Bilateral Mastectomy in Women With Unilateral Breast Cancer

Lim, David W.; Metcalfe, Kelly; Narod, Steven A.

doi:10.1001/jamasurg.2020.6664

Cited by 33 publications

(32 citation statements)

References 84 publications

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“…Knowledge of the physical impact of mastectomies in the post-operative setting could provide enhanced information for patients regarding the burden of a more extensive surgery when making surgical choices for early-stage disease. These considerations are especially important when more extensive surgery is not clinically indicated, especially with the increased use of contralateral prophylactic mastectomy 31 , despite efforts to deimplement them 32 , 33 . These results may be particularly relevant to patients with DCIS where ongoing active surveillance in lieu of surgery may be an option for select women 34 .…”

Section: Discussionmentioning

confidence: 99%

Acute health-related quality of life outcomes and systemic inflammatory markers following contemporary breast cancer surgery

et al. 2022

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Contemporary breast cancer surgical procedures vary greatly by the amount of tissue removed, anesthesia time, and reconstruction. Despite historical literature comparing the health-related quality of life (HRQOL) after lumpectomy and mastectomy, HRQOL data are limited regarding contemporary surgical procedures. Further, biological processes (e.g., inflammation) associated with HRQOL outcomes have not been described. We conducted two studies to examine differences in post-operative physical and mental functioning, pain, fatigue, and systemic inflammatory markers including interleukin (IL)-6, tumor necrosis factor (TNF)-α, and C-reactive protein (CRP) in women with early-stage breast cancer. Study 1 assessed women before and after surgery (n = 27) and Study 2 used a large cross-sectional sample (n = 240) to confirm findings from Study 1 and included a no-surgery comparison group. In Study 1, women who received mastectomy had lower physical functioning than lumpectomy (ps < 0.05), and those who received bilateral mastectomy had worse pain (p < 0.01) and fatigue (p = 0.029) than lumpectomy. Results were replicated in Study 2: mastectomy groups exhibited poorer physical functioning (ps < 0.01) and greater pain (ps < 0.001) than lumpectomy, and bilateral mastectomy was associated with worse fatigue (p < 0.05). Women who received bilateral mastectomy had higher levels of CRP than lumpectomy (p < 0.01) and higher TNF-α than the no-surgery group (p < 0.05). All surgery groups exhibited higher IL-6 than no-surgery (ps < 0.05). More extensive surgery is associated with poorer postoperative HRQOL. As compared to lumpectomy and no-surgery, mastectomy is associated with higher concentrations of systemic inflammatory markers.

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Section: Discussionmentioning

confidence: 99%

Acute health-related quality of life outcomes and systemic inflammatory markers following contemporary breast cancer surgery

et al. 2022

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“…RRM has also been shown to reduce anxiety levels in women at risk for developing BC: McCarthy, Hamill [12] found that general anxiety was significantly reduced 1 year after BRRM including reconstruction and they remained decreased at 2 years follow-up. However, RRM is known to produce adverse consequences in the wellbeing of women [13], especially regarding breast related body image [14,15] as well as sensuality and sexuality [16,17]. Studies have reported on feelings of dissatisfaction with the results of RRM surgery [17], making a small percentage of women even regret their decision [18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Psychological factors and the uptake of preventative measures in BRCA1/2 pathogenic variant carriers: results of a prospective cohort study

