In a recent comprehensive review, You et al.  report on common hereditary cancer syndromes and the role of prophylactic surgery. The authors propose five rational criteria for prophylactic surgery and conclude that only the type 2 multiple endocrine neoplasia (MEN) syndromes meet these criteria. We have some comments;
First, according to evidence-based medicine principles the authors are right. But even in the future randomized controlled trials to support prophylactic surgery over surveillance for the prevention of hereditary breast, gastric and colorectal cancer syndromes will never emerge, because it is very difficult to enroll sufficient number of patients in such RCTs given both the low incidence of these syndromes and current practice guidelines recommendations in favor of prophylactic surgery by international Organizations and experts [2,3].