Is bilateral radiation an option for BRCA mutation carriers with unilateral breast cancer?

The authors of the paper on prophylactic contralateral irradiation are to be congratulated on completing a study that many thoughts couldn’t be done (1). It is now commonplace to do bilateral surgery when there is cancer in one breast as a means of pre-empting a cancer in the contralateral breast (2,3). In the case of BRCA mutations, this strategy may be proposed by the physician but for non-carriers it is usually the patient who requests the operation (3). But it is not the case that we offer bilateral radiation to women with cancer in one breast to prevent cancer in the opposite breast—even though the logic is pretty much the same.