A systematic review of women’s satisfaction and regret following risk-reducing mastectomy

Braude, Lucy; Kirsten, Laura; Gilchrist, Jemma; Juraskova, Ilona

doi:10.1016/j.pec.2017.06.032

Cited by 27 publications

(24 citation statements)

References 52 publications

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“…Si bien nosotros no analizamos los resultados estéticos, distintas publicaciones refieren que la MRR generalmente provoca una alteración negativa de la imagen corporal 33 ; no obstante, el grado de satisfacción general es muy alto, así como la disminución de la ansiedad por el riesgo de padecer cáncer de mama [34][35][36] , por lo que la mayoría de las pacientes, en concordancia con publicaciones internacionales, optaría nuevamente por la cirugía [37][38][39][40] .…”

Section: Discussionunclassified

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Mastectomía de reducción de riesgo. Experiencia del Centro Mamario del Hospital Universitario Austra

Lean¹,

Montoya²,

Varela³

et al. 2020

Rev Argent Cirug

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Antecedentes: dada la mayor disponibilidad de estudios genéticos, en los últimos años se incrementaron significativamente las mastectomías de reducción de riesgo (MRR). Objetivo: analizar la experiencia institucional en MRR. Material y métodos: se tuvieron en cuenta las pacientes sanas sometidas a MRR bilateral simultánea y también las pacientes con antecedentes de cáncer de mama que luego fueron sometidas a MRR contralateral. No fueron tenidas en cuenta las mastectomías realizadas como tratamiento actual de un cáncer, pero sí la mastectomía contralateral. Resultados: se realizaron 70 MRR en 49 pacientes que cumplían con los criterios de inclusión para el análisis. La edad promedio fue de 44 años (rango 34-64). En 60 casos se conservó el complejo areolapezón. En 50 casos, la reconstrucción mamaria fue con implante protésico directo. En 57 pacientes la incisión fue radiada en cuadrante superoexterno. En 57 casos no presentaron complicaciones y, de las restantessolo en 1 (1,4%) se perdió el implante. En un solo caso se detectó un carcinoma de mama oculto, y, en la evolución, una paciente desarrolló un carcinoma pequeño en la mama operada. Conclusión: la MRR es una alternativa válida y segura en mujeres con alto riesgo de cáncer de mama, pues logra disminuir en forma significativa la probabilidad de padecer la enfermedad, con buenos resultados estéticos y alto nivel de satisfacción.

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Section: Discussionunclassified

“…Although we did not analyze the cosmetic results, different publications reported that RRM can be burdensome for body image; however, the overall satisfaction is very high, with less anxiety about the risk for breast cancer 34,35,36 . Thus, according to international publications, most patients would choose surgery again 37,38,39,40 .…”

Section: Discussionmentioning

confidence: 99%

Mastectomía de reducción de riesgo. Experiencia del Centro Mamario del Hospital Universitario Austra

Lean¹,

Montoya²,

Varela³

et al. 2020

Rev Argent Cirug

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“… 34 Notwithstanding the physical morbidity of surgery, many patients who undergo CPM experience regret, dissatisfaction, and disappointment with the results of surgery. 32 , 35 …”

Section: Discussionmentioning

confidence: 99%

Streamlining Decision Making in Contralateral Risk-Reducing Mastectomy: Impact of PREDICT and BOADICEA Computations

