Impact of Contralateral Prophylactic Mastectomy (CPM) on Psychosocial Outcomes

  • The decision to undergo CPM:
    • Is intensely personal
    • Frequently driven by:
      • A shifting balance between perceived future breast cancer risk
      • Anxiety over annual screening and potential future diagnostic procedures
      • The unknown physical, emotional, and cosmetic outcomes of the surgery
  • Long-term outcomes for women who have undergone CPM:
    • Report that 86% to 90% of respondents:
      • Were satisfied with the decision to undergo prophylactic surgery
    • With 20 years of follow-up:
      • More than 90 % of women definitely or probably would choose to undergo CPM again:
        • However, many of these same women report dissatisfaction with areas such as:
          • Body image, chronic pain, problems with implants, and sexual changes even though they noted overall satisfaction with their decision making
    • In a study of 296 women who participated in the National Prophylactic Mastectomy Registry and provided detailed responses to a survey evaluating their outcomes with CPM:
      • Only 6 % expressed regrets with the decision:
        • But of these women 39 % reported poor cosmetic outcomes and 22 % reported a reduced sense of sexuality:
          • Studies with longer follow-up had outcome data only on a proportion of the initial cohort, introducing possible bias between responders and nonresponders, limiting the strength of the evidence.
  • Few studies have examined quality of life between CPM and non-CPM patients:
    • One study, approximately 10 years ago:
      • Showed no difference in quality of life between patients undergoing CPM and those undergoing unilateral mastectomy or lumpectomy
    • In a study from Sweden:
      • No differences in overall health-related quality of life were identified up to two years post surgery in 60 women undergoing (delayed) CPM
  • Summary:
    • While 80% to 90 % of women report satisfaction with their decision to undergo CPM:
      • 20% to 30 % of these women report postsurgical dissatisfaction with cosmesis, body image, and sexuality
    • Studies show that CPM does not affect overall quality of life parameters
    • Women should be counseled on the potential long-term outcomes of CPM on body image and sexuality
  • References:
    • Roberts A, Habibi M, Frick KD. Cost-effectiveness of contralateral prophylactic mastectomy for prevention of contralateral breast cancer. Ann Surg Oncol. 2014;21:2209–2217. doi: 10.1245/s10434-014-3588-7.
    • Frost MH, Slezak JM, Tran NV, et al. Satisfaction after contralateral prophylactic mastectomy: the significance of mastectomy type, reconstructive complications, and body appearance. J Clin Oncol. 2005;23:7849–7856. doi: 10.1200/JCO.2005.09.233
    • Rosenberg SM, Sepucha K, Ruddy KJ, et al. Local therapy decision-making and contralateral prophylactic mastectomy in young women with early-stage breast cancer. Ann Surg Oncol. 2015;22:3809–3815. doi: 10.1245/s10434-015-4572-6
    • Geiger AM, West CN, Nekhlyudov L, et al. Contentment with quality of life among breast cancer survivors with and without contralateral prophylactic mastectomy. J Clin Oncol. 2006;24:1350–1356. doi: 10.1200/JCO.2005.01.9901
    • Frost MH, Hoskin TL, Hartmann LC, Degnim AC, Johnson JL, Boughey JC. Contralateral prophylactic mastectomy: long-term consistency of satisfaction and adverse effects and the significance of informed decision-making, quality of life, and personality traits. Ann Surg Oncol. 2011;18:3110–3116. doi: 10.1245/s10434-011-1917-7
    • Altschuler A, Nekhlyudov L, Rolnick SJ, et al. Positive, negative, and disparate–women’s differing long-term psychosocial experiences of bilateral or contralateral prophylactic mastectomy. Breast J. 2008;14:25–32. doi: 10.1111/j.1524-4741.2007.00521.x

#Arrangoiz #BreastSurgeon #CancerSurgeon #SurgicalOncologist #BreastCancer #ProphylacticMastectomy #CASO #Miami #CenterforAdvancedSurgicalOncology

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