Summary
Prophylactic mastectomy (PM) offers 90% or greater reduction in
risk of breast cancer to women at increased hereditary risk. Nonetheless,
acceptance in North America has been low (0–36%). Most women
report reduced cancer worry post-operatively, but up to 25–50%
of women electing surgery also report psychological distress and/or difficulty
adapting following PM. Psychological consultation to aid decision-making and
improve post-surgical coping isn’t routinely offered. This
retrospective, cross-sectional study explored, quantitatively and qualitatively,
interest in and acceptability of psychological consultation for issues related
to PM among 108 women who had undergone or were considering surgery. Of the 71
women who had undergone PM, more than half felt pre-surgical psychological
consultation was advisable and nearly 2/3 felt post-surgical psychological
consultation would be helpful. All 37 women (100%) currently considering
PM believed psychological consultation would aid decision-making and preparation
for surgery.
Narratives from the interviews illustrate the nature and intensity of the
need for psychological support and describe preferences for the role of the
psychologist. Suggestions are offered for the integration of psychological
services for women deciding about or adapting to PM.
Paraneoplastic cerebellar degeneration (PCD) is a rare condition which is characterised by global cerebellar dysfunction. Patients may present with these syndromes months or years before the diagnosis of underlying malignancy is established. Less often, PCD occurs in patients with a known malignancy or heralds the onset of a recurrence. The presence of specific antibodies in serum simples helps to guide identification the occult malignancy. We report here the case of a PCD in 74-year-old lady underwent a left mastectomy for breast cancer 5 years ago. She remained well until now. The diagnosis of the primary tumor, that is clinically undetectable with conventional imaging processes, is preformed with the aid of positron mission tomography (PET) to detect the presence of abdominal lymph node metastases. We briefly review the clinical and laboratory features of this syndrome, and emphasize the importance of its prompt recognition, which many times makes possible the early detection and treatment of the primary disorder.
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