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Erschienen in: Annals of Surgical Oncology 6/2017

05.01.2017 | Breast Oncology

Long-Term Satisfaction and Body Image After Contralateral Prophylactic Mastectomy

verfasst von: Chelsea Anderson, MPH, Jessica Y. Islam, MPH, M. Elizabeth Hodgson, PhD, Susan A. Sabatino, PhD, Juan L. Rodriguez, MPH, MS, Clara N. Lee, MD, MPP, Dale P. Sandler, PhD, Hazel B. Nichols, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 6/2017

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Abstract

Background

Contralateral prophylactic mastectomy (CPM) rates have been increasing in the US, and although high levels of satisfaction with CPM have been reported, few studies have evaluated the long-term effects on body image, comparing CPM with breast-conserving surgery (BCS) and unilateral mastectomy (UM).

Methods

We analyzed responses from a survey of women with both a personal and family history of breast cancer who were enrolled in the Sister Study (n = 1176). Among women who underwent mastectomy, we examined satisfaction with the mastectomy decision, as well as variation in the use of reconstruction and experience of complications. Five survey items, evaluated individually and as a summed total score, were used to compare body image across surgery types (BCS, UM without reconstruction, CPM without reconstruction, UM with reconstruction, and CPM with reconstruction).

Results

Participants were, on average, 3.6 years post-diagnosis at the time of survey (standard deviation 1.7). The majority of women (97% of CPM, 89% of UM) were satisfied with their mastectomy decision. Reconstruction was more common after CPM than after UM (70 vs. 47%), as were complications (28 vs. 19%). Body image scores were significantly worse among women who underwent CPM than among women who underwent BCS, with the lowest scores among women who underwent CPM without reconstruction.

