This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (94)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Oncology  • Breast Cancer  • Women's Health  • Women's Health, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

Marlene H. Frost, RN, PhD; Daniel J. Schaid, PhD; Thomas A. Sellers, PhD; Jeffrey M. Slezak, BS; Phillip G. Arnold, MD; John E. Woods, MD; Paul M. Petty, MD; Joanne L. Johnson, RN; Diana L. Sitta, RN; Shannon K. McDonnell, MS; Teresa A. Rummans, MD; Robert B. Jenkins, MD, PhD; Jeff A. Sloan, PhD; Lynn C. Hartmann, MD

JAMA. 2000;284:319-324.

Context  Prophylactic mastectomy is a preventive option for women who wish to reduce their risk of breast cancer. There has been concern about possible negative psychological sequelae following this procedure. However, few data are available regarding long-term satisfaction and psychological and social function following this procedure.

Objective  To evaluate patients' long-term satisfaction and psychological and social function following prophylactic mastectomy.

Design, Setting, and Participants  Descriptive study of all women known to be alive (n = 609) who had a family history of breast cancer and elected to undergo bilateral prophylactic mastectomy at a large, tertiary US health care clinic between 1960 and 1993, 94% (n = 572) of whom completed a study questionnaire.

Main Outcome Measures  Satisfaction with procedure and effects on psychological and social function, based on responses to the study-specific questionnaire.

Results  Mean time from prophylactic mastectomy to last follow-up was 14.5 years. Most women (70%) were satisfied with the procedure; 11% were neutral; and 19% were dissatisfied. Among the psychological and social variables, the most striking finding was that 74% reported a diminished level of emotional concern about developing breast cancer. The majority of women reported no change/favorable effects in levels of emotional stability (68%/23%), level of stress (58%/28%), self-esteem (69%/13%), sexual relationships (73%/4%), and feelings of femininity (67%/8%). Forty-eight percent reported no change in their level of satisfaction with body appearance; 16% reported favorable effects. However, 9%, 14%, 18%, 23%, 25%, and 36% reported negative effects in these 6 variables, respectively.

Conclusions  This study suggests that positive outcomes following prophylactic mastectomy include decreased emotional concern about developing breast cancer and generally favorable psychological and social outcomes. These must be weighed against the irreversibility of the decision, potential problems with implants and reconstructive surgery, and occurrence of adverse psychological and social outcomes in some women.

Author Affiliations: Divisions of Medical Oncology (Drs Frost and Hartmann), Research Services (Ms Sitta), Biostatistics (Drs Schaid and Sloan, Mr Slezak, and Ms McDonnell), Plastic and Reconstructive Surgery (Drs Arnold, Woods, and Petty), and Clinical Epidemiology (Dr Sellers and Ms Johnson), Departments of Laboratory Medicine and Pathology (Dr Jenkins) and Psychiatry and Psychology (Dr Rummans), Mayo Clinic and Mayo Foundation, Rochester, Minn.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

July 19, 2000
JAMA. 2000;284(3):375-376.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Psychological Reactions, Quality of Life, and Body Image After Bilateral Prophylactic Mastectomy in Women At High Risk for Breast Cancer: A Prospective 1-Year Follow-Up Study
Brandberg et al.
JCO 2008;26:3943-3949.
ABSTRACT | FULL TEXT  

Decision Making Regarding Prophylactic Mastectomy: Stability of Preferences and the Impact of Anticipated Feelings of Regret
van Dijk et al.
JCO 2008;26:2358-2363.
ABSTRACT | FULL TEXT  

The impact of a false-positive MRI on the choice for mastectomy in BRCA mutation carriers is limited
Hoogerbrugge et al.
Ann Oncol 2008;19:655-659.
ABSTRACT | FULL TEXT  

Applying Quality-of-Life Data Formally and Systematically Into Clinical Practice
Frost et al.
Mayo Clin Proc. 2007;82:1214-1228.
ABSTRACT | FULL TEXT  

Quality of Life After Contralateral Prophylactic Mastectomy in Newly Diagnosed High-Risk Breast Cancer Patients Who Underwent BRCA1/2 Gene Testing
Tercyak et al.
JCO 2007;25:285-291.
ABSTRACT | FULL TEXT  

Contentment With Quality of Life Among Breast Cancer Survivors With and Without Contralateral Prophylactic Mastectomy
Geiger et al.
JCO 2006;24:1350-1356.
ABSTRACT | FULL TEXT  

Satisfaction After Contralateral Prophylactic Mastectomy: The Significance of Mastectomy Type, Reconstructive Complications, and Body Appearance
Frost et al.
JCO 2005;23:7849-7856.
ABSTRACT | FULL TEXT  

