Satisfaction After Contralateral Prophylactic Mastectomy: The Significance of Mastectomy Type, Reconstructive Complications, and Body Appearance

2005 ◽  
Vol 23 (31) ◽  
pp. 7849-7856 ◽  
Author(s):  
Marlene H. Frost ◽  
Jeffrey M. Slezak ◽  
Nho V. Tran ◽  
Constance I. Williams ◽  
Joanne L. Johnson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Family History ◽  
Prophylactic Mastectomy ◽  
Contralateral Prophylactic Mastectomy ◽  
Social Function ◽  
Sexual Relationships ◽  
Body Appearance ◽  
Simple Mastectomy ◽  
History Of ◽  
Few Data

Purpose Contralateral prophylactic mastectomy (CPM) is one option for reducing the risk of a second breast cancer in women with a personal and family history of breast cancer. Few data are available regarding satisfaction, psychological, and social function after CPM. The purpose of this research is to evaluate women’s long-term satisfaction with CPM, factors influencing satisfaction, and psychological and social function after CPM. Patients and Methods This was a descriptive study of all women with a family history of breast cancer, known to be alive, who elected CPM at Mayo Clinic (Rochester, MN) between 1960 and 1993 (n = 621). Ninety-four percent of the women (n = 583) completed a study-specific questionnaire. Results A mean of 10.3 years after the procedure, the majority of women (83%) were satisfied with their CPM. A smaller number were neutral (8%) or dissatisfied (9%). Women who had a subcutaneous mastectomy had more problems with reconstruction, and fewer of these women were satisfied than women with simple mastectomy. Decreased satisfaction with CPM was associated with decreased satisfaction with appearance, complications with reconstruction, reconstruction after CPM, and increased level of stress in life. The majority of women experienced no change or favorable effects in self-esteem (83%), level of stress in life (83%), and emotional stability (88%). Satisfaction with body appearance, feelings of femininity, and sexual relationships were the most adversely affected with 33%, 26%, and 23% of the women responding negatively. Conclusion Although most women are satisfied with CPM, each woman should weigh the benefits alongside the potential adverse effects.

Predictors of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ (DCIS) who underwent evaluation for BRCA genetic testing.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1549-1549
Author(s):  
Nisreen Elsayegh ◽  
Angelica M. Gutierrez-Barrera ◽  
Kimberly I. Muse ◽  
Heather Lin ◽  
Diana L. Turco ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Genetic Counseling ◽  
Family History ◽  
Tumor Markers ◽  
Prophylactic Mastectomy ◽  
Contralateral Prophylactic Mastectomy ◽  
Educational Status ◽  
Nuclear Grade ◽  
Factors Associated ◽  
History Of

1549 Background: Patients with DCIS are at increased risk for developing contralateral breast cancer (CBC). Therefore, an increasing number of women with DCIS are electing for contralateral prophylactic mastectomy (CPM). In a previous study involving 2072 women with DCIS, 13.5% chose CPM. In this study, we aimed to evaluate factors associated with CPM in patients with DCIS who underwent genetic counseling for BRCA. Methods: 165 women with pure DCIS, who underwent genetic counseling, were included in the study. Patients’ characteristics were obtained from a prospectively maintained research database at UT M.D. Anderson Cancer Center. Univariate and multivaraite logistic regression analysis were used to determine predictive factors associated with CPM. Patients’ characteristics included age, marital and educational status, tumor markers, nuclear grade, family history with breast (BC) and ovarian cancer (OC), race, Ashkenazi Jewish ancestry, and BRCA genetic test results. Results: Out of 165 patients, 17(10.3%) were found to have a BRCA deleterious mutation. 44(26.7%) underwent CPM. Younger patients (median ≤ 45 yr) were more likely to elect for CPM than older patients (p= 0.0098). Patients who tested positive for a BRCA mutation were more likely to elect for CPM than those who tested negative or were not tested (p= 0.0001). Patients who had a family history of OC (15 (57.7%) were more likely to choose CPM than those who did not (p= 0.0004). These three factors remained significant in the multivariate model (p <0.008). Marital and educational status, tumor markers, nuclear grade, and family history of breast cancer were not significant predictors of CPM. Conclusions: The rate of CPM in patients with DCIS is high. Factors associated with increased likelihood of undergoing CPM include family history of OC, age, and BRCA positivity. Further studies are needed to evaluate patients perception of CBC risk, and if this may play a role in the high number of CPM.

