Patient-Reported Outcomes After Choice for Contralateral Prophylactic Mastectomy

Abstract

Choice for CPM was associated with an improvement in breast satisfaction and psychosocial well-being. However, the magnitude of the effect may be too small to be clinically meaningful. Such patient-reported outcomes data are important to consider when counseling women contemplating CPM as part of their breast cancer treatment.

Contralateral prophylactic mastectomy and quality of life: answering the unanswered questions?

“…CPM was not associated with worse physical or sexual well-being, and while breast satisfaction and psychosocial well-being were statistically better in women who had CPM vs. mastectomy alone, as noted by the authors, the differences between the two groups were small, and likely not clinically significant (3). Similarly, Koslow et al (in a study that also assessed post-surgical outcomes with the BREAST-Q), found that among women who had implant-based reconstruction, breast satisfaction was higher among those who had CPM compared to women who had mastectomy alone, however psychosocial, physical, and sexual well-being were similar between the two surgical groups (5).…”

“…As such the authors concluded that psychosocial functioning among women who had CPM was similar to those who had mastectomy alone, regardless of the length of time that had passed since their surgery (3). Importantly, psychosocial functioning trended positively over time for all patients, independent of their choice for CPM, which is good news for long-term breast cancer survivors (3).…”

“…Because CPM is a more extensive surgery (often accompanied with reconstruction) with a higher risk of complications (6,7), both physical and psychosocial functioning have the potential to be more acutely and adversely impacted in the weeks and months immediately after surgery and through an extended recovery period. Although it is unknown how prevalent complications were among study participants, Hwang et al reported a strong association between QOL and both major and minor surgical complications; with reduced physical, psychosocial, sexual functioning, and breast satisfaction reported among those who experienced a complication (3). While the authors also found reconstruction to be associated with higher breast satisfaction (higher than that associated with CPM) (3), findings from a recent study suggest that the specific type of reconstructive surgery can be an important factor when it comes to satisfaction with how the breast looks after surgery.…”

Commentary on the Consensus Statement of the American Society of Breast Surgeons on Contralateral Prophylactic Mastectomy

“…For example, it would be helpful to include information about absolute risk 9 for surgical complications and for contralateral breast cancer after CPM, as well as more recent data on quality of life after CPM. [10][11][12] In addition, women should be provided with information about breast reconstruction options 13 and should be encouraged to consult with a reconstructive surgeon 1 to ensure that they are better informed about the potential benefits and risks of reconstructive procedures before making a final decision. Recent studies that collected patient-reported outcomes (PROs) using a wellvalidated, breast surgery-specific instrument (BREAST-Q) 14 demonstrate that breast reconstruction can improve women's satisfaction as well as their psychosocial, physical, and sexual well-being after mastectomy.…”

“…For example, it would be helpful to include information about absolute risk 9 for surgical complications and for contralateral breast cancer after CPM, as well as more recent data on quality of life after CPM. [10][11][12] In addition, women should be provided with information about breast reconstruction options 13 and …”