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Original Article |
1 Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena, California 91188, USA
2 Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA
3 Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care, Boston, Massachusetts 02215, USA
4 Division of Research, Kaiser Permanente Northern California, Oakland, California 94612, USA
5 HealthPartners Research Foundation, Minneapolis, Minnesota 55440, USA
6 Center for Health Studies, Group Health, Seattle, Washington 98103, USA
7 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA
8 Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon 97227, USA
9 Division of General Internal Medicine, University of Washington, Seattle, Washington 98104, USA
10 Center for Community-Based Research, Dana Farber Cancer Institute, Boston, Massachusetts 02115, USA
Correspondence: Address correspondence and reprint requests to: Ann M. Geiger, PhD; E-mail: ageiger{at}wfubmc.edu
Background: Bilateral prophylactic mastectomy in women with increased breast cancer risk dramatically reduces breast cancer occurrence but little is known about psychosocial outcomes.
Methods: To examine long-term quality of life after bilateral prophylactic mastectomy, we mailed surveys to 195 women who had the procedure from 1979 to 1999 and to a random sample of 117 women at increased breast cancer risk who did not have the procedure. Measures were modeled on or drawn directly from validated instruments designed to assess quality of life, body image, sexuality, breast cancer concerns, depression, health perception, and demographic characteristics. We used logistic regression to examine associations between quality of life and other domains.
Results: The response rate was 58%, with 106 women with and 62 women without prophylactic mastectomy returning complete surveys. Among women who underwent bilateral prophylactic mastectomy, 84% were satisfied with their decision to have the procedure; 61% reported high contentment with quality of life compared with an identical 61% of women who did not have the procedure (P = 1.0). Among all subjects, diminished contentment with quality of life was not associated with bilateral prophylactic mastectomy but with dissatisfaction with sex life (adjusted ratio [OR] = 2.5, 95% confidence interval [CI] = 1.0–6.2), possible depression (CES-D > 16, OR = 4.9, CI = 2.0–11.8), and poor or fair general health perception (OR = 8.3, 95% CI = 2.4–29.0).
Conclusions: The majority of women reported satisfaction with bilateral prophylactic mastectomy and experienced psychosocial outcomes similar to women with similarly elevated breast cancer risk who did not undergo prophylactic mastectomy. Bilateral prophylactic mastectomy appears to neither positively nor negatively impact long-term psychosocial outcomes.
Key Words: Breast cancer • Prophylaxis • Mastectomy • Quality of life • Satisfaction
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L. R. Schover A Lesser Evil: Prophylactic Mastectomy for Women at High Risk for Breast Cancer J. Clin. Oncol., August 20, 2008; 26(24): 3918 - 3919. [Full Text] [PDF]
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