Predictors of and Satisfaction with Bilateral Prophylactic Mastectomy
Open accessAbstract
BACKGROUND: Women with a first-degree relative with breast cancer are at increased risk of developing this disease. The optimal medical management of these women is unclear, with options including close breast cancer screening, bilateral prophylactic mastectomy, or participation in chemoprevention trials. Among women who undergo prophylactic bilateral mastectomy, very little is known about satisfaction with this surgery. Also, we know very little about variables related to prophylactic mastectomy decision making. METHODS: Participants were women at increased risk of breast cancer due to family history. These women were categorized by self-report as not interested in prophylactic mastectomy (n = 58), interested but deciding against surgery (n = 92), or subsequently having a bilateral prophylactic mastectomy (n = 14). Information on screening practices, risk perception, level of depression, and cancer-related worry was collected. Women completing prophylactic mastectomy reported on their satisfaction with the surgery and breast reconstruction. RESULTS: Women selecting surgery reported more breast cancer worry. The group expressing no interest in surgery reported fewer biopsies and lower risk estimates. Women completing surgery were satisfied with their decision, although satisfaction with reconstruction was mixed. CONCLUSION: Factors influencing surgical decision making may include breast-cancer-related worry, biopsy history, and subjective breast cancer risk.
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Women who elected to undergo prophylactic mastectomy reported higher levels of anxiety associated with developing breast cancer than women who did not opt for surgery.
“Women who elected to undergo PM reported experiencing higher levels of anxiety associated with developing breast cancer than those women who did not opt for surgery [7].”
From Standard psychological consultations and follow up for women at increased risk of hereditary breast cancer considering prophylactic mastectomy (2009) · cites this paper as [7]
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“Being satisfied with result of PM/BR 113 68 (60) 13 (12) 32 (28) Would opt for PM again 112 106 (95) 5 (5) 1 (1) Would opt for BR again 112 89 (80) 12 (11) 11 (10) Feeling sufficiently informed 112 95 (85) 1 (1) 16 (14) Surgery did not meet expectations 112 35 (31) 8 (7) 69 (62) Complications‡ 113 48 (43) 2 (2) 63 (56…”
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“Interestingly, most women with BRCA mutations, as well as those without, did not feel that PM was too drastic, too scary, or too disfiguring as a method of treatment.(10) A study done by Casey et al,(12) the potentially underpowered, showed the feasibility and safety of performing combined intraabdominal procedures wi…”
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“satisfaction with PM and reconstruction in high-risk populations.(20) However, more recent studies have shown similar quality of life between women who choose to undergo PM compared with women who do not, and overall satisfaction with the decision to undergo PM.”
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“…proven BRCA mutation carriers did not express any regret if the prophylactic mastectomy followed adequate counselling nor did they report sexual function changes after surgery; conversely their fear of cancer was effectively relieved (Stefanek et al. 1995, Klijn et al. 1997, Borgen et al. 1998).”
Prophylactic bilateral mastectomy
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“Stefanek et al.20 reported that the most unsatisfied patients following prophylactic mastectomy were those who did not undergo formal risk assessment before surgery.”
BackgroundGershenwald, J., Hunt, K., Kroll, S., Ross, M., Baldwin, B., Feig, B., Ames, F., Schusterman, M., & Singletary, S. (1998) · Annals of Surgical Oncology · doi:10.1007/bf02303646 · Cited by 21 · see citing works
van Driel, C. M. G., Oosterwijk, J. C., Meijers-Heijboer, E. J., van Asperen, C. J., van Emmichoven, I. A. Z., de Vries, J., Mourits, M. J. E., Henneman, L., Timmermans, D. R. M., & de Bock, G. H. (2016) · The Breast · doi:10.1016/j.breast.2016.08.016 · Cited by 30 · see citing works
Predictors of Quality of Life in Women with a Bilateral Prophylactic Mastectomy
Metcalfe, K., Esplen, M., Goel, V., & Narod, S. (2005) · The Breast Journal · doi:10.1111/j.1075-122x.2005.21546.x · Cited by 36 · see citing works
Janssens, A. C. J. W., de Boer, J. B., van Doorn, P. A., van der Ploeg, H. M., van der Meché, F. G. A., Passchier, J., & Hintzen, R. Q. (2003) · European Journal of Neurology · doi:10.1046/j.1468-1331.2003.00583.x · Cited by 27 · see citing works
Fang, C. Y., Miller, S. M., Malick, J., Babb, J. S., Engstrom, P. F., & Daly, M. B. (2003) · Preventive Medicine · doi:10.1016/s0091-7435(03)00163-4 · Cited by 28 · see citing works
Tan, M. B., Bleiker, E. M., Menke-Pluymers, M. B., Van Gool, A. R., van Dooren, S., Van Geel, B. N., Tilanus-Linthorst, M. M., Bartels, K. C., Klijn, J. G., Brekelmans, C. T., et al. (2009) · Hereditary Cancer in Clinical Practice · doi:10.1186/1897-4287-7-6 · Cited by 27 · see citing works
“Women who elected to undergo PM reported experiencing higher levels of anxiety associated with developing breast cancer than those women who did not opt for surgery [7].”