Contralateral Prophylactic Mastectomy: Efficacy, Satisfaction, and Regret
Schwartz
JCO 2005;23:7777-7779.
FULL TEXT  

Women's Decision-Making Roles Regarding Contralateral Prophylactic Mastectomy
Nekhlyudov et al.
J Natl Cancer Inst Monogr 2005;2005:55-60.
ABSTRACT | FULL TEXT  

Helping Melanoma Patients Decide Whether to Choose Adjuvant High-Dose Interferon-{alpha}2b
Hurley and Chapman
The Oncologist 2005;10:739-742.
ABSTRACT | FULL TEXT  

Genetic Risk Assessment and BRCA Mutation Testing for Breast and Ovarian Cancer Susceptibility: Systematic Evidence Review for the U.S. Preventive Services Task Force
Nelson et al.
ANN INTERN MED 2005;143:362-379.
ABSTRACT | FULL TEXT  

Reproductive Issues for Women With BRCA Mutations
Friedman and Kramer
J Natl Cancer Inst Monogr 2005;2005:83-86.
ABSTRACT | FULL TEXT  

Descriptive Review of the Literature on Breast Cancer Outcomes: 1990 Through 2000
Mandelblatt et al.
J Natl Cancer Inst Monogr 2004;2004:8-44.
ABSTRACT | FULL TEXT  

Randomized Trial of a Shared Decision-Making Intervention Consisting of Trade-Offs and Individualized Treatment Information for BRCA1/2 Mutation Carriers
van Roosmalen et al.
JCO 2004;22:3293-3301.
ABSTRACT | FULL TEXT  

Short-Term Impact of Cancer Prevention and Screening Activities on Quality of Life
Cullen et al.
JCO 2004;22:943-952.
ABSTRACT | FULL TEXT  

Long-Term Psychological Impact of Carrying a BRCA1/2 Mutation and Prophylactic Surgery: A 5-Year Follow-Up Study
van Oostrom et al.
JCO 2003;21:3867-3874.
ABSTRACT | FULL TEXT  

Case 28-2003 - A 51-Year-Old Premenopausal Woman with Newly Diagnosed Breast Cancer and a Strong Family History of Breast Cancer
Ryan et al.
NEJM 2003;349:1076-1082.
FULL TEXT  

High Prevalence of Premalignant Lesions in Prophylactically Removed Breasts From Women at Hereditary Risk for Breast Cancer
Hoogerbrugge et al.
JCO 2003;21:41-45.
ABSTRACT | FULL TEXT  

Decision Analysis of Prophylactic Surgery or Screening for BRCA1 Mutation Carriers: A More Prominent Role For Oophorectomy
van Roosmalen et al.
JCO 2002;20:2092-2100.
ABSTRACT | FULL TEXT  

Recent developments: Breast cancer
Morrow and Gradishar
BMJ 2002;324:410-414.
FULL TEXT  

Impact of BRCA1/BRCA2 Mutation Testing on Psychologic Distress in a Clinic-Based Sample
Schwartz et al.
JCO 2002;20:514-520.
ABSTRACT | FULL TEXT  

Risk-Reduction Mastectomy: Clinical Issues and Research Needs
Stefanek et al.
JNCI J Natl Cancer Inst 2001;93:1297-1297.
ABSTRACT | FULL TEXT  

Breast Cancer after Prophylactic Bilateral Mastectomy in Women with a BRCA1 or BRCA2 Mutation
Meijers-Heijboer et al.
NEJM 2001;345:159-164.
ABSTRACT | FULL TEXT  

Prophylactic Mastectomy for Women with BRCA1 and BRCA2 Mutations -- Facts and Controversy
Eisen and Weber
NEJM 2001;345:207-208.
FULL TEXT  

The Power of Genetics to Target Surgical Prevention
Weitzel and McCahill
NEJM 2001;344:1942-1944.
FULL TEXT  

The psychosocial impact of bilateral prophylactic mastectomy: prospective study using questionnaires and semistructured
et al.
BMJ 2001;322:76-76.
ABSTRACT | FULL TEXT  

Update in Women's Health
Walsh et al.
ANN INTERN MED 2000;133:808-814.
FULL TEXT  

Women Report Satisfaction After Bilateral Prophylactic Mastectomy
JWatch Women's Health 2000;2000:2-2.
FULL TEXT  

What is the Psychological Impact of Prophylactic Mastectomy?
JWatch Psychiatry 2000;2000:4-4.
FULL TEXT