Long-term outcomes of risk-reducing surgery in unaffected women at increased familial risk of breast and/or ovarian cancer
This study prospectively investigated long-term psychosocial outcomes for women who opted for risk-reducing mastectomy (RRM) and/or risk-reducing salpingo-oophorectomy (RRSO). Unaffected women from high-risk breast cancer families who had completed baseline questionnaires for an existing study and subsequently underwent RRM and/or RRSO, completed measures of perceived breast and ovarian cancer risk, anxiety, depression, cancer-related anxiety, body image, sexual functioning, menopausal symptoms, use of hormone replacement therapy and decision regret 3 years post-surgery. Outcomes were compared to age- and risk-matched controls. Participants (N = 233) were 17 women who had RRM (39 controls), 38 women who had RRSO (94 controls) and 15 women who had RRM + RRSO (30 controls). Women who underwent RRM and those who underwent RRM + RRSO reported reductions in perceived breast cancer risk and perceived breast and ovarian cancer risk respectively, compared to their respective controls. RRM women reported greater reductions in cancer-related anxiety compared with both controls and RRSO women. RRSO women reported more sexual discomfort than controls and more urogenital menopausal symptoms than controls and RRM only women. No differences in general anxiety, depression or body image were observed. Regret was associated with greater reductions in body image since surgery and more sexual discomfort, although overall regret levels were low. Women who undergo RRM experience psychological benefits associated with reduced breast cancer risk. Although women who undergo RRSO experience some deterioration in sexual and menopausal symptoms, they do not regret their surgery decision. It is vital that women considering these procedures receive detailed information about potential psychosocial consequences.
KeywordsRisk-reducing surgery Breast Ovarian Psychosocial Outcomes Prospective
We wish to thank the many families who contribute to kConFab, Heather Thorne, Eveline Niedermayr, all the kConFab research nurses and staff, the heads and staff of the Family Cancer Clinics, and the Clinical Follow Up Study. kConFab is supported by a grant from the National Breast Cancer Foundation; and was previously supported by the National Health and Medical Research Council (NHMRC); the Queensland Cancer Fund, the Cancer Councils of New South Wales, Victoria, Tasmania and South Australia; and the Cancer Foundation of Western Australia. The Clinical Follow-up study received funding from the National Health and Medical Research Council [NHMRC], the National Breast Cancer Foundation, Cancer Australia, and the National Institutes of Health (USA). Prof Phyllis Butow receives an NHMRC Senior Principal Research Fellowship, and A/Professor Bettina Meiser an NHMRC Career Development Award Level 2.
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