Impact of Bilateral Prophylactic Mastectomy and Immediate Reconstruction on Health-Related Quality of Life in Women at High Risk for Breast Carcinoma: Results of the Mastectomy Reconstruction Outcomes Consortium Study

Abstract

Background Although bilateral prophylactic mastectomy (BPM) can reduce the risk of breast cancer, the decision to proceed surgically can have significant consequences and requires careful deliberation. To facilitate decision-making for women at high risk for breast carcinoma, the risks and benefits of BPM should be well-elucidated. We sought to determine the effects of BPM and immediate reconstruction on health-related quality of life outcomes among a multisite cohort of women at high risk for breast carcinoma. Methods Patient-reported outcome data were prospectively collected as part of the Mastectomy Reconstruction Outcomes Consortium Study. Data on a subgroup of 204 high-risk women who elected to have BPM and immediate reconstruction were evaluated. Baseline scores were compared with scores at one or two years after reconstruction. Results Satisfaction with breasts and psychosocial well-being were significantly higher at both one and two years (p<0.01). Anxiety was significantly lower at one or two years (p<0.01). However, physical well-being of the chest and upper body was significantly worse at one year (p<0.01). Conclusion Our results highlight the impact of BPM and immediate reconstruction on health-related quality of life outcomes in this setting. BPM and reconstruction can result in significant positive, lasting changes in a woman’s satisfaction with her breasts, as well as her psychosocial well-being. Furthermore, presurgery anxiety was significantly reduced by one year postreconstruction and remained reduced at two years. With this knowledge, women at high risk for breast carcinoma and their providers will be better equipped to make the best individualized treatment decisions.

Sexual function, menopausal symptoms, depression and cancer worry in women with BRCA mutations

“…Pleasure score † 12 (9-16) 11 (9)(10)(11)(12)(13)(14) .56 11 (9)(10)(11)(12)(13)(14) 12 (9)(10)(11)(12)(13)(14)(15) .34…”

“…In order to appropriately counsel women regarding the relative benefit of cancer risk reduction and the health consequences of RRSO, it is important to understand the impact of pre-versus postmenopausal RRSO relative to other factors such as age, cancer and cancer treatment on sexual and menopausal symptoms 6,7 and to be able to provide realistic expectations regarding immediate post-operative versus long-term impact. [8][9][10] The question of what happens after this immediate surgically induced menopause is not clearly described but is important for patient counseling. [8][9][10] The question of what happens after this immediate surgically induced menopause is not clearly described but is important for patient counseling.…”

“…As expected, RRSO has been shown to decrease cancer worry and several investigators have shown decreased sexual functioning and increased vasomotor symptoms, with overall QOL in the immediate postoperative year after RRSO comparable with the general population. [8][9][10] The question of what happens after this immediate surgically induced menopause is not clearly described but is important for patient counseling. Only one study of women with BRCA mutations has evaluated the impact of RRSO on sexual function over time.…”

Quality-of-life implications of risk-reducing cancer surgery

“…Reduction in anxiety and cancer‐related distress among BRCA1 /2 carriers was notable when compared to both carriers who opted for surveillance and non‐carrier individuals. McCarthy et al . and Pusic and co‐workers published results from the Mastectomy Reconstruction Outcomes Consortium and reported that women who underwent RRM with immediate reconstruction had significantly decreased anxiety 1 and 2 years after surgery compared with baseline scores.…”

“…Furthermore, RRM appears to decrease cancer‐related anxiety. A prospective study evaluated women with high‐risk cancer who underwent RRS (RRM, RRM plus RRSO, or RRSO alone) in comparison with age‐ and risk‐matched control patients in the same high‐risk group who did not have surgery.…”