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

Abstract

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

The effect of hormone therapy on quality of life and breast cancer risk after risk-reducing salpingo-oophorectomy: a systematic review

“…Studies included both BRCA1 and 2 carriers, except for 2, which included only BRCA1 carriers [21, 31]. In addition to BRCA mutation carriers, 6 studies included women who had high risk of breast and ovarian cancer with no confirmed genetic diagnosis [29, 32–36]. Other variables, such as time since RRSO, body mass index (BMI), smoking status, history of breast cancer and hysterectomy were reported in some but not all studies.…”

“…ET >0.05Vasomotor symptomsChallberg [33]FACT-ES j 141-Hot flashes OR = 0.55(0.23-1.28) f >0.05NANight sweats OR = 0.28(0.11-0.76) f <0.05 Finch [38]Self-reported73-Hot flashes OR = 0.27(0.09-0.80) f 0.03 13.6 months (10.8–21.8)Madalinska [34]FACT-ES j 164-Hot flashes OR = 0.34(0.17-0.70) f <0.01 NANight sweats OR = 0.51(0.26-1.00) f 0.04 Sexual functionFinch k [38]SAQ d 61Pleasure = 1.220.5013.6 months (10.8–21.8)Discomfort = 1.92 0.03 Habit = 0.190.10Heiniger [29]SAQ d 38NS for all 3 dimensions->0.05Johansen [36]SAQ l 157Pleasure systemic HT (both ET and EPT) = 0.9->0.05102Pleasure local HT = -1.5->0.05116Pleasure systemic ET = 0.8>0.05111Pleasure systemic EPT = 0.5>0.05112Pleasure systemic tibolone = 1.5>0.05157Discomfort systemic HT (both ET and EPT) = -1.2 <0.01 102Discomfort local HT = -0.70.2116Discomfort systemic ET = -1.1 0.04 111Discomfort systemic EPT = -1.2 0.02 112Discomfort systemic tibolone = -1.39 <0.01 Madalinska [34]…”

“…Six studies assessed the effect of HT on menopause-specific QOL [29, 32–34, 37, 38]. Tools of QOL assessment varied and included Functional Assessment of Cancer Therapy-Endocrine Score (FACT-ES) [33, 34]; Menopause Symptoms List (MSL) [37], Menopause-Specific Quality of Life-Intervention tool (MENQOL-I), [32, 38] and Menopause Rating Scale (MRS) [29].…”

“…Tools of QOL assessment varied and included Functional Assessment of Cancer Therapy-Endocrine Score (FACT-ES) [33, 34]; Menopause Symptoms List (MSL) [37], Menopause-Specific Quality of Life-Intervention tool (MENQOL-I), [32, 38] and Menopause Rating Scale (MRS) [29]. Where reported, the mean age of women was 46 years or older in these studies [33, 34, 37, 38].…”

“…Where reported, the mean age of women was 46 years or older in these studies [33, 34, 37, 38]. Studies differed with respect to the menopausal status at the time of RRSO surgery: 4 included pre and postmenopausal women, [29, 32, 37, 38] 2 included only pre-menopausal women [33, 34]. In one study including both pre and postmenopausal women, QOL was analyzed in the pre-menopausal group only [38].…”