Impact of reconstruction on satisfaction with contralateral prophylactic mastectomy.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 240-240
Author(s):  
J. C. Boughey ◽  
T. L. Hoskin ◽  
L. C. Hartmann ◽  
J. L. Johnson ◽  
S. R. Jacobson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prophylactic Mastectomy ◽  
Contralateral Prophylactic Mastectomy ◽  
Sexual Relationships ◽  
Breast Cancer Patients ◽  
Unilateral Breast Cancer ◽  
Psychosocial Consequences ◽  
History Of ◽  
Subsequent Effect ◽  
Tissue Flap

240 Background: Contralateral prophylactic mastectomy (CPM) is increasingly chosen by patients with breast cancer. Satisfaction after CPM is high. However, decreased satisfaction has been associated with reoperation after reconstruction. This study’s aim was to examine the adverse aspects patients attribute to reconstruction and the subsequent effect on psychosocial consequences and satisfaction with CPM. Methods: 487 unilateral breast cancer patients with a family history of breast cancer who underwent CPM between 1960 and 1993 were mailed a questionnaire evaluating QOL and satisfaction with CPM. Results: Of 269 respondents, 210 (78%) underwent reconstruction and 59 (22%) did not. Mean age at CPM was 46 and 50 years respectively (p=0.01). Mean follow-up was 20.2 years. Reconstruction was immediate in 96%, 98% with implants and 2% with tissue flap. Reconstruction was associated with lower satisfaction with CPM (p=0.03), but still only 7% (vs 2% in those without reconstruction) said they were dissatisfied. Most (83%) of those with reconstruction said they would choose reconstruction again while 7% were unsure and 10% said they would not. In those who did not undergo reconstruction, 18% said they would choose reconstruction if able to make the choice again while 5% were unsure and 77% said they still would not. 95 patients (45%) of those that underwent reconstruction required one or more reoperations for complications. Those with reoperation reported poorer responses for satisfaction with CPM (p=0.04), choice to have CPM again (p=0.008), and choice to have reconstruction again (p=0.004) when compared to patients with reconstruction and no reoperation. Those with and without reconstruction did not differ significantly with respect to femininity, sexual relationships or emotional stability, but those without reconstruction reported significantly poorer effects related to self esteem (p=0.04) and body appearance (p=0.002). Conclusions: In patients who undergo CPM, many years after surgery satisfaction with CPM is higher in those choosing not to have reconstruction than those with reconstruction although it was high in both groups. Reoperation is common after reconstruction and is associated with lower satisfaction.

scholarly journals Influencers of the Decision to Undergo Contralateral Prophylactic Mastectomy among Women with Unilateral Breast Cancer

Cancers ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 2050
Author(s):  
Akshara Singareeka Raghavendra ◽  
Hala F. Alameddine ◽  
Clark R. Andersen ◽  
Jesse C. Selber ◽  
Abenaa M. Brewster ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Family History ◽  
Prophylactic Mastectomy ◽  
Early Stage ◽  
Contralateral Prophylactic Mastectomy ◽  
Self Determination ◽  
High Rate ◽  
Unilateral Breast Cancer ◽  
History Of ◽  
The Media

(1) Background: The relatively high rate of contralateral prophylactic mastectomy (CPM) among women with early stage unilateral breast cancer (BC) has raised concerns. We sought to assess the influence of partners, physicians, and the media on the decision of women with unilateral BC to undergo CPM and identify clinicopathological variables associated with the decision to undergo CPM. (2) Patients and Methods: Women with stage 0 to III unilateral BC who underwent CPM between January 2010 and December 2017. Patients were surveyed regarding factors influencing their self-determined decision to undergo CPM. Partner, physician, and media influence factors were modeled by logistic regressions with adjustments for a family history of breast cancer and pathological stage. (3) Results: 397 (29.6%) patients completed the survey and were included in the study. Partners, physicians, and the media significantly influenced patients’ decision to undergo CPM. The logistic regression models showed that, compared to self-determination alone, overall influence on the CPM decision was significantly higher for physicians (p = 0.0006) and significantly lower for partners and the media (p < 0.0001 for both). Fifty-nine percent of patients’ decisions were influenced by physicians, 28% were influenced by partners, and only 17% were influenced by the media. The model also showed that patients with a family history of BC had significantly higher odds of being influenced by a partner than did those without a family history of BC (p = 0.015). (4) Conclusions: Compared to self-determination, physicians had a greater influence and partners and the media had a lower influence on the decision of women with unilateral BC to undergo CPM. Strong family history was significantly associated with a patient’s decision to undergo CPM.

