Satisfaction with Prophylactic Mastectomy and Breast Reconstruction in Genetically Predisposed Women

Bresser, P; Seynaeve, Caroline; Gool, Arthur R. Van; Brekelmans, C. T. M.; Meijers-Heijboer, Hanne; Geel, A.N. van; Menke-Pluijmers, Marian B. E.; Duivenvoorden, Hugo J.; Klijn, Jan G.M.; Tibben, Aad

doi:10.1097/01.prs.0000217383.99038.f5

Cited by 106 publications

(71 citation statements)

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“…However, while many women who have RRM plus breast reconstruction are pleased with the appearance of their new breasts [18][19][20], some experience ongoing complications following reconstructive surgery [21,22]; are unhappy with the cosmetic result, particularly the lack of sensation in their breasts [22][23][24]; and report a negative impact upon sexual functioning [15,22,25,26]. Similar findings have been reported in studies of RRSO, which indicate that some symptoms of surgically induced menopause, primarily hot flushes and loss of libido, are experienced negatively by women who undergo RRSO [27].…”

Section: Introductionmentioning

confidence: 99%

Looking different, feeling different: women’s reactions to risk-reducing breast and ovarian surgery

et al. 2011

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Objectives Most studies of quality of life following risk-reducing bilateral salpingo -oophorectomy (RRSO) and mastectomy (RRM) for inherited breast and ovarian cancer susceptibility were conducted before counseling protocols were established and included women at varying times since surgery. This study aimed to overcome these deficiencies and to provide current data on outcomes for this growing group of women.Methods Semi-structured interviews were used to explore the experiences of an Australian cohort of 40 high-risk women three years after they underwent RRM and/or RRSO. Data were analyzed using the method of constant comparison.Results Nineteen women underwent RRSO, 8 RRM and 13 both procedures. Two themes -looking different and feeling different -captured the psychosocial impact of surgery upon interviewees. All were relieved at having the risk of cancer substantially reduced that had previously been embodied in their breasts and ovaries; however, reducing risk by removing these body parts is not without costs. Interviewees reported experiencing a range of negative emotions and a range of unexpected bodily sensations following surgery and reflected upon both positive and negative changes in their appearance. Women said they had been unprepared for the lack of sensation in reconstructed breasts and/or the severity of menopausal symptoms, which often had a negative impact upon sexuality. ConclusionsAlthough women who undergo RR surgery are informed about its sequelae, however, few are entirely prepared for the reality of undergoing this procedure. We recommend that women who undergo these procedures should be provided with psychosocial support before and after RR surgery.

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Section: Introductionmentioning

confidence: 99%

Looking different, feeling different: women’s reactions to risk-reducing breast and ovarian surgery

et al. 2011

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“…[7][8][9] Overall, most women reported high levels of satisfaction, 8,9 favorable effects on emotional stability and stress, 8 and significantly lower levels of breast cancer concerns than women who had not undergone CPM. 9 Distress levels and quality of life were comparable with those of women who did not undergo CPM.…”

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confidence: 96%

“…9 Negative effects were reported for body appearance, sense of femininity, 8 and sexuality. 7 However, these were all retrospective studies focusing on a delayed CPM in patients not aware of their genetic status at the time of their breast cancer diagnosis 8,9 or describing a group of both affected and unaffected women. 7 Less is known about the psychosocial impact of RGCT and of immediate CPM at the time of the initial breast cancer diagnosis.…”

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confidence: 99%

“…7 However, these were all retrospective studies focusing on a delayed CPM in patients not aware of their genetic status at the time of their breast cancer diagnosis 8,9 or describing a group of both affected and unaffected women. 7 Less is known about the psychosocial impact of RGCT and of immediate CPM at the time of the initial breast cancer diagnosis. In a retrospective study of breast cancer patients who underwent RGCT, approximately one-quarter of women reported clinically relevant levels of breast cancer-specific distress at a mean follow-up of 29 months.…”

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confidence: 99%

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Does rapid genetic counseling and testing in newly diagnosed breast cancer patients cause additional psychosocial distress? results from a randomized clinical trial

