Psychological and Social Impacts of Prophylactic Mastectomy
Mayo Clinic scientists report that most women who have a contralateral (opposite to malignant breast) prophylactic mastectomy (CPM) are satisfied and would elect this procedure again. Satisfaction with CPM was studied an average of 10 years after the procedure was done. The findings were published online Oct. 3 in the Journal of Clinical Oncology.
CPM is the removal of the unaffected breast in addition to the malignant breast -- to reduce risk of future breast cancer. "Contralateral prophylactic mastectomy is one option to reduce contralateral risk in women diagnosed with a first breast cancer who also have a strong family history of breast cancer," says Marlene Frost, Ph.D., Mayo Clinic oncology scientist and lead investigator of the study. "Women need to carefully weigh the benefits of this procedure with the potential adverse effects."
Over 211,000 women are diagnosed each year with breast cancer in the United States. The risk of developing breast cancer in the other breast after an initial diagnosis is about 15 percent over a woman's lifetime. However, this risk increases dramatically in women with an inherited mutation of the BRCA1/2 genes, to 52 percent over a lifetime, and for women under 40 at initial diagnosis, the risk is 40 percent within the first 10 years. To manage these risks, women may have more frequent screenings for breast cancer, take preventive chemotherapy, or have a prophylactic oophorectomy (preventive removal of ovaries) or mastectomy.
Over 80 percent of the 583 women in the study reported satisfaction with having a CPM, eventhough Dr. Frost and her team found that satisfaction depended on the type of surgical procedure -- women who had a subcutaneous mastectomy (about 95 percent of breast tissue removed with a small amount left behind the nipple while the skin, nipple and areola are preserved) reported more problems with reconstruction and fewer were satisfied with the procedure than those women who had a simple mastectomy (breast tissue and nipple removed). Additionally, the majority of women reported no change or favorable effects in sense of femininity, sexual relationships, stress in life, emotional stability, self-esteem and body appearance. Satisfaction levels were higher (83 percent) on average in comparison to those levels (70 percent) of women who had bilateral (both breasts) prophylactic mastectomies (BPM) -- as Dr. Frost learned in a previous study.1 .
Differing results suggest that different factors lead to a woman's decision to have a BPM as opposed to women who've had CPM after experiencing a diagnosis of cancer necessitating surgery on one breast. "Clearly, a woman diagnosed with a first breast cancer who has a family history of breast cancer is faced with complex decisions about the treatment of her cancer and her risk for cancer in the other breast," says Dr. Frost. "It is important that these women have information about the probable effectiveness, as well as psychological and social outcomes, of their options."
Some adverse psychological and social outcomes were noted for a number of women, including negative feelings toward body appearance (33 percent), loss of sense of femininity (26 percent), negative impact on sexual relationships (23 percent), added stress (17 percent), decrease in self-esteem (17 percent) or decrease in emotional stability (12 percent).
The women who participated in this study had a personal and family history of breast cancer and a CPM at Mayo Clinic between 1960 and 1993. Participants completed a study-specific questionnaire.
In addition to Dr. Frost, members of the Mayo Clinic research team included Jeffrey Slezak; Nho (Bill) Tran, M.D.; Constance Williams, M.D.; Joanne Johnson; John Woods, M.D.; Paul Petty, M.D.; John Donohue, M.D.; Clive Grant, M.D.; Jeff Sloan, Ph.D.; and Lynn Hartmann, M.D. Also on the research team was Thomas Sellers, Ph.D., Moffitt Cancer Center and Research Institute, Moffitt, Fla. The National Cancer Institute and Department of Defense funded this study, with additional support from the Andersen Foundation and Lonabelle (Kappie) Spencer.
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1Frost et al., Long-term satisfaction and psychological and social function following bilateral prophylactic mastectomy, (JAMA 284:319-324, 2000).