Efficacy of Contralateral Prophylactic Mastectomy in Women With a Personal and Family History of Breast Cancer

2001 ◽  
Vol 19 (19) ◽  
pp. 3938-3943 ◽  
Author(s):  
Shannon K. McDonnell ◽  
Daniel J. Schaid ◽  
Jeffrey L. Myers ◽  
Clive S. Grant ◽  
John H. Donohue ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Family History ◽  
Risk Reduction ◽  
Contralateral Breast Cancer ◽  
Prophylactic Mastectomy ◽  
Contralateral Prophylactic Mastectomy ◽  
Contralateral Breast ◽  
Breast Cancers ◽  
History Of

PURPOSE: To estimate the efficacy of contralateral prophylactic mastectomy in women with a personal and family history of breast cancer. PATIENTS AND METHODS: We followed the course of 745 women with a first breast cancer and a family history of breast and/or ovarian cancer who underwent contralateral prophylactic mastectomy at the Mayo Clinic between 1960 and 1993. Family history information and cancer follow-up information were obtained from the medical record, a study-specific questionnaire, and telephone follow-up. Life-tables for contralateral breast cancers, which consider age at first breast cancer, current age, and type of family history, were used to calculate the number of breast cancers expected in our cohort had they not had a prophylactic mastectomy. RESULTS: Of the 745 women in our cohort, 388 were premenopausal (age < 50 years) and 357 were post- menopausal. Eight women developed a contralateral breast cancer. Six events were observed among the premenopausal women, compared with 106.2 predicted, resulting in a risk reduction of 94.4% (95% confidence interval [CI], 87.7% to 97.9%). For the 357 postmenopausal women, 50.3 contralateral breast cancers were predicted, whereas only two were observed, representing a 96.0% risk reduction (95% CI, 85.6% to 99.5%). CONCLUSION: The incidence of contralateral breast cancer seems to be reduced significantly after contralateral prophylactic mastectomy in women with a personal and family history of breast cancer.

Efficacy of Bilateral Prophylactic Mastectomy in Women with a Family History of Breast Cancer

1999 ◽  
Vol 54 (6) ◽  
pp. 381-383
Author(s):  
Lynn C. Hartmann ◽  
Daniel J. Schaid ◽  
John E. Woods ◽  
Thomas P. Crotty ◽  
Jeffrey L. Myers ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Family History ◽  
Prophylactic Mastectomy ◽  
Bilateral Prophylactic Mastectomy ◽  
History Of

Clinical factors that affect breast cancer risk reduction decisions in high risk women tested for the BRCA1/2 genetic mutation

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 1013-1013
Author(s):  
A. R. Uyei ◽  
K. R. Broglio ◽  
T. L. Solomon ◽  
K. J. Vogel ◽  
C. I. Amos ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ovarian Cancer ◽  
Family History ◽  
Risk Reduction ◽  
Breast Biopsy ◽  
Prophylactic Mastectomy ◽  
Prophylactic Surgery ◽  
Clinical Factors ◽  
Prophylactic Oophorectomy ◽  
History Of

1013 Background: Women with an increased risk for breast cancer have many risk reduction options including: prophylactic mastectomy, prophylactic oophorectomy, chemoprevention, and screening. Women without breast cancer make such decisions in a purely preventive setting and factors that affect their decisions are unclear. Method: We performed an IRB approved retrospective review of the medical records on women who underwent BRCA testing. We evaluated the women without a history of breast cancer to assess clinical characteristics and their relation to decision making. The risk reduction categories analyzed were: prophylactic mastectomy, prophylactic oophorectomy, tamoxifen, increased surveillance with MRI, and standard screening (clinical breast exam and mammography). Patient characteristics were tabulated by clinical decision group and the chi-square test or Fisher’s exact test was used. Results: From 2001, 627 patients have undergone genetic testing. 202 of these women did not have a history of breast cancer among whom 58 were mutation carriers. Most patients chose standard screening (47%) or increased surveillance (38%). 4% chose tamoxifen, 7% chose prophylactic mastectomy, 3% chose both prophylactic mastectomy and oophorectomy, and 5% chose oophorectomy. The tamoxifen group was too small to do further analysis. Increased surveillance did not show any significant association with any of the clinical factors that we evaluated. The majority of women who chose standard screening had a personal history of ovarian cancer (p<0.0001) and had no family history of ovarian cancer (p=0.02). Prophylactic surgeries were significantly associated with positive BRCA status (p=0.01). Women with a family history of ovarian cancer tended to have prophylactic surgery (p=0.02). Women who had DCIS or a breast biopsy tended to have prophylactic mastectomies (p=0.0001 and p<0.001 respectively). Conclusion: In breast cancer free women, BRCA status, family history of ovarian cancer, DCIS, and breast biopsy were associated with prophylactic surgeries. Having ovarian cancer or no family history of ovarian cancer were associated with standard screening. We are performing a questionnaire study to determine the reasons behind these women’s choices. No significant financial relationships to disclose.

