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A 74-year-old woman with a history of von Recklinghausen's disease presented with infiltrating lobular carcinoma of the left breast (T2N0M0 [stage IB], according to the tumor–node–metastasis [TNM] staging system). On physical examination, the patient had innumerable cutaneous neurofibromas (Panels A and B). Of the patient's three children (twin daughters and a son), all had inherited the condition, which is also called neurofibromatosis 1. One of her daughters had died at the age of 12 years from complications of a viral illness, and both her other daughter and her son had died at the age of 38 from cancer. The patient's . . .