Body image and psychological distress after prophylactic mastectomy and breast reconstruction in genetically predisposed women: A prospective long-term follow-up study

Heijer, Mariska den; Seynaeve, Caroline; Timman, Reinier; Duivenvoorden, Hugo J.; Vanheusden, Kathleen; Tilanus-Linthorst, Madeleine M.A.; Menke-Pluijmers, Marian B. E.; Tibben, Aad

doi:10.1016/j.ejca.2011.10.020

Cited by 74 publications

(64 citation statements)

References 20 publications

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“…Interestingly, den Heijer et al [38] reported that, following the initial deterioration in breastrelated body image, there was a significant improvement between T1 and T2. However we calculate that the overall deterioration in breast-related body image from T0 to T2 is, in fact, significant (t[35]=-2.57, p=.01).…”

Section: Discussionmentioning

confidence: 99%

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Long-term outcomes of risk-reducing surgery in unaffected women at increased familial risk of breast and/or ovarian cancer

et al. 2014

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Purpose: To prospectively investigate long-term psychosocial outcomes for women who opted for risk-reducing mastectomy (RRM) and/or risk-reducing salpingo-oophorectomy (RRSO).Methods: Unaffected women from high-risk breast cancer families who had completed baseline questionnaires for an existing study and subsequently underwent RRM and/or RRSO, completed measures of perceived breast and ovarian cancer risk, anxiety, depression, cancer-related anxiety, body image, sexual functioning, menopausal symptoms, use of hormone replacement therapy and decision regret three years post-surgery. Outcomes were compared to age-and risk-matched controls.Results: Participants (N=233) were 17 women who had RRM (39 controls), 38 women who had RRSO (94 controls) and 15 women who had RRM+RRSO (30 controls). Women who underwent RRM and those who underwent RRM+RRSO reported reductions in perceived breast cancer risk and perceived breast and ovarian cancer risk respectively, compared to their respective controls. RRM women reported greater reductions in cancer-related anxiety compared with both controls and RRSO women. RRSO women reported more sexual discomfort than controls and more urogenital menopausal symptoms than controls and RRM only women. No differences in general anxiety, depression or body image were observed. Regret was associated with greater reductions in body image since surgery and more sexual discomfort, although overall regret levels were low. Conclusions:Women who undergo RRM experience psychological benefits associated with reduced breast cancer risk. Although women who undergo RRSO experience some deterioration in sexual and menopausal symptoms, they do not regret their surgery decision. It is vital that women considering these procedures receive detailed information about potential psychosocial consequences.3

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Section: Discussionmentioning

confidence: 99%

“…In a study of long-term outcomes of RRM, den Heijer et al [38] investigated body image in 36 women prior to risk-reducing mastectomy (T0) then again at six months (T1) and six to nine years (T2) post-surgery. All participants underwent breast reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes of risk-reducing surgery in unaffected women at increased familial risk of breast and/or ovarian cancer

et al. 2014

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“…19 In addition studies by den Heijer et al, Nelson et al and Didier also reiterated the role of body image on acceptance, satisfaction and psychological adjustment following mastectomy. 8,9,23 Other reasons proffered were fear of surgery, husband opposition to such a procedure and lack of understanding of the benefits of the surgery. This finding was comparable to a study by Stefanek et al when he assessed the interest of women at average-risk and highrisk in preventive bilateral mastectomy.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Despite outstanding benefit of preventive bilateral mastectomy, the procedure has its attendant consequences as women who have had removal of both breasts experienced varying degree of psychological effects and consequences on their feminine personality. 8,9,22 Putting in place mechanisms to improve information on breast cancer including its risk factors especially in rural areas would in prospect improve the health seeking behaviour thereby influencing early presentation of patient with breast cancer.…”

Section: Discussionmentioning

confidence: 99%

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Willingness to accept preventive bilateral mastectomy among women in rural and urban communities in South-Western Nigeria

Aduayi

Onayade

Aduayi

et al. 2015

Int J Community Med Public Health

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Risk Assessment, Genetic Counseling, and Genetic Testing forBRCA-Related Cancer

Owens

Davidson

Krist

et al. 2019

JAMA

346

121

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US Preventive Services Task Force IMPORTANCE Potentially harmful mutations of the breast cancer susceptibility 1 and 2 genes (BRCA1/2) are associated with increased risk for breast, ovarian, fallopian tube, and peritoneal cancer. For women in the United States, breast cancer is the most common cancer after nonmelanoma skin cancer and the second leading cause of cancer death. In the general population, BRCA1/2 mutations occur in an estimated 1 in 300 to 500 women and account for 5% to 10% of breast cancer cases and 15% of ovarian cancer cases. OBJECTIVE To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on risk assessment, genetic counseling, and genetic testing for BRCA-related cancer. EVIDENCE REVIEW The USPSTF reviewed the evidence on risk assessment, genetic counseling, and genetic testing for potentially harmful BRCA1/2 mutations in asymptomatic women who have never been diagnosed with BRCA-related cancer, as well as those with a previous diagnosis of breast, ovarian, tubal, or peritoneal cancer who have completed treatment and are considered cancer free. In addition, the USPSTF reviewed interventions to reduce the risk for breast, ovarian, tubal, or peritoneal cancer in women with potentially harmful BRCA1/2 mutations, including intensive cancer screening, medications, and risk-reducing surgery. FINDINGS For women whose family or personal history is associated with an increased risk for harmful mutations in the BRCA1/2 genes, or who have an ancestry associated with BRCA1/2 gene mutations, there is adequate evidence that the benefits of risk assessment, genetic counseling, genetic testing, and interventions are moderate. For women whose personal or family history or ancestry is not associated with an increased risk for harmful mutations in the BRCA1/2 genes, there is adequate evidence that the benefits of risk assessment, genetic counseling, genetic testing, and interventions are small to none. Regardless of family or personal history, the USPSTF found adequate evidence that the overall harms of risk assessment, genetic counseling, genetic testing, and interventions are small to moderate. CONCLUSIONS AND RECOMMENDATION The USPSTF recommends that primary care clinicians assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with BRCA1/2 gene mutations with an appropriate brief familial risk assessment tool. Women with a positive result on the risk assessment tool should receive genetic counseling and, if indicated after counseling, genetic testing. (B recommendation) The USPSTF recommends against routine risk assessment, genetic counseling, or genetic testing for women whose personal or family history or ancestry is not associated with potentially harmful BRCA1/2 gene mutations. (D recommendation)

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Body image and psychological distress after prophylactic mastectomy and breast reconstruction in genetically predisposed women: A prospective long-term follow-up study

Cited by 74 publications

References 20 publications

Long-term outcomes of risk-reducing surgery in unaffected women at increased familial risk of breast and/or ovarian cancer

Long-term outcomes of risk-reducing surgery in unaffected women at increased familial risk of breast and/or ovarian cancer

Willingness to accept preventive bilateral mastectomy among women in rural and urban communities in South-Western Nigeria

Risk Assessment, Genetic Counseling, and Genetic Testing forBRCA-Related Cancer

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