Dick

Tüchler

Brédart

et al. 2022

Hered Cancer Clin Pract

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Background Women carrying BRCA1/2 pathogenic variants are exposed to elevated risks of developing breast cancer (BC) and are faced by a complex decision-making process on preventative measures, i.e., risk-reducing mastectomy (RRM), and intensified breast surveillance (IBS). In this prospective cohort study we investigated the effect of anxiety, personality factors and coping styles on the decision-making process on risk management options in women with pathogenic variants in BRCA1/2. Methods Breast cancer unaffected and affected women with a pathogenic variant in the BRCA1 or BRCA2 gene were psychologically evaluated immediately before (T0), 6 to 8 weeks (T1) and 6 to 8 months (T2) after the disclosure of their genetic test results. Uptake of RRM and IBS was assessed at T2. Psychological data were gathered using questionnaires on risk perception, personality factors, coping styles, decisional conflict, depression and anxiety, including the Hospital Anxiety and Depression Scale (HADS). We performed tests on statistical significance and fitted a logistic regression based on significance level. Results A total of 98 women were included in the analysis. Baseline anxiety levels in women opting for RRM were high but decreased over time, while they increased in women opting for intensified breast surveillance (IBS). Elevated levels of anxiety after genetic test result disclosure (T1) were associated with the decision to undergo RRM (p < 0.01; OR = 1.2, 95% CI = 1.05–1.42), while personal BC history and personality factors seemed to be less relevant. Conclusions Considering psychosocial factors influencing the decision-making process of women with pathogenic variants in BRCA1/2 may help improving their genetic and psychological counselling. When opting for IBS they may profit from additional medical and psychological counselling. Trial registration Retrospectively registered at the German Clinical Trials Register under DRKS00027566 on January 13, 2022.

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“…In countries where breast reconstruction is relatively accessible—such as the Unites States, Australia, Japan, and several European countries—the non-weighted average uptake after therapeutic mastectomy is 17% [ 64 ]. Increasing numbers of women continue to live with the consequences of these surgeries owing to the rising incidence of breast cancer [ 65 ], a rapid increase in women with unilateral breast cancer electing bilateral mastectomy [ 66 ], and prolonged survival after diagnosis [ 67 ]. Special efforts are being made to preserve and restore these patients’ normal physical, sexual, and social functioning as much as possible.…”

Section: Discussionmentioning

confidence: 99%

Patient-Reported Outcome Measures Used for Assessing Breast Sensation after Mastectomy: Not Fit for Purpose

Smeele

Dijkstra

Kimman

et al. 2022

Patient

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AIMS The aims of this review were (i) to evaluate whether patient-reported outcome measures used in clinical studies for assessing sensation after mastectomy and breast reconstruction are suitable for this purpose, and (ii) to explore whether any measures used for assessing sensation after non-oncologic breast surgery are worth modifying for use in post-mastectomy patients. Methods PRISMA guidelines were followed (PROSPERO number CRD42020178066). We searched six databases for studies of oncologic (i.e., therapeutic, prophylactic, and reconstructive) and non-oncologic breast surgery (e.g., breast reduction) in which sensation was assessed with a patient-reported outcome measure. From the selected studies, we extracted eligible measures, evaluated their fitness for purpose, and summarized the content of sensation-specific items. Results Of 6728 articles identified, we selected 135 studies that used 124 eligible patient-reported outcome measures. For 97% of these measures, details regarding development and measurement properties were unavailable. Four (3%) validated measures-the Sensory Disturbances subscale of the Breast Cancer Sequelae Cause Scales, the Discomfort subscale of the Breast Sensation Assessment Scale (BSAS), Didier et al.'s questionnaire for "Assessment of the patients' satisfaction with cosmetic results, physical and emotional impact of mastectomy", and the Breast Specific Pain subscale of the Breast Cancer Treatment Outcomes Scale (BCTOS)-each contain at least one item pertaining to breast sensation, but target different concepts of interest. In total, the measures feature 215 sensation-specific items, most of which concern symptom severity (97%) as opposed to impact on daily functioning (3%). Conclusion Patient-reported outcome measures used in clinical studies for assessing sensation after mastectomy and breast reconstruction are unsuitable for this purpose: they are either non-validated or non-specific. We failed to identify any measures for use in non-oncologic breast surgery populations worth modifying. To collect meaningful, patient-relevant data regarding sensation after mastectomy, it is pertinent that future clinical trials adopt psychometrically robust, specific patient-reported outcome measures. Hansje P. Smeele and Rachel C. H. Dijkstra have made an equal contribution to the work.

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Bilateral Mastectomy in Women With Unilateral Breast Cancer

Cited by 33 publications

References 84 publications

Acute health-related quality of life outcomes and systemic inflammatory markers following contemporary breast cancer surgery

Acute health-related quality of life outcomes and systemic inflammatory markers following contemporary breast cancer surgery

Psychological factors and the uptake of preventative measures in BRCA1/2 pathogenic variant carriers: results of a prospective cohort study

Patient-Reported Outcome Measures Used for Assessing Breast Sensation after Mastectomy: Not Fit for Purpose

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