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“Peace of Mind” After Mastectomy: A Scoping Review

  • Breast Oncology
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Abstract

Background

Many women eligible for breast conservation therapy (BCT) elect unilateral mastectomy (UM) with or without contralateral prophylactic mastectomy (CPM) and cite a desire for “peace of mind.” This study aimed to characterize how peace of mind is defined and measured and how it relates to surgical choice.

Methods

Nine databases were searched for relevant articles through 8 October 2023, and data were extracted from articles meeting the inclusion criteria.

Results

The inclusion criteria were met by 20 studies. Most were prospective cohort studies (65%, 13/20). In the majority of the studies (72%, 13/18), Non-Hispanic white/Caucasian women comprised 80 % or more of the study’s sample. Almost half of the studies used the phrase “peace of mind” in their publication (45%, 9/20), and few directly defined the construct (15%, 3/20). Instead, words representing an absence of peace of mind were common, specifically, “anxiety” (85%, 17/20), “fear” (75%, 15/20), and “concern” (75%, 15/20). Most of the studies (90%, 18/20) measured peace of mind indirectly using questionnaires validated for anxiety, fear, worry, distress, or concern, which were administered at multiple postoperative time points (55%, 11/20). Most of the studies (95%, 18/19) reported at least one statistically significant result showing no difference in peace of mind between BCT, UM, and/or CPM at their latest time of assessment.

Conclusion

Peace of mind is largely framed around concepts that suggest its absence, namely, anxiety, fear, and concern. Existing literature suggests that peace of mind does not differ among average-risk women undergoing BCT, UM, or CPM. Shared surgical decisions should emphasize at least comparable emotional and/or psychosocial well-being between CPM and breast conservation.

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Fig. 1

Adapted from Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj. N71. For more information, visit http://www.prisma-statement.org/.

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Acknowledgments

Dr. Shoshana Rosenberg received funding from Conquer Cancer Foundation/Pfizer Global Medical Grants (NIH R01CA256877-01A1). Dr. Rachel Greenup was supported by NCI R01.

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Authors and Affiliations

  1. Department of Surgery, Yale School of Medicine, New Haven, CT, USA

    Safraz A. Hamid MD, Baylee Bakkila BS, Kurt S. Schultz MD, Elizabeth L. Godfrey MD, Elizabeth Berger MD & Rachel A. Greenup MD, MPH

  2. Yale National Clinician Scholars Program, New Haven, CT, USA

    Safraz A. Hamid MD

  3. Yale Investigative Medicine Program, New Haven, CT, USA

    Kurt S. Schultz MD

  4. Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA

    Alyssa A. Grimshaw MBA, MSLIS

  5. Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA

    Craig G. Gunderson MD

  6. Department of Surgery, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA

    Clara Lee MD, MPP

  7. Weill Cornell Medical College, New York, NY, USA

    Shoshana Rosenberg ScD, MPH

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  1. Safraz A. Hamid MD
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  2. Baylee Bakkila BS
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Correspondence to Safraz A. Hamid MD.

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Hamid, S.A., Bakkila, B., Schultz, K.S. et al. “Peace of Mind” After Mastectomy: A Scoping Review. Ann Surg Oncol (2024). https://doi.org/10.1245/s10434-024-15360-3

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