Contralateral Prophylactic Mastectomy Surgery to Reduce Risk of Breast Cancer

Women who had one breast removed because of cancer and chose to have the other breast removed to reduce their risk of developing a second breast cancer are satisfied with their decision more than 10 years after the surgery, according to a survey conducted by the Mayo Clinic Cancer Center .

Of the 583 women responding to the survey, 83 percent said they were highly satisfied with their decision to have a contralateral prophylactic mastectomy (CPM), says Marlene Frost, Ph.D., nurse researcher with the Women's Cancer Program at Mayo Clinic in Rochester, Minn. Eight percent of the women were neutral about their CPM, and 9 percent said they were dissatisfied with the surgery. Dr. Frost reports the survey findings today (June 1, 2003) at the 39th annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago .

The CPM procedure involves the surgical removal of the healthy breast to lessen the chances of cancer developing in that breast. It is an option for reducing the risk of a second breast cancer in women with personal and family histories of breast cancer. This includes women known to have inherited abnormalities in BRCA1 and BRCA2, two genes that predispose to breast cancer. Between five and 10 percent of the more than 200,000 women diagnosed with breast cancer each year in the United States fall into this higher risk category.

A survey was mailed to 621 women with both personal and family histories of breast cancer who chose to undergo the CPM procedure at Mayo Clinic between 1960 and 1993; 583 of those women (94 percent) responded to the survey.

“We surveyed these women because we wanted to know about their satisfaction, as well as about their psychological well-being and their social functioning after CPM,” says Dr. Frost. “Before this survey, very little data existed to tell us how women felt about their experiences with CPM.”

The questionnaire focused on identifying the women's reasons for CPM, their perceived risk of breast cancer, their satisfaction with CPM, and their self-esteem, body image, feelings of femininity, sexual relationships, emotional concern about developing breast cancer, stress and emotional stability.

On average, the women responding to the survey were 10.7 years past their CPM. The women averaged 49 years of age at the time of surgery and 61 years of age when surveyed. Their answers indicated that:

• 83 percent experienced no change or unfavorable effects to their self-esteem after the surgery.

• 83 percent experienced either no change or less stress in their lives after the surgery.

• 88 percent experienced no change or reduced emotional distress.

The minority of women who were dissatisfied cited problems with body appearance, feelings of femininity and sexual relationships. Another reason for decreased satisfaction included complications with reconstruction surgery after CPM.

“Choosing to have CPM is a very personal decision,” says Dr. Frost. “We can provide information from previous research that shows prophylactic mastectomy reduces a woman's risk of getting breast cancer by more than 90 percent. We also need a balanced understanding of the benefits and adverse effects associated with this procedure.

“With the results of this survey, we now can say that the majority of women who choose CPM to reduce their risks of a second breast cancer are satisfied,” she says. “However, women must weigh the possible adverse effects to their body appearance, feelings of femininity and sexual relationships when making this decision.”