Conclusions

In our sample, most women were highly satisfied with their mastectomy decision, including those who elected to undergo CPM. However, body image was lower among those who underwent CPM than among those who underwent BCS. Our findings may inform decisions among women considering various courses of surgical treatment.
Literatur
1.
Zurück zum Zitat Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233–41.CrossRefPubMed Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233–41.CrossRefPubMed
2.
Zurück zum Zitat Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227–32.CrossRef Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227–32.CrossRef
3.
Zurück zum Zitat Gomez SL, Lichtensztajn D, Kurian AW, Telli ML, Chang ET, Keegan TH, et al. Increasing mastectomy rates for early-stage breast cancer? Population-based trends from California. J Clin Oncol. 2010;28(10):e155–7; author reply e158. Gomez SL, Lichtensztajn D, Kurian AW, Telli ML, Chang ET, Keegan TH, et al. Increasing mastectomy rates for early-stage breast cancer? Population-based trends from California. J Clin Oncol. 2010;28(10):e155–7; author reply e158.
4.
Zurück zum Zitat Mahmood U, Hanlon AL, Koshy M, Buras R, Chumsri S, Tkaczuk KH, et al. Increasing national mastectomy rates for the treatment of early stage breast cancer. Ann Surg Oncol. 2013;20(5):1436–43.CrossRefPubMed Mahmood U, Hanlon AL, Koshy M, Buras R, Chumsri S, Tkaczuk KH, et al. Increasing national mastectomy rates for the treatment of early stage breast cancer. Ann Surg Oncol. 2013;20(5):1436–43.CrossRefPubMed
5.
Zurück zum Zitat Katipamula R, Degnim AC, Hoskin T, Boughey JC, Loprinzi C, Grant CS, et al. Trends in mastectomy rates at the Mayo Clinic Rochester: effect of surgical year and preoperative magnetic resonance imaging. J Clin Oncol. 2009;27(25):4082–8.CrossRefPubMedPubMedCentral Katipamula R, Degnim AC, Hoskin T, Boughey JC, Loprinzi C, Grant CS, et al. Trends in mastectomy rates at the Mayo Clinic Rochester: effect of surgical year and preoperative magnetic resonance imaging. J Clin Oncol. 2009;27(25):4082–8.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Tuttle TM, Habermann EB, Grund EH, Morris TJ, Virnig BA. Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol. 2007;25(33):5203–9.CrossRefPubMed Tuttle TM, Habermann EB, Grund EH, Morris TJ, Virnig BA. Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol. 2007;25(33):5203–9.CrossRefPubMed
7.
Zurück zum Zitat Morrow M, Jagsi R, Alderman AK, Griggs JJ, Hawley ST, Hamilton AS, et al. Surgeon recommendations and receipt of mastectomy for treatment of breast cancer. JAMA. 2009;302(14):1551–6.CrossRefPubMedPubMedCentral Morrow M, Jagsi R, Alderman AK, Griggs JJ, Hawley ST, Hamilton AS, et al. Surgeon recommendations and receipt of mastectomy for treatment of breast cancer. JAMA. 2009;302(14):1551–6.CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Herrinton LJ, Barlow WE, Yu O, Geiger AM, Elmore JG, Barton MB, et al. Efficacy of prophylactic mastectomy in women with unilateral breast cancer: a cancer research network project. J Clin Oncol. 2005;23(19):4275–86.CrossRefPubMed Herrinton LJ, Barlow WE, Yu O, Geiger AM, Elmore JG, Barton MB, et al. Efficacy of prophylactic mastectomy in women with unilateral breast cancer: a cancer research network project. J Clin Oncol. 2005;23(19):4275–86.CrossRefPubMed
9.
Zurück zum Zitat Kurian AW, Lichtensztajn DY, Keegan TH, Nelson DO, Clarke CA, Gomez SL. Use of and mortality after bilateral mastectomy compared with other surgical treatments for breast cancer in California, 1998-2011. JAMA. 2014;312(9):902–14.CrossRefPubMed Kurian AW, Lichtensztajn DY, Keegan TH, Nelson DO, Clarke CA, Gomez SL. Use of and mortality after bilateral mastectomy compared with other surgical treatments for breast cancer in California, 1998-2011. JAMA. 2014;312(9):902–14.CrossRefPubMed
10.
Zurück zum Zitat Soran A, Ibrahim A, Kanbour M, McGuire K, Balci FL, Polat AK, et al. Decision making and factors influencing long-term satisfaction with prophylactic mastectomy in women with breast cancer. Am J Clin Oncol. 2015;38(2):179–83.CrossRefPubMed Soran A, Ibrahim A, Kanbour M, McGuire K, Balci FL, Polat AK, et al. Decision making and factors influencing long-term satisfaction with prophylactic mastectomy in women with breast cancer. Am J Clin Oncol. 2015;38(2):179–83.CrossRefPubMed
11.
Zurück zum Zitat Frost MH, Slezak JM, Tran NV, Williams CI, Johnson JL, Woods JE, et al. Satisfaction after contralateral prophylactic mastectomy: the significance of mastectomy type, reconstructive complications, and body appearance. J Clin Oncol. 2005;23(31):7849–56.CrossRefPubMed Frost MH, Slezak JM, Tran NV, Williams CI, Johnson JL, Woods JE, et al. Satisfaction after contralateral prophylactic mastectomy: the significance of mastectomy type, reconstructive complications, and body appearance. J Clin Oncol. 2005;23(31):7849–56.CrossRefPubMed
