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

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

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Hatcher, M. B.·2001·BMJ

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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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Braude, L., Kirsten, L., Gilchrist, J., & Juraskova, I. (2017) · Patient Education and Counseling · doi:10.1016/j.pec.2017.06.032 · Cited by 39
Reasons for risk-reducing mastectomy versus MRI-screening in a cohort of women at high hereditary risk of breast cancer.
Haroun, I., Graham, T., Poll, A., Sun, P., Hill, K., Weitzner, E., Narod, S., & Warner, E. (2011) · Breast · doi:10.1016/j.breast.2011.01.006 · Cited by 39
The psychological impact of breast and ovarian cancer preventive options in BRCA1 and BRCA2 mutation carriers
Borreani, C., Manoukian, S., Bianchi, E., Brunelli, C., Peissel, B., Caruso, A., Morasso, G., & Pierotti, M. A. (2014) · Clinical Genetics · doi:10.1111/cge.12298 · Cited by 38
Less correspondence between expectations before and cosmetic results after risk-reducing mastectomy in women who are mutation carriers: A prospective study
Brandberg, Y., Arver, B. W., Johansson, H., Wickman, M., Sandelin, K., & Liljegren, A. (2011) · European Journal of Surgical Oncology · doi:10.1016/j.ejso.2011.10.010 · Cited by 36
Preoperative psychological reactions and quality of life among women with an increased risk of breast cancer who are considering a prophylactic mastectomy
Brandberg, Y., Arver, B. W., Lindblom, A., Sandelin, K., Wickman, M., & Hall, P. N. (2003) · European Journal of Cancer · doi:10.1016/j.ejca.2003.08.026 · Cited by 36
“Recently, a study of 143 British women offered PM because of an increased risk of breast cancer indicated that psychosocial morbidity significantly declined in those 79 women that underwent surgery, in contrast to these 64 women who did not choose surgery [13].”
Result
Effects of cognitive behavioral counseling on body Image following mastectomy.
Fadaei, S., Janighorban, M., Mehrabi, T., Ahmadi, S. A., Mokarian, F., & Gukizade, A. (2011) · PubMed Central · Cited by 34
Reasons for undergoing cosmetic surgery: a retrospective study
Thorpe, S. J., Ahmed, B., & Steer, K. (2004) · Sexualities Evolution & Gender · doi:10.1080/14616660412331303857 · Cited by 34
Health Beliefs and Breast Cancer Screening in Rural Appalachia: An Evaluation of the Health Belief Model
VanDyke, S., & Shell, M. D. (2016) · The Journal of Rural Health · doi:10.1111/jrh.12204 · Cited by 33
“In addition to the physical benefits of early detection, breast cancer screening has been shown to have positive effects on psychological well-being by reducing worry and anxiety.(78,79) Therefore, reducing barriers to screening could increase both the physical and psychological health of rural women.”
Background
Can self-esteem, mastery and perceived stigma predict long-term adjustment in women carrying a BRCA1/2-mutation? Evidence from a multi-center study
Vodermaier, A., Esplen, M. J., & Maheu, C. (2010) · Familial Cancer · doi:10.1007/s10689-010-9325-x · Cited by 32
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
Technical Aspects and Outcome after Prophylactic Mastectomy and Immediate Breast Reconstruction in 30 Consecutive High-Risk Patients
Wickman, M., Sandelin, K., & Arver, B. W. (2003) · Plastic & Reconstructive Surgery · doi:10.1097/01.prs.0000046250.95557.c6 · Cited by 28
Standard psychological consultations and follow up for women at increased risk of hereditary breast cancer considering prophylactic mastectomy
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
“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].”
BackgroundResult
Contralateral Prophylactic Mastectomy: Caveat Emptor
Recht, A. (2009) · Journal of Clinical Oncology · doi:10.1200/jco.2008.21.0518 · Cited by 25
Intensive radiologic surveillance: a focus on the psychological issues.
Warner, E. (2004) · Annals of Oncology · doi:10.1093/annonc/mdh657 · Cited by 27
