Some Women Have Regrets About Preventive Mastectomy
Oct. 4, 1999 (New York) -- Some breast cancer patients who choose to have their healthy breast removed in addition to their cancerous breast ultimately regret the decision, according to a survey conducted by researchers at Memorial Sloan-Kettering Cancer Center in New York. The strongest reasons for regretting the preventive measure are dissatisfaction with the cosmetic results, a diminished sense of sexuality, and not having had their alternatives clearly explained to them, the researchers report in the September issue of the Annals of Surgical Oncology.
"This study reminds [doctors] to take the time to effectively counsel a patient who is strongly considering [a preventive mastectomy]," write Leslie L. Montgomery, MD, and colleagues. They say the most effective way to minimize the risk of regret is for physicians to talk to women about their risk of additional cancer, the alternatives to a preventive mastectomy, and the effectiveness of a preventive mastectomy in reducing the risk of cancer. The authors also say women should be given a realistic expectation of the cosmetic outcomes of the surgery and should be made aware of the potential for distress about body image.
From a medical standpoint, the decision to remove the remaining breast as a preventive measure remains controversial with regard to risks and benefits. It is generally assumed that the risk of developing cancer in the opposite breast is about 0.5% to 0.75% per year from the initial diagnosis of breast cancer.
Ultimately, the decision to remove the other breast as a precaution is highly personal for women with a family history of breast cancer and those with early aggressive cancers that have a high likelihood of returning in the remaining breast. The issue has gained attention in recent years with the introduction of tests that indicate the presence of inherited genetic mutations known as BRCA1 and BRCA2, which significantly increase a woman's risk of breast cancer.
Montgomery and colleagues surveyed 296 women who had had both breasts removed between 1954 and 1998; 53% of the procedures occurred within the last 10 years. Of these women, 30% had at least one first-degree relative (mother or sister) with breast cancer; 14 had more than one first-degree relative and nine had undergone BRCA1 testing. Another 20% had at least one second-degree relative (aunt, grandmother, or cousin) with breast cancer.
After diagnosis of the cancer, a discussion about preventive mastectomy of the other breast was initiated by the physician in the majority of cases (72%). The majority of women who initiated the discussion themselves had at least one first-degree relative with breast cancer.
Among all the women who chose to undergo preventive mastectomy, 18 (6%) had regrets. "Regrets tended to be less common in the women with whom the discussion of [preventive mastectomy] had been initiated by their physician than in the women who had initiated the discussion themselves," Montgomery and colleagues write.