family had lost her life to breast cancer and you were told you carried a gene that increased your risk, wouldn't you do all you could to reduce that risk? Next question: what exactly is all you can do?

Some folks have studied breast cancer prevention options specifically to compare the cost and effectiveness of various preventive strategies.

The authors of the study, published in the March 21 issue of Annals of Internal Medicine, used a computer model to analyze breast cancer data and calculate the risks, benefits, and costs of six different prevention approaches for women who don't have breast cancer but carry a single BRCA1 or BRCA2 gene mutation. These are the strategies compared in the study:

• use of oral contraceptives, which appears to reduce the risk for ovarian cancer
• taking the drug tamoxifen, which reduces the risk for breast cancer
• surgical removal of both ovaries (oopherectomies)
• surgical removal of both breasts (mastectomies)
• surgical removal of breasts and ovaries
• no preventive actions (surveillance)

Using their decision model, the researchers found that for women with the BRCA2 gene mutation, the combination of preventive surgical removal of the ovaries (oophorectomy) and breasts (mastectomy) was more cost-effective than removal of the ovaries alone.

Both of these treatment approaches were less costly and more effective than mastectomy alone, tamoxifen, or surveillance. For BRCA1 carriers, oophorectomy alone was the most cost-effective of all strategies.

What's the message? For women who are genetically positive, that is, who carry a gene that increases their risk of developing breast cancer, it's important to take aggressive action to reduce your risk of following in your family member's footsteps - or, as I like to say, of wearing her bra.

It's reassuring to know that doing so is also economically smart, although I'd do it no matter what the expense.