Prophylactic Surgery to Reduce the Risk of Developing Breast Cancer:Issues and Clinical Implications

Decision making for breast cancer prevention among women at elevated risk

“…There is, however, a sparse evidence base for these comparisons and combinations [69, 70]. It is known that BRCA mutation carriers can achieve greater risk reduction by undergoing both BPM and BPSO than either alone [27, 71], and that prophylactic surgeries generally reduce both cancer risk and anxiety about cancer [28]. BPSO is likely the single intervention with the best risk-benefit ratio for BRCA mutation carriers [72, 73].…”

“…Decisions can be changed or delayed by fear of surgery or side effects [67, 159]. Women’s decisions are also shaped by aspirations for their future (e.g., desire to have children), predictions about future emotions, perceived control over health, self-worth, experiences in high-risk families, risk fatigue, and cancer-related stigma [28, 97, 159, 164, 179]. Affective influences merit more thorough attention, and socio-emotional factors so far absent from the academic literature may also exert powerful influence on women’s decisions [164].…”

The development of a template for psychological assessment of women considering risk‐reducing or contralateral prophylactic mastectomy: A national Delphi consensus study

“…It is important for the clinician to be mindful of issues below and assess if clinically indicated: -History of psychological difficulty 11…”

“…While they are not always necessary nor feasible, psychological consultations are frequently recommended and completed in order to best support decision-making, minimise potential patient regret, and assess suitability and readiness for surgery. [11][12][13][14] Literature suggests that some patients may especially benefit from presurgical assessment, including those with anxiety or other psychological distress, [12][13][14][15] a high perception of cancer risk, 15,16 decisionmaking difficulty, 15 a family member who has experienced BC, 13,15 or perception that others are endorsing patient's surgery uptake. 15,16 Studies suggest that some women may perceive a routine psychological consultation to be appropriate and helpful in consolidating their preferences and assisting with decision-making.…”

What about prophylactic surgery in BRCA1/BRCA2 mutation carriers? Observations from an Italian pilot study

“…1,2 Prophylactic mastectomy and salpingo-oophorectomy are effective risk-reducing surgical options that strongly impact women's life and their health care needs. [2][3][4][5] Management of BRCA mutation carriers is in constant evolution and reflects the position of different worldwide health care systems. 6,7 Investigations about women's experience are needed in Southern European Countries.…”