Does Having Preventive Mastectomy Improve Quality of Life?

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Some women who’ve been diagnosed with early-stage breast cancer in one breast choose to have that breast and the other healthy breast removed – a double mastectomy. Removing the other healthy breast is called contralateral prophylactic mastectomy.

The healthy breast usually is removed because of an understandable fear that a new, second breast cancer might develop in that breast. More and more women who’ve been diagnosed are opting for contralateral prophylactic mastectomy – in the late 1990s, between 4% and 6% of women who were having mastectomy decided to have the other healthy breast removed. More recently, between 11% and 25% of women having a mastectomy decided to have contralateral prophylactic mastectomy.

Because of this increase in contralateral prophylactic mastectomies, researchers at Duke University wondered if having this surgery led to better quality of life.

Their study has found that women who have contralateral prophylactic mastectomy are slightly more satisfied with how their breasts look and feel, but reconstruction after breast cancer surgery has a bigger effect on satisfaction.

"In our analysis, women who had [contralateral prophylactic mastectomy] reported marginally higher psychosocial well-being --- feeling confident, emotionally healthy, accepting of their bodies," said Shelley Hwang, M.D., chief of breast surgery at the Duke Cancer Institute and senior author of the study. "But the differences between women who did and did not get [contralateral prophylactic mastectomy] were very small and diminished over time. Psychosocial well-being continued to increase in both groups, even beyond 10 years after treatment."

It’s important to know that a double mastectomy is a bigger operation than a single mastectomy or a lumpectomy. The recovery is longer and more difficult, and the risk of complications is higher.

It’s also important to know that research has found that women diagnosed with early-stage breast cancer in one breast who are treated with lumpectomy followed by radiation therapy have the same survival rates as women who are treated with double mastectomy.

The study was published online on March 7, 2016 by the Journal of Clinical Oncology. Read the abstract of “Patient-Reported Outcomes After Choice for Contralateral Prophylactic Mastectomy."

To do the study, the researchers asked nearly 8,000 women who had been diagnosed with breast cancer to complete an online survey about the treatments they had and their satisfaction with the outcomes. The survey also included questions designed to measure the women’s physical, psychosocial, and sexual well-being. To judge the women’s satisfaction with their breasts, the researchers asked about breast symmetry, appearance, feel, fit in a bra, and how the breasts looked in and out of clothing.

Of the women who completed the survey:

  • 3,977 women had mastectomy
  • 1,598 women had contralateral prophylactic mastectomy

Compared to women who had single mastectomy, women who chose to have contralateral prophylactic mastectomy:

  • were younger
  • had earlier stage disease
  • had higher incomes

Overall, the researchers found that women who opted for contralateral prophylactic mastectomy were slightly more satisfied with their breasts than women who had single mastectomy.

Still, the researchers found that breast reconstruction had a much bigger effect on quality of life than contralateral prophylactic mastectomy. No matter which surgery women had, women who then had reconstruction had much higher breast satisfaction and sexual and psychosocial well-being.

"Even though women imagine they will be much happier after [contralateral prophylactic mastectomy], we found that these patients' experiences are not greatly different from those of patients undergoing a single mastectomy," Dr. Hwang said. "[Contralateral prophylactic mastectomy] does not appear to translate into a much better quality of life in the way that breast reconstruction can.

"This study supports what has concerned many of us -- that women are not benefiting as greatly from [contralateral prophylactic mastectomy] as they expect they will," she continued. "Unless a woman has a gene mutation that places her at significantly increased risk of a new cancer in the other breast, [contralateral prophylactic mastectomy] doesn't prolong life and our study shows that it doesn't make for a notably better quality of life."

When you’re first diagnosed with breast cancer, fears about the future can affect how you make decisions. This is especially true for women who have an abnormal breast cancer gene or who have watched a mother or sister be diagnosed with breast cancer. You have to make a number of decisions at a very emotional time when it can be hard to absorb and understand all the new information you’re being given.

At Breastancer.org, we support every woman’s right to make treatment decisions based on the characteristics of the cancer she’s been diagnosed with, her medical history, her risk of recurrence or a new breast cancer, and her personal preferences. But it’s very important to make sure you understand all the pros and cons of any treatment or procedure you’re considering, including how the treatment or procedure may affect your reconstruction options and if the treatment is likely to make you live longer.

If you’ve been diagnosed with early-stage breast cancer, ask your doctor about ALL of your treatment and risk reduction options. Contralateral prophylactic mastectomy is only one of these options and is an aggressive step. While it may be the right decision for you, give yourself the time you need to consider the decision carefully. It’s a good idea to talk to your doctor about how the details in your pathology report may affect your future risk. You want to be sure that your decisions are based on your actual risk of recurrence or a new cancer. Make sure you understand the benefits and risks of all your options. Together, you and your doctor can make the choices that are best for you and your unique situation.



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