“The situation is further complicated by the fact that, as previously mentioned [16, 17], mutation carriers who i45”
Background
Heightened perception of breast cancer risk in young women at risk of familial breast cancer
kConFab Investigators, Glassey, R., O’Connor, M., Ives, A. D., Saunders, C. M., O’Sullivan, S., & Hardcastle, S. J. (2017) · Familial Cancer · doi:10.1007/s10689-017-0001-2 · Cited by 23
Prophylactic Mastectomy for Women withBRCA1andBRCA2Mutations — Facts and Controversy
Eisen, A. F., & Weber, B. L. (2001) · New England Journal of Medicine · doi:10.1056/nejm200107193450309 · Cited by 22
Cost–utility analysis of risk-reducing strategies to prevent breast and ovarian cancer in BRCA-mutation carriers in Switzerland
Bommer, C., Lupatsch, J. E., Bürki, N., & Schwenkglenks, M. M. (2021) · The European Journal of Health Economics · doi:10.1007/s10198-021-01396-9 · Cited by 21
Inherited Medullary Thyroid Cancer and the Duty to Warn: Revisiting Pate v. Threlkel in Light of HIPAA
Rosenthal, M. S., & Pierce, H. (2005) · Thyroid · doi:10.1089/thy.2005.15.140 · Cited by 21
“In addition, mastectomies may be disfiguring, psy-chosocially traumatic, and difficult to accept as a prevention strategy (23,24).”
Factors Impacting on Decision-Making towards Prophylactic Surgeries in BRCA Mutation Carriers and Women with Familial Predisposition
Segerer, R. K., Peschel, C., Kämmerer, U., Häussler, S., Wöckel, A., & Segerer, S. E. (2019) · Breast Care · doi:10.1159/000503370 · Cited by 19
Influences on decision-making for young women undergoing bilateral prophylactic mastectomy
Glassey, R., O’Connor, M., Ives, A. D., Saunders, C. M., & Hardcastle, S. J. (2017) · Patient Education and Counseling · doi:10.1016/j.pec.2017.08.008 · Cited by 19
Who is prone to high levels of distress after prophylactic mastectomy and/or salpingo-ovariectomy?
Bresser, P. J. C., Van Gool, A. R., Seynaeve, C., Duivenvoorden, H. J., Niermeijer, M. F., van Geel, A. N., Menke, M., Klijn, J. G. M., & Tibben, A. (2007) · Annals of Oncology · doi:10.1093/annonc/mdm274 · Cited by 18
Building the Cancer Family: Family Planning in the Context of Inherited Breast and Ovarian Cancer Risk
Werner-Lin, A. (2010) · Journal of the Society for Social Work and Research · doi:10.5243/jsswr.2010.3 · Cited by 21
Assessing the additional surgical risk of contralateral prophylactic mastectomy and immediate breast implant reconstruction
Nealon, K. P., Sobti, N., Gadd, M. A., Specht, M. C., & Liao, E. C.-W. (2019) · Breast Cancer Research and Treatment · doi:10.1007/s10549-019-05460-0 · Cited by 18
Prophylactic Bilateral Mastectomy for Breast Cancer Prevention
Metcalfe, K. (2004) · Journal of Women's Health · doi:10.1089/jwh.2004.13.822 · Cited by 22
Genetic counselling and prophylactic surgery in women from families with hereditary breast or ovarian cancer
Lobb, E., & Meiser, B. (2004) · The Lancet · doi:10.1016/s0140-6736(04)16393-9 · Cited by 23
Long-Term Evaluation of Women Referred to a Breast Cancer Family History Clinic (Manchester UK 1987–2020)
Howell, A., Gandhi, A., Howell, S. J., Wilson, M., Maxwell, A., Astley, S., Harvie, M., Pegington, M., Barr, L. C., Baildam, A. D., et al. (2020) · Cancers · doi:10.3390/cancers12123697 · Cited by 15
“Of the 451 women who underwent RRM, four developed post-surgery BCs (all in BRCA1/2 PV carriers) compared to 94 expected over a period of follow up of 7894 years, giving a risk reduction of 95.8%.”
BackgroundMethodResultInfluential
Uptake and timing of bilateral and contralateral risk-reducing mastectomy in women with Li–Fraumeni syndrome
Siegel, A., Bremer, R. C., Klein, W. M. P., Savage, S. A., Loud, J. T., & Khincha, P. P. (2021) · Breast Cancer Research and Treatment · doi:10.1007/s10549-021-06410-5 · Cited by 16
The impact of prophylactic mastectomy on sexual well-being: a systematic review
Scotto, L., Pizzoli, S. F. M., Marzorati, C., Mazzocco, K., & Pravettoni, G. (2023) · Sexual Medicine Reviews · doi:10.1093/sxmrev/qead054 · Cited by 16
Have We Lost Sight of the Mirrors?
