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Psychosocial Effects of Contralateral Prophylactic Mastectomy Among Women With Nonhereditary Breast Cancer

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Key Points

  • Prior to surgery, women who elected CPM had higher cancer distress, cancer worry, and body image concerns.
  • After surgery, CPM was associated with greater body image distress and poorer QOL.

In a prospective study reported in the Journal of Clinical Oncology, Parker et al found that among women with nonhereditary breast cancer electing contralateral prophylactic mastectomy (CPM), fear and worry over breast cancer may be dominant at the time of surgical decisions without sufficient recognition of potential effects of CPM on quality of life (QOL).

Study Details

The study involved 288 women (mean age = 56 years, 58% white) who provided questionnaire data while being treated at MD Anderson Cancer Center and a community-based clinic in Houston. Of these, 50 women underwent CPM. Questionnaires were completed before and 1, 6, 12, and 18 months after surgery. The primary psychosocial measures were cancer worry and cancer-specific distress. Instruments used included the Body Image Scale and Functional Assessment of Cancer Therapy–Breast (v4), the total score on which was used to assess overall QOL.  

Psychosocial Measures Before and After Surgery

Prior to surgery, women who subsequently received CPM had higher cancer distress (P = .04), cancer worry (P < .001), and body image concerns (P < .001) than women not undergoing CPM. In a multivariate analysis adjusted for time, age, race/ethnicity, and disease stage, CPM was associated with more body image distress (P < .001) and worse QOL (P = .02) after surgery. A significant interaction was found between time point and CPM group for cancer worry (P for interaction < .001); this finding indicated that CPM patients had greater presurgery cancer worry, with postsurgery worry decreasing over time and becoming similar to worry among patients who did not undergo CPM. QOL was similar between groups before surgery but declined at 1 month after surgery among CPM patients and remained lower than patients who did not have CPM after surgery (P for interaction = .05).

The investigators concluded, “The results of this prospective study are highly relevant to clinical practice and should be used to better inform discussions between women and physicians regarding CPM. Fear and worry regarding breast cancer may be foremost concerns at the time surgical decisions are made, and women may not anticipate the effect of CPM on QOL. Incorporating discussions about psychosocial outcomes, such as cancer worry, QOL, and body image concerns, in addition to clinical outcomes, may enable women to fully consider the psychosocial effect of having CPM. For women experiencing high levels of cancer worry, psychological interventions that directly address cancer worry and concerns about body image may be warranted.”

The study was supported by a Patient-Centered Outcomes Research Institute Award, the National Cancer Institute, and the Duncan Family Institute for Cancer Prevention and Risk Assessment at MD Anderson Cancer Center.

Patricia A. Parker, PhD, of Memorial Sloan Kettering Cancer Center, is the corresponding author for the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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