12.
Zurück zum Zitat Geiger AM, West CN, Nekhlyudov L, Herrinton LJ, Liu IL, Altschuler A, et al. Contentment with quality of life among breast cancer survivors with and without contralateral prophylactic mastectomy. J Clin Oncol. 2006;24(9):1350–6.CrossRefPubMed Geiger AM, West CN, Nekhlyudov L, Herrinton LJ, Liu IL, Altschuler A, et al. Contentment with quality of life among breast cancer survivors with and without contralateral prophylactic mastectomy. J Clin Oncol. 2006;24(9):1350–6.CrossRefPubMed
13.
Zurück zum Zitat Unukovych D, Sandelin K, Liljegren A, Arver B, Wickman M, Johansson H, et al. Contralateral prophylactic mastectomy in breast cancer patients with a family history: a prospective 2-years follow-up study of health related quality of life, sexuality and body image. Eur J Cancer. 2012;48(17):3150–6.CrossRefPubMed Unukovych D, Sandelin K, Liljegren A, Arver B, Wickman M, Johansson H, et al. Contralateral prophylactic mastectomy in breast cancer patients with a family history: a prospective 2-years follow-up study of health related quality of life, sexuality and body image. Eur J Cancer. 2012;48(17):3150–6.CrossRefPubMed
14.
Zurück zum Zitat Buchanan ND, Dasari S, Rodriguez JL, Smith JL, Hodgson ME, Weinberg CR, et al. Post-treatment neurocognition and psychosocial care among breast cancer survivors. Am J Prev Med. 2015;49(6 Suppl 5):S498–508.CrossRefPubMedPubMedCentral Buchanan ND, Dasari S, Rodriguez JL, Smith JL, Hodgson ME, Weinberg CR, et al. Post-treatment neurocognition and psychosocial care among breast cancer survivors. Am J Prev Med. 2015;49(6 Suppl 5):S498–508.CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Hopwood P, Fletcher I, Lee A, Al Ghazal S. A body image scale for use with cancer patients. Eur J Cancer. 2001;37(2):189–97.CrossRefPubMed Hopwood P, Fletcher I, Lee A, Al Ghazal S. A body image scale for use with cancer patients. Eur J Cancer. 2001;37(2):189–97.CrossRefPubMed
16.
Zurück zum Zitat Steiner CA, Weiss AJ, Barrett ML, Fingar KR, Davis PH. Trends in bilateral and unilateral mastectomies in hospital inpatient and ambulatory settings, 2005-2013. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality; 2016. Steiner CA, Weiss AJ, Barrett ML, Fingar KR, Davis PH. Trends in bilateral and unilateral mastectomies in hospital inpatient and ambulatory settings, 2005-2013. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality; 2016.
17.
Zurück zum Zitat Freedman RA, Kouri EM, West DW, Rosenberg S, Partridge AH, Lii J, et al. Higher stage of disease is associated with bilateral mastectomy among patients with breast cancer: a population-based survey. Clin Breast Cancer. 2016;16(2):105–12.CrossRefPubMed Freedman RA, Kouri EM, West DW, Rosenberg S, Partridge AH, Lii J, et al. Higher stage of disease is associated with bilateral mastectomy among patients with breast cancer: a population-based survey. Clin Breast Cancer. 2016;16(2):105–12.CrossRefPubMed
18.
Zurück zum Zitat Arrington AK, Jarosek SL, Virnig BA, Habermann EB, Tuttle TM. Patient and surgeon characteristics associated with increased use of contralateral prophylactic mastectomy in patients with breast cancer. Ann Surg Oncol. 2009;16(10):2697–704.CrossRefPubMed Arrington AK, Jarosek SL, Virnig BA, Habermann EB, Tuttle TM. Patient and surgeon characteristics associated with increased use of contralateral prophylactic mastectomy in patients with breast cancer. Ann Surg Oncol. 2009;16(10):2697–704.CrossRefPubMed
19.
Zurück zum Zitat Yao K, Stewart AK, Winchester DJ, Winchester DP. Trends in contralateral prophylactic mastectomy for unilateral cancer: a report from the National Cancer Data Base, 1998-2007. Ann Surg Oncol. 2010;17(10):2554–62.CrossRefPubMed Yao K, Stewart AK, Winchester DJ, Winchester DP. Trends in contralateral prophylactic mastectomy for unilateral cancer: a report from the National Cancer Data Base, 1998-2007. Ann Surg Oncol. 2010;17(10):2554–62.CrossRefPubMed
20.
Zurück zum Zitat Hwang ES, Locklear TD, Rushing CN, Samsa G, Abernethy AP, Hyslop T, et al. Patient-reported outcomes after choice for contralateral prophylactic mastectomy. J Clin Oncol. 2016;34(13):1518–27.CrossRefPubMed Hwang ES, Locklear TD, Rushing CN, Samsa G, Abernethy AP, Hyslop T, et al. Patient-reported outcomes after choice for contralateral prophylactic mastectomy. J Clin Oncol. 2016;34(13):1518–27.CrossRefPubMed
21.
Zurück zum Zitat Yi M, Hunt KK, Arun BK, Bedrosian I, Barrera AG, Do KA, et al. Factors affecting the decision of breast cancer patients to undergo contralateral prophylactic mastectomy. Cancer Prev Res (Phila). 2010;3(8):1026–34.CrossRefPubMedPubMedCentral Yi M, Hunt KK, Arun BK, Bedrosian I, Barrera AG, Do KA, et al. Factors affecting the decision of breast cancer patients to undergo contralateral prophylactic mastectomy. Cancer Prev Res (Phila). 2010;3(8):1026–34.CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Cassileth L, Kohanzadeh S, Amersi F. One-stage immediate breast reconstruction with implants: a new option for immediate reconstruction. Ann Plast Surg. 2012;69(2):134–8.CrossRefPubMed Cassileth L, Kohanzadeh S, Amersi F. One-stage immediate breast reconstruction with implants: a new option for immediate reconstruction. Ann Plast Surg. 2012;69(2):134–8.CrossRefPubMed
