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28 August 2008
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Mastectomy alleviates anxiety but impairs sexuality in women at risk for breast cancer
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MedWire News: Women who opt for bilateral prophylactic mastectomy (BPM) to prevent hereditary breast cancer report considerable sexual and body image problems 1 year after the operation, study results show.
However, despite these personal problems, the women actually showed improvements in anxiety, depression, and overall quality of life.
"Some of them probably consider a negative impact in intimate situations to be a less important problem than having to live with the high risk of breast cancer," Yvonne Brandberg (Karolinska Institute, Stockholm, Sweden) and colleagues comment.
The researchers explain that women in Sweden with hereditary risk for breast cancer are offered regular follow-ups and are informed of the possibility to undergo BPM including immediate breast reconstruction.
This surgical option has been shown to reduce breast cancer incidence in women of families with a well-defined history of breast cancer and in women with BRCA1 or BRCA2 mutations. However, few prospective studies have evaluated the psychosocial impact of BPM.
For the study, the researchers recruited 90 women who underwent BPM between October 1997 and December 2005, and interviewed them before the operation and again 6 months and 1 year postsurgery.
Several measures of sexuality and body image deteriorated over the study period, such that 1 year after surgery 48% of women reported considerable self-consciousness, 48% reported feeling less sexually attractive, and 44% felt dissatisfied with their scars. In addition, sexual pleasure was lower 1-year postsurgery than before the operation.
By contrast, anxiety, depression, and quality of life all improved after surgery. Notably, the proportion of women meeting the threshold for clinical anxiety was 18% before surgery compared with just 6% at 1-year follow-up.
Discussing their findings in the Journal of Clinical Oncology, Brandberg and colleagues speculate that "the reduction of risk by BPM and subsequently decreased worry for breast cancer might have influenced life in a positive way."
J Clin Oncol 2008; 26: 3943-3949
http://jco.ascopubs.org/cgi/content/abstract/26/24/3943
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