Wevers

Ausems

Verhoef

et al. 2016

Genetics in Medicine

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Original research article IntroductIonFemale breast cancer patients who carry a BRCA1 or BRCA2 gene mutation have an increased risk of 20-55% for developing a second primary breast cancer 1 and are at increased risk for ovarian cancer. The risk of contralateral breast cancer is highest for carriers who were diagnosed with their first breast cancer at a young age. 1 Between 18 and 29% of carriers with a favorable prognosis opt for immediate or, more often, delayed contralateral prophylactic mastectomy (CPM) to reduce their risk of a second breast cancer. [2][3][4] Several studies have shown that a CPM leads to a large reduction (up to 95%) in the risk of contralateral breast cancer, with increasing evidence of improved breast cancer-specific survival. 5,6 Advances in the technology and logistics of genetic testing of the BRCA1 and BRCA2 genes have made it possible to offer high-risk breast cancer patients the opportunity to undergo rapid genetic counseling and testing (RGCT) during the time period between diagnosis and primary surgery. Women who Purpose: Female breast cancer patients carrying a BRCA1/2 mutation have an increased risk of second primary breast cancer. Rapid genetic counseling and testing (RGCT) before surgery may influence choice of primary surgical treatment. In this article, we report on the psychosocial impact of RGCT. Methods:Newly diagnosed breast cancer patients at risk for carrying a BRCA1/2 mutation were randomized to an intervention group (offer of RGCT) or a usual care control group (ratio 2:1). Psychosocial impact and quality of life were assessed with the Impact of Events Scale, Hospital Anxiety and Depression Scale, Cancer Worry Scale, and the EORTC QLQ-C30 and QLQ-BR23. Assessments took place at study entry and at 6-and 12-month follow-up visits.results: Between 2008 and 2010, 265 patients were recruited into the study. Completeness of follow-up data was more than 90%. Of the 178 women in the intervention group, 177 had genetic counseling, of whom 71 (40%) had rapid DNA testing and 59 (33%) received test results before surgery. Intention-to-treat and per-protocol analyses showed no statistically significant differences between groups over time in any of the psychosocial outcomes. conclusions:In this study, RGCT in newly diagnosed breast cancer patients did not have any measurable adverse psychosocial effects.

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“…An integrative review on 13 studies indicated that up to one-half of the women suffer a negative effect on body image and lead to changes in sexuality (McGaughey, 2006). Sexual problems after prophylactic mastectomy are common (Payne et al, 2000;Bresser et al, 2006;Brandberg et al, 2008). Some studies ( DudokdeWit et al, 1997;Bebbington et al, 2003) have suggested that women tended to be reluctant to confront possible sexual problems before the surgery, and rated prevention of cancer risk as the priority.…”

Section: Introductionmentioning

confidence: 99%

What Made Her Give Up Her Breasts: a Qualitative Study on Decisional Considerations for Contralateral Prophylactic Mastectomy among Breast Cancer Survivors Undergoing BRCA1/2 Genetic Testing

Kwong

Chu²

2012

Asian Pacific Journal of Cancer Prevention

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Objective: This qualitative study retrospectively examined the experience and psychological impact of contralateral prophylactic mastectomy (CPM) among Southern Chinese females with unilateral breast cancer history who underwent BRCA1/2 genetic testing. Limited knowledge is available on this topic especially among Asians; therefore, the aim of this study was to acquire insight from Chinese females' subjective perspectives. Methods: A total of 12 semi-structured in-depth interviews, with 11 female BRCA1/BRCA 2 mutated gene carriers and 1 non-carrier with a history of one-sided breast cancer and genetic testing performed by the Hong Kong Hereditary Breast Cancer Family Registry, who subsequently underwent CPM, were assessed using thematic analysis and a Stage Conceptual Model. Breast cancer history, procedures conducted, cosmetic satisfaction, pain, body image and sexuality issues, and cancer risk perception were discussed. Retrieval of medical records using a prospective database was also performed. Results: All participants opted for prophylaxis due to their reservations concerning the efficacy of surveillance and worries of recurrent breast cancer risk. Most participants were satisfied with the overall results and their decision. One-fourth expressed different extents of regrets. Psychological relief and decreased breast cancer risk were stated as major benefits. Spouses' reactions and support were crucial for post-surgery sexual satisfaction and long-term adjustment. Conclusions: Our findings indicate that thorough education on cancer risk and realistic expectations of surgery outcomes are crucial for positive adjustment after CPM. Appropriate genetic counseling and pre-and post-surgery psychological counseling were necessary. This study adds valuable contextual insights into the experiences of living with breast cancer fear and the importance of involving spouses when counseling these patients.Keywords: Breast and ovarian cancer -qualitative -prophylactic mastectomy -BRCA1 and BRCA2 -genetic testing

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Satisfaction with Prophylactic Mastectomy and Breast Reconstruction in Genetically Predisposed Women

Abstract: A majority of women would choose the procedure again, but adverse effects and untoward changes in the perception of the sexual relationship need to be addressed in the counselling of women at high risk, to optimize an informed choice and enable adequate adjustment postoperatively.

Cited by 106 publications

References 23 publications

Looking different, feeling different: women’s reactions to risk-reducing breast and ovarian surgery

Looking different, feeling different: women’s reactions to risk-reducing breast and ovarian surgery

Does rapid genetic counseling and testing in newly diagnosed breast cancer patients cause additional psychosocial distress? results from a randomized clinical trial

What Made Her Give Up Her Breasts: a Qualitative Study on Decisional Considerations for Contralateral Prophylactic Mastectomy among Breast Cancer Survivors Undergoing BRCA1/2 Genetic Testing

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