Clinical follow-up after bilateral risk reducing ('prophylactic') mastectomy: mental health and body image outcomes.
Baildam, Andrew D
Evans, D Gareth R
AffiliationThe CRC Psychological Medicine Group, Christie Hospital NHS Trust, Withington, Manchester, UK. firstname.lastname@example.org
MetadataShow full item record
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.
CitationClinical follow-up after bilateral risk reducing ('prophylactic') mastectomy: mental health and body image outcomes., 9 (6):462-72 Psychooncology
- Psychological reactions, quality of life, and body image after bilateral prophylactic mastectomy in women at high risk for breast cancer: a prospective 1-year follow-up study.
- Authors: Brandberg Y, Sandelin K, Erikson S, Jurell G, Liljegren A, Lindblom A, Lindén A, von Wachenfeldt A, Wickman M, Arver B
- Issue date: 2008 Aug 20
- Aesthetic outcome, patient satisfaction, and health-related quality of life in women at high risk undergoing prophylactic mastectomy and immediate breast reconstruction.
- Authors: Isern AE, Tengrup I, Loman N, Olsson H, Ringberg A
- Issue date: 2008 Oct
- Satisfaction after contralateral prophylactic mastectomy: the significance of mastectomy type, reconstructive complications, and body appearance.
- Authors: Frost MH, Slezak JM, Tran NV, Williams CI, Johnson JL, Woods JE, Petty PM, Donohue JH, Grant CS, Sloan JA, Sellers TA, Hartmann LC
- Issue date: 2005 Nov 1
- The impact of genetic counselling on risk perception and mental health in women with a family history of breast cancer.
- Authors: Watson M, Lloyd S, Davidson J, Meyer L, Eeles R, Ebbs S, Murday V
- Issue date: 1999 Feb
- Body image and psychological distress after prophylactic mastectomy and breast reconstruction in genetically predisposed women: a prospective long-term follow-up study.
- Authors: den Heijer M, Seynaeve C, Timman R, Duivenvoorden HJ, Vanheusden K, Tilanus-Linthorst M, Menke-Pluijmers MB, Tibben A
- Issue date: 2012 Jun