Clinical follow-up after bilateral risk reducing ('prophylactic') mastectomy: mental health and body image outcomes.

2.50
Hdl Handle:
http://hdl.handle.net/10541/86472
Title:
Clinical follow-up after bilateral risk reducing ('prophylactic') mastectomy: mental health and body image outcomes.
Authors:
Hopwood, Penelope; Lee, Andrew; Shenton, Andrew; Baildam, Andrew D; Brain, Anne; Lalloo, Fiona; Evans, D Gareth R; Howell, Anthony ( 0000-0002-3879-5991 )
Abstract:
BACKGROUND: In Manchester, approximately 120 women at > or = 1:4 lifetime risk of breast cancer have considered preventative surgery since 1992. Women treated within the Manchester protocol receive two genetic counselling sessions, a psychological assessment and a surgical consultation pre-operatively and annual follow-up post-operatively. The vast majority of women have breast reconstruction. METHODS: Since 1996, mental health and body image have been assessed in women attending annual follow-up using self-report questionnaires: the 28-item General Health Questionnaire (GHQ) and 10-item Body Image Scale (BIS). Women with high scores are assessed by clinical interview together with a proportion who have no significant problems. RESULTS: Between 1995 and 1999, 76 women completed surgery. Ten were awaiting post-operative review and 60 (91%) attended for follow-up of whom 45 (75%) were interviewed. Questionnaire data were available for 52 (79%) women, mean age 40.8 years (range 27-58). Six women were gene mutation carriers and of these three had had breast cancer. One additional patient was affected but had not been genetically tested. Eight (17%) of 47 women with assessments in the first post-operative year scored in the 'caseness' range on the GHQ: the mean GHQ score was 3.8 (S.D. 6.7), range 0-25. Results were comparable with those for women attending the Family History Clinic for risk assessment. The mean score on the BIS was 5.1 (S.D. 5.5), range 0-25, comparable with scores for women undergoing conservative surgery for breast cancer. Twenty-one percent of women reported no negative change in body image following surgery (i.e. zero questionnaire summary scores) and the majority of changes reported were of minor degree (item scores 0 or 1). The most frequently reported changes were in sexual attractiveness (55%), feeling less physically attractive (53%) and self-consciousness about appearance (53%): a third of women felt less feminine to a minimal degree. These results appeared stable over time. A minority of women had more serious psychological or body image concerns, usually in relation to surgical complications: they received further psychiatric intervention. CONCLUSIONS: For the majority of women there is no evidence of significant mental health or body image problems in the first 3 years following Bilateral Prophylactic Mastectomy (BPM), but women who have complications warrant additional psychological help. Careful pre-operative preparation and long-term monitoring are advocated in this new field of cancer prevention.
Affiliation:
The CRC Psychological Medicine Group, Christie Hospital NHS Trust, Withington, Manchester, UK. penelope.hopwood@man.ac.uk
Citation:
Clinical follow-up after bilateral risk reducing ('prophylactic') mastectomy: mental health and body image outcomes., 9 (6):462-72 Psychooncology
Journal:
Psycho-Oncology
Issue Date:
19-Nov-2009
URI:
http://hdl.handle.net/10541/86472
DOI:
10.1002/1099-1611(200011/12)9:6<462::AID-PON485>3.0.CO;2-J
PubMed ID:
11180581
Type:
Article
Language:
en
ISSN:
1057-9249
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorHopwood, Penelopeen
dc.contributor.authorLee, Andrewen
dc.contributor.authorShenton, Andrewen
dc.contributor.authorBaildam, Andrew Den
dc.contributor.authorBrain, Anneen
dc.contributor.authorLalloo, Fionaen
dc.contributor.authorEvans, D Gareth Ren
dc.contributor.authorHowell, Anthonyen
dc.date.accessioned2009-11-19T15:18:04Z-
dc.date.available2009-11-19T15:18:04Z-
dc.date.issued2009-11-19T15:18:04Z-
dc.identifier.citationClinical follow-up after bilateral risk reducing ('prophylactic') mastectomy: mental health and body image outcomes., 9 (6):462-72 Psychooncologyen
dc.identifier.issn1057-9249-
dc.identifier.pmid11180581-
dc.identifier.doi10.1002/1099-1611(200011/12)9:6<462::AID-PON485>3.0.CO;2-J-
dc.identifier.urihttp://hdl.handle.net/10541/86472-
dc.description.abstractBACKGROUND: In Manchester, approximately 120 women at > or = 1:4 lifetime risk of breast cancer have considered preventative surgery since 1992. Women treated within the Manchester protocol receive two genetic counselling sessions, a psychological assessment and a surgical consultation pre-operatively and annual follow-up post-operatively. The vast majority of women have breast reconstruction. METHODS: Since 1996, mental health and body image have been assessed in women attending annual follow-up using self-report questionnaires: the 28-item General Health Questionnaire (GHQ) and 10-item Body Image Scale (BIS). Women with high scores are assessed by clinical interview together with a proportion who have no significant problems. RESULTS: Between 1995 and 1999, 76 women completed surgery. Ten were awaiting post-operative review and 60 (91%) attended for follow-up of whom 45 (75%) were interviewed. Questionnaire data were available for 52 (79%) women, mean age 40.8 years (range 27-58). Six women were gene mutation carriers and of these three had had breast cancer. One additional patient was affected but had not been genetically tested. Eight (17%) of 47 women with assessments in the first post-operative year scored in the 'caseness' range on the GHQ: the mean GHQ score was 3.8 (S.D. 6.7), range 0-25. Results were comparable with those for women attending the Family History Clinic for risk assessment. The mean score on the BIS was 5.1 (S.D. 5.5), range 0-25, comparable with scores for women undergoing conservative surgery for breast cancer. Twenty-one percent of women reported no negative change in body image following surgery (i.e. zero questionnaire summary scores) and the majority of changes reported were of minor degree (item scores 0 or 1). The most frequently reported changes were in sexual attractiveness (55%), feeling less physically attractive (53%) and self-consciousness about appearance (53%): a third of women felt less feminine to a minimal degree. These results appeared stable over time. A minority of women had more serious psychological or body image concerns, usually in relation to surgical complications: they received further psychiatric intervention. CONCLUSIONS: For the majority of women there is no evidence of significant mental health or body image problems in the first 3 years following Bilateral Prophylactic Mastectomy (BPM), but women who have complications warrant additional psychological help. Careful pre-operative preparation and long-term monitoring are advocated in this new field of cancer prevention.en
dc.language.isoenen
dc.subjectBreast Canceren
dc.subjectSecond Primary Canceren
dc.subject.meshAdult-
dc.subject.meshBody Image-
dc.subject.meshBreast Neoplasms-
dc.subject.meshFemale-
dc.subject.meshFollow-Up Studies-
dc.subject.meshHumans-
dc.subject.meshMastectomy-
dc.subject.meshMental Health-
dc.subject.meshMiddle Aged-
dc.subject.meshNeoplasms, Second Primary-
dc.subject.meshPostoperative Complications-
dc.subject.meshRisk Factors-
dc.titleClinical follow-up after bilateral risk reducing ('prophylactic') mastectomy: mental health and body image outcomes.en
dc.typeArticleen
dc.contributor.departmentThe CRC Psychological Medicine Group, Christie Hospital NHS Trust, Withington, Manchester, UK. penelope.hopwood@man.ac.uken
dc.identifier.journalPsycho-Oncologyen

Related articles on PubMed

All Items in Christie are protected by copyright, with all rights reserved, unless otherwise indicated.