Patient factors and satisfaction in the choice of contralateral prophylactic mastectomy.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1117-1117
Author(s):  
Amanda Kathleen Arrington ◽  
Karin London ◽  
Steven L. Chen ◽  
Courtney Vito ◽  
John H Yim ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Perceived Risk ◽  
Prophylactic Mastectomy ◽  
Contralateral Prophylactic Mastectomy ◽  
School Level ◽  
Thought Processes ◽  
High School Level ◽  
Cross Sectional ◽  
Level Of Satisfaction ◽  
History Of

1117 Background: The percentage of women undergoing contralateral prophylactic mastectomy (CPM) has more than doubled in recent years. The underlying reasons patients choose CPM have not been fully evaluated. Our objective was to survey patients who have undergone a unilateral mastectomy with or without CPM to identify reasons surrounding their decisions. Methods: After obtaining IRB approval, a 30-question cross-sectional validated survey was mailed to 691 patients who underwent mastectomy from 1972 to 2011 and are receiving treatment or surveillance at City of Hope. The questionnaire queried the factors behind the choice of surgery for each patient. Demographic questions were included and patient charts were also reviewed. Results: The overall response rate was 53% (N=368). Patients were classified into those who underwent mastectomy with CPM (N=139, 38%) and those who underwent mastectomy without CPM (no-CPM) (N=229, 62%). Of returned surveys, the median age was 50; 24% of patients reported a family history of breast cancer (42% CPM vs. 13% no-CPM, p<0.0001) and 80% of patients had education beyond the high school level (87% CPM vs. 77% no-CPM, p=0.013). PM patients reported being “very concerned” about breast cancer more often than no-CPM patients (46% vs. 34%, p=0.033).The primary reasons for CPM were: concern of recurrence (55%), cosmetic symmetry (27%), physician recommendation (17%), and unclear pre-operative imaging (9%). When questioned about regrets, the top response was decreased sensation (26%). Although 81% of CPM patients were “very satisfied” with their decision, 32% of no-CPM patients reported the same level of satisfaction with their decision (p<0.0001). For no-CPM patients, the primary reasons for the choice of no-CPM was physician advice and “monitoring is sufficient”; with 18% of the responders still considering a CPM. Conclusions: Patients’ perceived risk of contralateral breast cancer is the primary reason for CPM. CPM patients tend to be more satisfied with their decision compared to no-CPM patients. This may be related to the active decision-making thought processes and education necessary to choose CPM. Further patient education is warranted to minimize the risk of regret in making this decision.

Prophylactic mastectomy: The role of risk aversion.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 39-39
Author(s):  
Laura Kruper ◽  
Meghana Bhatt ◽  
Karin London ◽  
Katherine Henderson ◽  
Courtney Vito ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Family History ◽  
Marital Status ◽  
Prophylactic Mastectomy ◽  
Brca Mutation ◽  
Large Population ◽  
Factors Associated ◽  
Younger Age ◽  
History Of ◽  
Caucasian Patients

39 Background: The rate of women undergoing contralateral prophylactic mastectomy (CPM) has increased significantly over the past decade. Large population studies have examined factors associated with the use of CPM. We studied the factors associated with CPM within our institution. Methods: A 30-question validated survey was mailed to all patients who underwent mastectomy from 1972 to 2011 and are currently receiving treatment or surveillance at our institution. Responses were analyzed to determine the factors predictive of CPM. Multivariate logistic regression methods were used to calculate odds ratios (OR) and 95% confidence intervals (CI) for possible associations between exposures (including age at surgery, marital status, education, race, family history of breast cancer, and BRCA genetic mutation (BRCA mutation) and likelihood of CPM. Results: 368 of 691 surveys were returned. Younger age was statistically significantly associated with increased likelihood of CPM (p-trend < 0.001). Caucasian patients were 4 times as likely to undergo CPM compared to non-Caucasian patients (OR 3.95, 95%CI=1.89-8.23). Patients with a family history of breast cancer were 3 times as likely to undergo CPM as compared with those with no family history (OR 3.38, 95%CI=1.4-8.16). Married patients were also 3 times as likely to undergo CPM compared with unmarried patients (OR 3.00, 95%CI=1.39-6.52). Reporting a BRCA mutation was highly correlated with younger age, positive family history, higher level of education and marital status. Conclusions: When faced with the decision of whether to undergo a CPM, patients must assess both objective future risks and subjective feelings about those risks. These results suggest that the decision to undergo CPM is associated with known risk factors for the development of contralateral cancer such as younger age and positive breast cancer family history. In addition, multiple demographic factors including Caucasian race and married status increased the likelihood of choosing CPM. This may relate to social support as well socioeconomic status. Further exploration into societal factors that impact CPM use is warranted.

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