Another Study Looks at Quality of Life After Preventive Mastectomy

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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. A 2016 study found that rates of contralateral prophylactic mastectomy more than tripled from 2002 to 2012.

A study suggests that women who have contralateral prophylactic mastectomy have poorer quality of life up to 18 months after the surgery compared to women who have single mastectomy.

The research was published online on July 25, 2018 by the Journal of Clinical Oncology. Read the abstract of “Prospective Study of Psychosocial Outcomes of Having Contralateral Prophylactic Mastectomy Among Women With Nonhereditary Breast Cancer.”

How worried are women before and after surgery?

To do the study, the researchers surveyed 288 women who were recently diagnosed with early-stage breast cancer in one breast:

  • the average age at diagnosis was 56
  • 58% were non-Hispanic white women
  • none of the women had a genetic mutation linked to a higher risk of breast cancer
  • 50 of the women had contralateral prophylactic mastectomy

The women completed questionnaires before surgery and 1, 6, 12, and 18 months after surgery. The questionnaires asked about:

  • how worried the women were about breast cancer
  • any body image concerns the women had
  • quality of life
  • how satisfied the women were with their choice of surgery

Compared to women who didn’t have contralateral prophylactic mastectomy, women who had the procedure had:

  • higher cancer distress
  • more cancer worry
  • higher body image distress

before surgery.

Does quality of life improve over time?

At 6, 12, and 18 months after surgery, women who had contralateral prophylactic mastectomy had:

  • higher cancer distress
  • more body image concerns
  • lower quality of life

compared to women who didn’t have contralateral prophylactic mastectomy.

There was no real difference in cancer worry between the two groups of women at any time after surgery.

There also were no differences in how satisfied the women were with their choice of surgery between the two groups at any time after surgery.

Overall, quality of life was similar between the two groups of women before surgery, but declined more in the 18 months after surgery among women who had contralateral prophylactic mastectomy.

While the results of this study are somewhat troubling, it’s important to know that a 2016 Duke University study found that about 4.6 years after surgery women who had contralateral prophylactic mastectomy had slightly higher psychosocial well-being compared to women who had single mastectomy, meaning they felt more confident, more emotionally healthy, and were more accepting of their bodies. So, it may be that quality of life improves over time for women who have contralateral prophylactic mastectomy.

“Individual women will differ in their needs and timelines, and thus a personal approach on a patient-by-patient basis is required,” said Alastair Thompson, M.D., Ph.D., of the University of Texas MD Anderson Cancer Center and one of the study’s authors. “Good patient-clinician relationships and adequate time to explore the options, together with support from caregivers, are the most likely ways to get to a point where the patient has made the right decision for her own circumstances.”

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 watched a mother, sister, or friend 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. It’s also 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.

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.

If you're considering preventive mastectomy and want to talk with others about this decision, join the Breastcancer.org Discussion Board forum Surgery - Before, During, and After.


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