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Few Women Who Opt for Preventive Mastectomy Have Regrets


WebMD Health News

April 26, 2000 -- Some women with a strong family history of breast cancer are choosing to have their healthy breasts removed to lower their risks of developing the disease. This may seem like a drastic measure, but a new study indicates that few women who have these operations have regrets afterward.

Women with mutated copies of the breast cancer genes -- BRCA1 and BRCA2 -- are thought to have an 85% risk of developing breast cancer over their lifetimes. Such genetic breast cancers make up about 5% of all breast cancers. Some women with a family history of the cancer are now choosing to be tested for these genes, and may decide to have a preventive mastectomy on one or both breasts, depending on their test results.

An earlier study by researchers at the Mayo Clinic in Rochester, Minn., found that this procedure -- known as a prophylactic mastectomy -- could reduce a woman's risk of developing breast cancer by at least 90%.

The new study, published in the Annals of Surgical Oncology, looks at 370 women who had preventive surgical removal of both breasts between 1970 and 1993. Just 21 of these women said they had serious regrets about their decision.

Commonly cited regrets included emotional trauma, a lack of available psychological counseling, complications of surgery, and diminished sexual satisfaction or body image. None of these women had been tested for mutations in the breast cancer genes, but most said they feared they had a genetic predisposition for the cancer.

More than two-thirds of the women with regrets reported feeling severe anxiety before the procedure, writes researcher David K. Payne, PhD, a psychiatrist at the Memorial Sloan Kettering Cancer Center in New York.

"Careful evaluation, education, and support both before and after the procedure may reduce the level of distress and dissatisfaction in these women," Payne and colleagues conclude in the article.

One woman who has undergone genetic testing says she would not hesitate to have the operation if she found she was at high risk of breast cancer.

The woman, a 29-year-old New York resident who spoke on condition of anonymity, is awaiting results of her breast cancer gene test. "If the results come back positive, I would [have a bilateral prophylactic mastectomy] in a second," she tells WebMD.

"I have undergone counseling, and we talked about some the psychological issues involved in my decision, including how it feels to lose a breast," she says. "But for me, that seems superficial. It's a trade-off and you do what you have to what to do to live as long as you can."

She says that her only concern is whether a mastectomy will make it difficult for doctors to detect cancer in the remaining breast tissue. "It's a personal decision," she says. "I want to heighten my chances for survival as much as possible if I have the gene."

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