et al. 2018

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IntroductionPatients with sporadic breast cancer (BC) have low contralateral breast cancer risk (CLBCR; approximately 0.7% per annum) and contralateral prophylactic mastectomy (CPM) offers no survival advantage. CPM with autologous reconstruction (AR) has major morbidity and resource implications.ObjectiveThe aim of this study was to review the impact of PREDICT survival estimates and lifetime CLBCR scores on decision making for CPM in patients with unilateral BC.MethodsOf n = 272 consecutive patients undergoing mastectomy and AR, 252 were included. Five- and 10-year survival was computed with the PREDICT(V2) online prognostication tool, using age and clinicopathological factors. Based on family history (FH) and tumor biology, CLBCR was calculated using validated BODICEA web-based software. Survival scores were correlated against CLBCR estimates to identify patients receiving CPM with ‘low’ CLBCR (< 30% lifetime risk) and poor prognosis (5-year survival < 80%). Patients with ‘high’ CLBCR receiving unilateral mastectomy (UM) were similarly identified (UK National Institute of Health and Care Excellence [NICE] criteria for CPM, ≥ 30% lifetime BC risk). Justifications motivating CPM were investigated.ResultsOf 252 patients, 215 had UM and 37 had bilateral mastectomy and AR. Only 23 (62%) patients receiving CPM fulfilled the NICE criteria. Of 215 patients, 5 (2.3%) failed to undergo CPM despite high CLBCR and good prognosis. CPMs were performed, at the patient’s request, for no clear justification (n = 8), contralateral non-invasive disease, and/or FH (n = 5), FH alone (n = 4) and ipsilateral cancer recurrence-related anxiety (n = 3).ConclusionIn the absence of prospective risk estimates of CLBCR and prognosis, certain patients receive CPM and reconstruction despite modest CLBCR, yet a proportion of patients with good prognoses and substantial risk are not undergoing CPM.

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“…There may also be an improvement in women with BRCA2 PVs with longer follow up [97]. Our previous studies indicated good acceptance and psychological health after RRM [37,38] More recent overviews have emphasised the enormous importance of excellent pre-surgical explanation, the presence of a psychologist in the multidisciplinary team and improved surgical techniques have been emphasised (Braude 2017) [98].…”

Section: Risk-reducing Surgerymentioning

confidence: 94%

Long-Term Evaluation of Women Referred to a Breast Cancer Family History Clinic (Manchester UK 1987–2020)

Howell

Gandhi

Howell

et al. 2020

Cancers

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Clinics for women concerned about their family history of breast cancer are widely established. A Family History Clinic was set-up in Manchester, UK, in 1987 in a Breast Unit serving a population of 1.8 million. In this review, we report the outcome of risk assessment, screening and prevention strategies in the clinic and propose future approaches. Between 1987–2020, 14,311 women were referred, of whom 6.4% were from known gene families, 38.2% were at high risk (≥30% lifetime risk), 37.7% at moderate risk (17–29%), and 17.7% at an average/population risk who were discharged. A total of 4168 (29.1%) women were eligible for genetic testing and 736 carried pathogenic variants, predominantly in BRCA1 and BRCA2 but also other genes (5.1% of direct referrals). All women at high or moderate risk were offered annual mammographic screening between ages 30 and 40 years old: 646 cancers were detected in women at high and moderate risk (5.5%) with a detection rate of 5 per 1000 screens. Incident breast cancers were largely of good prognosis and resulted in a predicted survival advantage. All high/moderate-risk women were offered lifestyle prevention advice and 14–27% entered various lifestyle studies. From 1992–2003, women were offered entry into IBIS-I (tamoxifen) and IBIS-II (anastrozole) trials (12.5% of invitees joined). The NICE guidelines ratified the use of tamoxifen and raloxifene (2013) and subsequently anastrozole (2017) for prevention; 10.8% women took up the offer of such treatment between 2013–2020. Since 1994, 7164 eligible women at ≥25% lifetime risk of breast cancer were offered a discussion of risk-reducing breast surgery and 451 (6.2%) had surgery. New approaches in all aspects of the service are needed to build on these results.

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A systematic review of women’s satisfaction and regret following risk-reducing mastectomy

Cited by 27 publications

References 52 publications

Mastectomía de reducción de riesgo. Experiencia del Centro Mamario del Hospital Universitario Austra

Mastectomía de reducción de riesgo. Experiencia del Centro Mamario del Hospital Universitario Austra

Streamlining Decision Making in Contralateral Risk-Reducing Mastectomy: Impact of PREDICT and BOADICEA Computations

Long-Term Evaluation of Women Referred to a Breast Cancer Family History Clinic (Manchester UK 1987–2020)

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