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Mastectomy to Prevent Cancer Reduces Women's Worries

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WebMD Health News

July 18, 2000 -- For a woman at high risk of developing breast cancer, the decision to have her breasts removed as a preventive measure -- called prophylactic mastectomy -- is difficult at best. Will she regret it later? Will her self-esteem, femininity, and sexual relationships be affected? If she chooses breast reconstructive surgery, will her breasts look and feel natural?

A new study shows that most women who had the surgery were glad they did -- that it significantly eased their worries about developing cancer. Some of the women had the surgery as long as 14 years ago and still felt they had done the right thing. Among the handful who eventually developed breast cancer anyway, most were still glad they had chosen breast-removal surgery.

Why would someone choose to have their breasts removed? Women who opt for this procedure are those who are at high risk for breast cancer because of a strong family history or because they have mutations in the structure of certain genes, such as the BRCA1 and BRCA2 genes. Women with these mutations tend to develop breast cancer at earlier ages than other women and to develop more aggressive tumors.

For the new study, Marlene H. Frost, RN, PhD, and colleagues surveyed almost 600 women who had both breasts removed at the Mayo Clinic in Rochester, Minn., from 1960 to 1993. All the women had a family history of breast cancer and were considered to be at high or moderately high risk of developing the disease.

"The majority reported satisfaction with prophylactic mastectomy ... that they would likely choose the procedure again," writes Frost, a medical oncology researcher at Mayo Clinic. Her study appears in TheJournal of the American Medical Association.

"This is probably going to be considered a landmark paper," John Hoffman, MD, professor of surgery at Temple University School of Medicine and senior surgical oncologist at Fox Chase Cancer Center in Philadelphia, tells WebMD. "It's one of the largest studies of its kind. ...A lot of women are aware whether they have the BRCA1 or BRCA2 gene. For them, this paper shows that a large percentage of women who had prophylactic surgery were satisfied with their decision."

There has been "intense speculation" about the psychological ramifications of such surgery, says Frost, who found that 70% of the women surveyed were satisfied with the procedure, 11% were neutral, and 19% were dissatisfied.

"The most striking finding was that 74% reported less emotional concern about developing breast cancer," Frost writes. "The majority reported favorable effects or no change in self-esteem, satisfaction with body appearance, feelings of femininity, sexual relationships, level of stress in life, and overall emotional stability."

But among those who felt negatively about their decision, 18% suffered from lower self-esteem, 25% indicated the surgery adversely affected their sexual relationships, and 36% felt less feminine.

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