BackgroundEisinger, F., Paillerets, B. B., Castaigne, D., Cottu, P. H., Lansac, J., Lefranc, J., Lesur, A., Noguès, C., Pierret, J., Puy‐Pernias, S., et al. (2006) · Pathologie Biologie · doi:10.1016/j.patbio.2006.02.002 · Cited by 149 · see citing works
Price, M. A., Butow, P. N., Lo, S. K., & Wilson, J. (2007) · Journal of Genetic Counseling · doi:10.1007/s10897-007-9105-4 · Cited by 24 · see citing works
“…that higher levels of cancer anxiety or worry, rather than objective risk, is associated with uptake of prophylactic surgery and adherence to screening programs (Andersen et al. 2003; Hurley et al. 2001; Meiser et al. 2000; Stefanek et al. 1995; Schwartz et al. 1999; Schwartz et al. 2005).”
BackgroundBrain, K. E., Gravell, C., France, E., et al. (2004) · Gynecologic Oncology · doi:10.1016/j.ygyno.2003.12.019 · Cited by 24 · see citing works
Advising on the management of genetic risk: Offering choice or prescribing action?
Hallowell, N. (1999) · Health Risk & Society · doi:10.1080/13698579908406316 · Cited by 24 · see citing works
Prophylactic Mastectomy or Screening in Women Suspected to Have the BRCA1/2 Mutation
Unic, I. J., Verhoef, L. C. G., Stalmeier, P. F. M., et al. (2000) · Medical Decision Making · doi:10.1177/0272989x0002000301 · Cited by 24 · see citing works
Reducing breast cancer incidence in familial breast cancer: overlooking the present panorama.
Marchetti, P., Rocco, C. D., Ricevuto, E., Bisegna, R., Cianci, G., Calista, F., Sidoni, T., Porzio, G., & Ficorella, C. (2004) · Annals of Oncology · doi:10.1093/annonc/mdh654 · Cited by 22 · see citing works
Clinical management of women with genomic BRCA1 and BRCA2 mutations*
Chang, J. C., & Elledge, R. (2001) · Breast Cancer Research and Treatment · doi:10.1023/a:1012203917104 · Cited by 25 · see citing works
“Women at risk of breast cancer generally report satisfaction with their decision to undergo prophylactic mastectomy [61], though there may be loss of nipple sensitivity and alteration of body image and self esteem.”
BackgroundPSYCHOLOGICAL OPPORTUNITIES AND HAZARDS IN PREDICTIVE GENETIC TESTING FOR CANCER RISK
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BREAST CANCER GENETICS: Implications for Clinical Practice
Olopade, O., & Fackenthal, J. (2000) · Hematology/Oncology Clinics of North America · doi:10.1016/s0889-8588(05)70304-x · Cited by 22 · see citing works
Oostendorp, L. J. M., Ottevanger, P. B., van der Graaf, W. T. A., & Stalmeier, P. F. M. (2011) · BMC Medical Informatics and Decision Making · doi:10.1186/1472-6947-11-9 · Cited by 21 · see citing works
“[19]: ‘Did you think of cancer last week?’, ‘Did these thoughts affect your mood?’, and ‘Did these thoughts affect your daily activities?’.”
de Leeuw, J. R. J., van Vliet, M. J., & Ausems, M. G. E. M. (2008) · Familial Cancer · doi:10.1007/s10689-008-9189-5 · Cited by 21 · see citing works
McQuirter, M., Castiglia, L. L., Loiselle, C. G., & Wong, N. (2010) · Oncology nursing forum · doi:10.1188/10.onf.313-320 · Cited by 20 · see citing works
- Authors
- Stefanek, M. E., Helzlsouer, K. J., Wilcox, P. M., & Houn, F.
- Affiliations
- United States Food and Drug Administration (US)
- ORCID
- Helzlsouer, K.J.
- Venue
- Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 1995-07
- Volume
- 24
- Issue
- 4
- Pages
- 412-419
- ISSN
- 0091-7435 (ISSN-L)
- OpenAlex
- W2044170626
- Cited by
- 177
- References
- 0
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 1 · 2019: 2 · 2018: 2 · 2017: 2 · 2016: 2 · 2015: 1 · 2014: 3 · 2013: 2 · 2012: 4
- FWCI
- 2.08
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Preventive Medicine (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › BRCA gene mutations in cancer
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Health Sciences › Medicine › Surgery › Breast Implant and Reconstruction
- Keywords
- bilateral prophylactic mastectomy, breast cancer risk, family history of breast cancer, patient satisfaction, surgical decision-making, breast cancer worry, risk perception, breast cancer screening, breast reconstruction, depression, chemoprevention
- MeSH terms
- Adult, Analysis of Variance, Biopsy, Breast Neoplasms, Decision Making, Disease Susceptibility, Family Health, Female, Humans, Life Change Events, Mastectomy, Middle Aged, Stress, Psychological, Chi-Square Distribution, Mammaplasty, Patient Satisfaction, Patient Selection
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