23.
Zurück zum Zitat Ashfaq A, McGhan LJ, Pockaj BA, Gray RJ, Bagaria SP, McLaughlin SA, et al. Impact of breast reconstruction on the decision to undergo contralateral prophylactic mastectomy. Ann Surg Oncol. 2014;21(9):2934–40.CrossRefPubMed Ashfaq A, McGhan LJ, Pockaj BA, Gray RJ, Bagaria SP, McLaughlin SA, et al. Impact of breast reconstruction on the decision to undergo contralateral prophylactic mastectomy. Ann Surg Oncol. 2014;21(9):2934–40.CrossRefPubMed
24.
Zurück zum Zitat Bajaj AK, Kon PS, Oberg KC, Miles DA. Aesthetic outcomes in patients undergoing breast conservation therapy for the treatment of localized breast cancer. Plast Reconstr Surg. 2004;114(6):1442–9.CrossRefPubMed Bajaj AK, Kon PS, Oberg KC, Miles DA. Aesthetic outcomes in patients undergoing breast conservation therapy for the treatment of localized breast cancer. Plast Reconstr Surg. 2004;114(6):1442–9.CrossRefPubMed
25.
Zurück zum Zitat Janz NK, Mujahid M, Lantz PM, Fagerlin A, Salem B, Morrow M, et al. Population-based study of the relationship of treatment and sociodemographics on quality of life for early stage breast cancer. Qual Life Res. 2005;14(6):1467–79.CrossRefPubMed Janz NK, Mujahid M, Lantz PM, Fagerlin A, Salem B, Morrow M, et al. Population-based study of the relationship of treatment and sociodemographics on quality of life for early stage breast cancer. Qual Life Res. 2005;14(6):1467–79.CrossRefPubMed
26.
Zurück zum Zitat Engel J, Kerr J, Schlesinger-Raab A, Sauer H, Holzel D. Quality of life following breast-conserving therapy or mastectomy: results of a 5-year prospective study. Breast J. 2004;10(3):223–31.CrossRefPubMed Engel J, Kerr J, Schlesinger-Raab A, Sauer H, Holzel D. Quality of life following breast-conserving therapy or mastectomy: results of a 5-year prospective study. Breast J. 2004;10(3):223–31.CrossRefPubMed
27.
Zurück zum Zitat Hopwood P, Haviland J, Mills J, Sumo G, M Bliss J; Start Trial Management Group. The impact of age and clinical factors on quality of life in early breast cancer: an analysis of 2208 women recruited to the UK START Trial (Standardisation of Breast Radiotherapy Trial). Breast. 2007;16(3):241–51.CrossRefPubMed Hopwood P, Haviland J, Mills J, Sumo G, M Bliss J; Start Trial Management Group. The impact of age and clinical factors on quality of life in early breast cancer: an analysis of 2208 women recruited to the UK START Trial (Standardisation of Breast Radiotherapy Trial). Breast. 2007;16(3):241–51.CrossRefPubMed
28.
Zurück zum Zitat Al-Ghazal SK, Fallowfield L, Blamey RW. Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. Eur J Cancer. 2000;36(15):1938–43.CrossRefPubMed Al-Ghazal SK, Fallowfield L, Blamey RW. Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. Eur J Cancer. 2000;36(15):1938–43.CrossRefPubMed
29.
Zurück zum Zitat Parker PA, Youssef A, Walker S, Basen-Engquist K, Cohen L, Gritz ER, et al. Short-term and long-term psychosocial adjustment and quality of life in women undergoing different surgical procedures for breast cancer. Ann Surg Oncol. 2007;14(11):3078–89.CrossRefPubMed Parker PA, Youssef A, Walker S, Basen-Engquist K, Cohen L, Gritz ER, et al. Short-term and long-term psychosocial adjustment and quality of life in women undergoing different surgical procedures for breast cancer. Ann Surg Oncol. 2007;14(11):3078–89.CrossRefPubMed
30.
Zurück zum Zitat Reiner AS, John EM, Brooks JD, Lynch CF, Bernstein L, Mellemkjær L, et al. Risk of asynchronous contralateral breast cancer in noncarriers of BRCA1 and BRCA2 mutations with a family history of breast cancer: a report from the Women’s Environmental Cancer and Radiation Epidemiology Study. J Clin Oncol. 2013;31(4):433–9.CrossRefPubMed Reiner AS, John EM, Brooks JD, Lynch CF, Bernstein L, Mellemkjær L, et al. Risk of asynchronous contralateral breast cancer in noncarriers of BRCA1 and BRCA2 mutations with a family history of breast cancer: a report from the Women’s Environmental Cancer and Radiation Epidemiology Study. J Clin Oncol. 2013;31(4):433–9.CrossRefPubMed
Metadaten
Titel
Long-Term Satisfaction and Body Image After Contralateral Prophylactic Mastectomy
verfasst von
Chelsea Anderson, MPH
Jessica Y. Islam, MPH
M. Elizabeth Hodgson, PhD
Susan A. Sabatino, PhD
Juan L. Rodriguez, MPH, MS
Clara N. Lee, MD, MPP
Dale P. Sandler, PhD
Hazel B. Nichols, PhD
Publikationsdatum
05.01.2017
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 6/2017
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5753-7

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