Prospective Study of Psychosocial Outcomes of Having Contralateral Prophylactic Mastectomy Among Women With Nonhereditary Breast Cancer

Abstract

Purpose The incidence of contralateral prophylactic mastectomy (CPM) has continued to increase. We prospectively examined psychosocial outcomes before and up to 18 months after surgery in women who did or did not have CPM. Methods Women with unilateral, nonhereditary breast cancer completed questionnaires before and 1, 6, 12, and 18 months after surgery. Primary psychosocial measures were cancer worry and cancer-specific distress. Secondary measures were body image, quality of life (QOL), decisional satisfaction, and decisional regret. Results A total of 288 women (mean age, 56 years; 58% non-Hispanic white) provided questionnaire data, of whom 50 underwent CPM. Before surgery, women who subsequently received CPM had higher cancer distress ( P = .04), cancer worry ( P < .001), and body image concerns ( P < .001) than women who did not have CPM. In a multivariable repeated measures model adjusted for time, age, race/ethnicity, and stage, CPM was associated with more body image distress ( P < .001) and poorer QOL ( P = .02). There was a significant interaction between time point and CPM group for cancer worry ( P < .001), suggesting that CPM patients had higher presurgery cancer worry, but their postsurgery worry decreased over time and was similar to the worry of patients who did not have CPM. QOL was similar between CPM groups before surgery but declined 1 month after surgery and remained lower than patients who did not have CPM after surgery ( P = .05). Conclusion These results may facilitate informed discussions between women and their physicians regarding CPM. Fear and worry may be foremost concerns at the time surgical decisions are made, when women may not anticipate the adverse future effect of CPM on body image and QOL.

Magnitude of reduction in risk of second contralateral breast cancer with bilateral mastectomy in patients with breast cancer: Data from California, 1998 through 2015

“…Moreover, BLM has greater morbidity than unilateral mastectomy (ULM) or breast-conserving surgery with radiotherapy (breast conserving therapy [BCT]), in terms of complications, body image, recovery time, and impact on employment. [4][5][6][7][8] The choice to undergo BLM is complex. Although the probability of developing a contralateral second breast cancer has declined in the United States over time, 9 potentially due to the more widespread use of adjuvant endocrine therapy, 10 the majority of patients report that fear of a subsequent breast cancer was their primary motivation for choosing to undergo BLM.…”

Who should get a contralateral prophylactic mastectomy for breast cancer?

“…These data are emerging, and a recent study demonstrated that, although women who had CPM had more presurgical cancer worry, their worry after surgery was similar to the worry of patients who did not undergo CPM . However, women who underwent CPM also had poorer quality of life and body image concerns after surgery than women who did not undergo CPM in the 18 months after surgery . These results and other data should be used to counsel women about the potential for both positive and negative effects of CPM on body image, quality of life, and decision satisfaction in the short and long term after surgery .…”

“…14 However, women who underwent CPM also had poorer quality of life and body image concerns after surgery than women who did not undergo CPM in the 18 months after surgery. 15 These results and other data should be used to counsel women about the potential for both positive and negative effects of CPM on body image, quality of life, and decision satisfaction in the short and long term after surgery. [17][18][19] It has been demonstrated that a surgeon's recommendation about CPM is an important factor in a woman choosing for or against CPM, 20 highlighting the importance of engaging in patient-centered communication in the decision-making process.…”

“…13 For many women, the decision to pursue CPM is driven by psychosocial concerns, such as cancer worry, fear of cancer recurrence, and negative body image. 14,15 Therefore in addition to providing information about the impact of CPM on CBC risk and survival, the oncologist should encourage the patient in our vignette to share her reasons for wanting CPM and should elicit her personal treatment preferences and values. 16 One challenge that oncologists face is that there are minimal prospectively collected data about what women can expect after surgery if they do and do not undergo CPM.…”

Assessing the additional surgical risk of contralateral prophylactic mastectomy and immediate breast implant reconstruction

“…relative to breast-conserving surgery [22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Psychologically, many patients continue to undergo the elective procedure out of anxiety over developing a new primary breast cancer [36][37][38][39][40][41][42][43][44][45]. A study conducted by Rosenberg et al demonstrated that 87% of women reported high concerns of being diagnosed with contralateral breast cancer in the future, 98% undergo CPM to decrease their contralateral breast cancer risks, 80% were confident in their decision, and 90% would "definitely [choose]" to undergo the procedure again, if given the opportunity [46].…”