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Cited by 160BRCA gene mutations in cancerWomen's cancer prevention and managementBreast Implant and Reconstruction

The psychosocial impact of bilateral prophylactic mastectomy: prospective study using questionnaires and semistructured

Open access
Hatcher, M. B.·2001·BMJ
DOI 10.1136/bmj.322.7278.76PMC PMC26594
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Abstract

OBJECTIVES: To investigate the psychosocial impact of bilateral prophylactic mastectomy for women with increased risk of breast cancer and to identify, preoperatively, risk factors for postoperative distress. DESIGN: Prospective study using interviews and questionnaire assessments. SETTING: Participants' homes throughout the United Kingdom. PARTICIPANTS: 143 women with increased risk of developing breast cancer who were offered bilateral prophylactic mastectomy and who accepted or declined the surgery; a further 11 were offered surgery but deferred making a decision. MAIN OUTCOME MEASURES: Psychological and sexual morbidity. RESULTS: Psychological morbidity decreased significantly over time for the 79 women who chose to have surgery (accepters): 58% (41/71) preoperatively v 41% (29/71) 6 months postoperatively (difference in percentages 17%, 95% confidence interval 2% to 32%; P=0.04) and 60% (39/65) preoperatively v 29% (19/65) 18 months postoperatively (31%, 15% to 47%; P<0.001). Psychological morbidity in the 64 women who declined surgery (decliners) did not decrease significantly: 57% (31/54) at baseline v 43% (23/54) at 6 months (14%, 0% to 29%; P=0.08) and 57% (29/52) at baseline v 41% (21/52) at 18 months (16%; -2% to 33%; P=0.11). Greater than normal proneness to anxiety was more common in the decliners than in the accepters: 78% (45/58) v 56% (41/73) (22%, 6% to 38%; P=0.006). Accepters were more likely than decliners to believe it inevitable that they would develop breast cancer (32% (24/74) v 10% (6/58) (difference in percentages 22%, 9% to 35%; P=0.003)), and decliners were more likely to believe that screening could help (92% (55/60) v 74% (55/74) (18%, 5% to 31%; P=0.007)). Level of sexual discomfort and degree of sexual pleasure did not change significantly over time in either of the two groups. CONCLUSIONS: Bilateral prophylactic mastectomy may provide psychological benefits in women with a high risk of developing breast cancer.

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  • The information provided at the family cancer clinic is complex, thus stressing the importance of repetitive but consistent information regarding cancer risk by the different clinicians involved.

    “These results are consistent with the findings of others [9,18,19], and indicate that the information provided at the family cancer clinic is complex, thus stressing the importance of repetitive but consistent information regarding the cancer risk by the different clinicians involved.”

    From Standard psychological consultations and follow up for women at increased risk of hereditary breast cancer considering prophylactic mastectomy (2009) · cites this paper as [9]

    The Discussion reports inaccurate perceptions of breast-cancer risk and calls for research on how best to ensure accurate risk perception. The 'What this study adds' section says genetic counsellors should ensure decisions are based on accurate perceptions. The paper does not say that clinic information is complex or recommend repeated, consistent risk information from different clinicians; those are the citing authors’ further conclusions. (LLM, conf=0.84)

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  • The majority of women following prophylactic mastectomy reported decreased hereditary cancer-related distress, while other psychosocial functioning does not appear to be significantly negatively affected.

    “Studies have shown that the majority of women following PM reported decreased (hereditary) cancer related distress while other psychosocial functioning does not appear to be significantly affected in a negative way [5,8-10].”

    From Standard psychological consultations and follow up for women at increased risk of hereditary breast cancer considering prophylactic mastectomy (2009) · cites this paper as [9]

    The Discussion reports that anxiety and psychological morbidity fell significantly after surgery, and ‘What this study adds’ says body image and sexual functioning were not adversely affected (page numbers unavailable). The paper does not establish that a majority of individual women reported decreased hereditary cancer-related distress specifically; it reports changes in group-level anxiety and psychological morbidity. (LLM, conf=0.84)

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Cites

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Research works printed but not linked: 4

  1. Macke E. A family history of breast and ovarian cancer. In: Marteau TM, Richards MPM, eds. The troubled helix: social and psychological implications of the new human genetics. Cambridge: Cambridge University Press, 1996:31-7.
  2. Lynch HT, Lynch J. Psychological aspects of monitoring high risk women for breast cancer. Cancer 1994;74:1184-92.
  3. Fallowfield L. Psychological implication of tamoxifen treatment in women at high risk to breast cancer. In: Maltoni C, Soffritti M, Davis W, eds. The scientific bases of cancer chemoprevention. Amsterdam: Elsevier Science, 1996:219-25.
  4. Hopwood P, Keeling F, Long A, Pool C, Evans G, Howell A. Psychological support needs for women at high genetic risk of breast cancer: some pre- liminary indicators. Psycho-oncology 1998;7:402-12.

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Authors
Hatcher, M. B.
Affiliations
The Royal Free Hospital (GB)
Corresponding author
Hatcher, M. B.
Venue
BMJ
Publisher
BMJ
Published
2001-01-13
Volume
322
Issue
7278
Pages
76-76
ISSN
0959-8138 (ISSN-L)
DOI
10.1136/bmj.322.7278.76
PMC
PMC26594
OpenAlex
W2013619739
Cited by
160
References
21
Citations by year
2026: 1 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 1 · 2021: 4 · 2020: 3 · 2019: 8 · 2018: 3 · 2017: 9 · 2016: 5 · 2015: 1 · 2014: 3 · 2013: 5 · 2012: 4
FWCI
6.93
Type
journal article
Language
en
Open access
Locations
  • BMJ (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Sussex Research Online (University of Sussex) (submittedVersion)
  • Figshare (submittedVersion)
  • HighWire Press Open Archive (submittedVersion)
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, psychosocial impact, psychological morbidity, anxiety proneness, breast cancer screening, helplessness
MeSH terms
Adaptation, Psychological, Adult, Anxiety, Body Image, Breast Neoplasms, Female, Humans, Mastectomy, Middle Aged, Patient Acceptance of Health Care, Prospective Studies, Surveys and Questionnaires, Risk Factors, Sexual Behavior

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