Freysteinson, W. M., & Cesario, S. K. (2008) · Holistic Nursing Practice · doi:10.1097/01.hnp.0000339343.80758.46 · Cited by 15
Current status of prophylactic mastectomy.
Ghosh, K., & Hartmann, L. C. (2002) · PubMed · Cited by 15
Validated Questionnaires in Female Sexual Function Assessment
Lorenz, T. K., Stephenson, K. R., & Meston, C. M. (2011) · Humana Press eBooks · doi:10.1007/978-1-60761-916-1_21 · Cited by 16
“While some studies have suggested that the SAQ is sensitive to changes in sexual pleasure following prophylactic mastectomies [15], others have suggested no difference in SAQ scores between women who did and did not accept surgery [16].”
Result
Psychosocial factors and uptake of risk-reducing salpingo-oophorectomy in women at high risk for ovarian cancer
Meiser, B., Price, M. A., Butow, P. N., Karatas, J., Wilson, J., Heiniger, L. E., Baylock, B., Charles, M. A., McLachlan, S., & Phillips, K. (2012) · Familial Cancer · doi:10.1007/s10689-012-9585-8 · Cited by 14
When is contralateral mastectomy warranted in unilateral breast cancer?
Barry, M., & Sacchini, V. (2011) · Expert Review of Anticancer Therapy · doi:10.1586/era.11.100 · Cited by 14
Estimating the survival benefits gained from providing national cancer genetic services to women with a family history of breast cancer
Griffith, G., Edwards, R., Gray, J., Wilkinson, C., Turner, J., France, B., & Bennett, P. (2004) · British Journal of Cancer · doi:10.1038/sj.bjc.6601794 · Cited by 16
“…Test Wales (personal communication, 2002). cEstimated by this research team. dUp to 35 – 51% of women at increased risk of developing breast cancer (Hatcher et al, 2001; Meijers-Heijboer et al, 2003) have been found to have prophylactic mastectomy and 27 – 49% (Meijers-Heijboer et al, 2003;…”
Background
Perceived influence of psychological consultation on psychological well‐being, body image, and intimacy following bilateral prophylactic mastectomy: A qualitative analysis
Glassey, R., Hardcastle, S. J., O'Connor, M., Ives, A., kConFab Investigators, & Saunders, C. (2018) · Psycho-Oncology · doi:10.1002/pon.4558 · Cited by 13
What contributes to long-term quality of life in breast cancer patients who are undergoing surgery? Results of a multidimensional study
Wittmann, V., Látos, M., Horváth, Z., Simonka, Z., Paszt, A., Lázár, G., & Csabai, M. (2017) · Quality of Life Research · doi:10.1007/s11136-017-1563-z · Cited by 13
The Prevention of Hereditary Breast Cancer
Rodriquez, E., & Domchek, S. M. (2007) · Seminars in Oncology · doi:10.1053/j.seminoncol.2007.07.006 · Cited by 13
Shortened time interval between colorectal cancer diagnosis and risk testing for hereditary colorectal cancer is not related to higher psychological distress
Landsbergen, K. M., Prins, J. B., Brunner, H. G., & Hoogerbrugge, N. (2010) · Familial Cancer · doi:10.1007/s10689-010-9387-9 · Cited by 11
“difficulties, a score above 26 indicates serious adaptation difficulties [18].”
Background
‘That's like chopping off a finger because you’re afraid it might get broken’: Disease and illness in women's views of prophylactic mastectomy
Press, N. A., Reynolds, S., Pinsky, L. E., Murthy, V. S., Leo, M. C., & Burke, W. (2005) · Social Science & Medicine · doi:10.1016/j.socscimed.2005.01.012 · Cited by 11
Comparing Patient Satisfaction in Bilateral and Unilateral Breast Reconstruction
Sinno, S., Salvino, M. J., & Vandevender, D. K. (2014) · Plastic and Aesthetic Nursing · doi:10.1097/psn.0000000000000048 · Cited by 11
Adaptation of couples living with a high risk of breast/ovarian cancer and the association with risk-reducing surgery
Shapira, R., Turbitt, E., Erby, L. H., Biesecker, B. B., Klein, W. M. P., & Hooker, G. W. (2017) · Familial Cancer · doi:10.1007/s10689-017-0065-z · Cited by 10

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: bronze
doi.org
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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The psychosocial impact of bilateral prophylactic mastectomy: prospective study using questionnaires and semistructured

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