Psychosocial functioning in women who have undergone bilateral prophylactic mastectomy

Abstract

The purpose of this study was to determine the current psychosocial functioning of women who had previously had a bilateral prophylactic mastectomy. Women in the province of Ontario who had undergone prophylactic mastectomy between 1991 and 2000 were asked to complete questionnaires that assessed psychological distress, sexual activity, overall satisfaction with decision to have a prophylactic mastectomy, and body image. Ninety-seven percent of the women were satisfied with their decision to have a prophylactic mastectomy, but young women (<50 years) were less likely to report satisfaction than older women (p=0.001). Women with a strong family history of breast cancer or a BRCA1 or BRCA2 mutation experienced more cancer-related distress than those with a limited family history. Women who had reconstruction following mastectomy reported higher levels of satisfaction with general body shape and appearance than those without reconstruction. In conclusion, the majority of women were satisfied with their decision to undergo prophylactic mastectomy and were not experiencing abnormal levels of psychological distress, low levels of sexual activity, or difficulties with body image.

Who is prone to high levels of distress after prophylactic mastectomy and/or salpingo-ovariectomy?

“…However, increased levels of general and cancer-related distress at both 6 and 12 months after prophylactic surgery were found to be predicted by their respective baseline levels. Consistent with previous findings [17,20] we observed a decline of general and cancer-related distress after surgery. Although we do not have any quantitative data on additional counselling in other echelons of health care, the observed alleviation of distress could be related to post-operative counselling.…”

Who is prone to high levels of distress after prophylactic mastectomy and/or salpingo-ovariectomy?

“…However, increased levels of general and cancer-related distress at both 6 and 12 months after prophylactic surgery were found to be predicted by their respective baseline levels. Consistent with previous findings [17,20] we observed a decline of general and cancer-related distress after surgery. Although we do not have any quantitative data on additional counselling in other echelons of health care, the observed alleviation of distress could be related to post-operative counselling.…”

Quality of life after risk-reducing surgery for breast and ovarian cancer prevention: a systematic review and meta-analysis

“…Patient pathways in many/most centers include mandatory appointments with a psychologist as part of the decision-making process. Nevertheless, RRM is cost-effective, has high satisfaction of ~97% and minimal decision regret, 65 which along-with our systematic review findings strongly supports RRM as an acceptable approach for BC prevention.…”

The impact of prophylactic salpingo‐oophorectomy on quality of life and psychological distress in women with a BRCA mutation

“…This is much lower than the 32% of women above the clinical cut‐off described by Metcalfe et al . in a study of women who underwent prophylactic mastectomy in Ontario and lower than found in male and female patients with cancer (30%) . All women in our study had undergone genetic counseling that may have contributed the difference between our study and the study by Metcalfe et al .…”

“…We found that 9% of women in our study were above clinical cut-offs (as defined by the BSI 18) consistent with the need for clinical counseling before surgery compared with 7% after surgery. This is much lower than the 32% of women above the clinical cut-off described by Metcalfe et al in a study of women who underwent prophylactic mastectomy in Ontario and lower than found in male and female patients with cancer (30%) [22,26]. All women in our study had undergone genetic counseling that may have contributed the difference between our study and the study by Metcalfe et al Metcalfe et al found that women who did not have genetic testing tended to overestimate their risk of breast cancer and had higher levels of psychological distress [26,27].…”

Who is prone to high levels of distress after prophylactic mastectomy and/or salpingo-ovariectomy?

“…However, increased levels of general and cancer-related distress at both 6 and 12 months after prophylactic surgery were found to be predicted by their respective baseline levels. Consistent with previous findings [17,20] we observed a decline of general and cancer-related distress after surgery. Although we do not have any quantitative data on additional counselling in other echelons of health care, the observed alleviation of distress could be related to post-operative counselling.…”

Quality of life after risk-reducing surgery for breast and ovarian cancer prevention: a systematic review and meta-analysis

“…Patient pathways in many/most centers include mandatory appointments with a psychologist as part of the decision-making process. Nevertheless, RRM is cost-effective, has high satisfaction of ~97% and minimal decision regret, 65 which along-with our systematic review findings strongly supports RRM as an acceptable approach for BC prevention.…”

The impact of prophylactic salpingo‐oophorectomy on quality of life and psychological distress in women with a BRCA mutation

“…This is much lower than the 32% of women above the clinical cut‐off described by Metcalfe et al . in a study of women who underwent prophylactic mastectomy in Ontario and lower than found in male and female patients with cancer (30%) . All women in our study had undergone genetic counseling that may have contributed the difference between our study and the study by Metcalfe et al .…”

“…We found that 9% of women in our study were above clinical cut-offs (as defined by the BSI 18) consistent with the need for clinical counseling before surgery compared with 7% after surgery. This is much lower than the 32% of women above the clinical cut-off described by Metcalfe et al in a study of women who underwent prophylactic mastectomy in Ontario and lower than found in male and female patients with cancer (30%) [22,26]. All women in our study had undergone genetic counseling that may have contributed the difference between our study and the study by Metcalfe et al Metcalfe et al found that women who did not have genetic testing tended to overestimate their risk of breast cancer and had higher levels of psychological distress [26,27].…”

Who is prone to high levels of distress after prophylactic mastectomy and/or salpingo-ovariectomy?

“…However, increased levels of general and cancer-related distress at both 6 and 12 months after prophylactic surgery were found to be predicted by their respective baseline levels. Consistent with previous findings [17,20] we observed a decline of general and cancer-related distress after surgery. Although we do not have any quantitative data on additional counselling in other echelons of health care, the observed alleviation of distress could be related to post-operative counselling.…”

Quality of life after risk-reducing surgery for breast and ovarian cancer prevention: a systematic review and meta-analysis

“…Patient pathways in many/most centers include mandatory appointments with a psychologist as part of the decision-making process. Nevertheless, RRM is cost-effective, has high satisfaction of ~97% and minimal decision regret, 65 which along-with our systematic review findings strongly supports RRM as an acceptable approach for BC prevention.…”

The impact of prophylactic salpingo‐oophorectomy on quality of life and psychological distress in women with a BRCA mutation

“…This is much lower than the 32% of women above the clinical cut‐off described by Metcalfe et al . in a study of women who underwent prophylactic mastectomy in Ontario and lower than found in male and female patients with cancer (30%) . All women in our study had undergone genetic counseling that may have contributed the difference between our study and the study by Metcalfe et al .…”

“…We found that 9% of women in our study were above clinical cut-offs (as defined by the BSI 18) consistent with the need for clinical counseling before surgery compared with 7% after surgery. This is much lower than the 32% of women above the clinical cut-off described by Metcalfe et al in a study of women who underwent prophylactic mastectomy in Ontario and lower than found in male and female patients with cancer (30%) [22,26]. All women in our study had undergone genetic counseling that may have contributed the difference between our study and the study by Metcalfe et al Metcalfe et al found that women who did not have genetic testing tended to overestimate their risk of breast cancer and had higher levels of psychological distress [26,27].…”