Study Finds No Difference in Psychosocial Scores Following Contralateral Mastectomy

Undergoing contralateral prophylactic mastectomy did not improve body image and psychosocial functioning following surgery among average-risk women with unilateral breast cancer; however, those who did not undergo surgery had a decrease in breast satisfaction, according to study findings presented at the 37^th Annual Miami Breast Cancer Conference®.

Dr. David Lim, from the Women’s College Researchcont Institute in Toronto, Ontario, and colleagues hope this emerging data may be used to further facilitate decision-making regarding contralateral prophylactic mastectomy.

In the study, which is ongoing, 506 women with a first diagnosis of unilateral, nonhereditary breast cancer were recruited from 2014-2017. Patients completed demographic and validated psychosocial questionnaires that assessed breast satisfaction and quality of life, cancer-related distress and anxiety and depression at six and 12 months after surgery.

“These are important questions — like what is driving women to choose bilateral mastectomy when they have a breast cancer. Is it because they're more anxious or they're more fearful or they're just unhappy with their breasts in general?” Lim said in an interview with CURE®. “And on the flip side, we want to know once these women have their surgeries, are they actually happy or does it make a difference? Because I think when a woman with breast cancer is trying to (decide between their options), they want to know whether they'll be happy with their decision afterwards.”

In total, 109 women (21.5%) underwent contralateral prophylactic mastectomy. Women in this group tended to be significantly younger than those who did not have surgery (47.7 years versus 56.9 years, respectively), were married or living with a partner (80% versus 70%) and were employed (84% versus 57%). In addition, more women with ductal carcinoma in situ (DCIS) opted to have contralateral prophylactic mastectomy (39% versus 13%) with immediate reconstruction (75% versus 18%), compared with patients with invasive disease.

The researchers noted that there was no difference in ethnicity, education level, annual income and receipt of chemotherapy or endocrine therapy. However, those who had contralateral prophylactic mastectomy were less likely to have received radiotherapy (35% versus 73%).

At six and 12 months after surgery, there was no difference in breast satisfaction and quality of life, cancer-related distress and anxiety and depression scores among women who underwent the procedure and those who did not.

Moreover, Lim and colleagues found that the significant differences in breast satisfaction and chest physical well-being that was seen preoperatively were no longer seen after surgery, due to a decrease in psychosocial scores in the non-surgery group.

“Interestingly, was the group that didn't have bilateral mastectomies, their scores all went down, they became more unhappy with their physical appearance, such that now their scores were similar to the women who did have bilateral mastectomies,” Lim explained. “We are going to look into this further because in that group that did not have bilateral mastectomies, we grouped together women who had lumpectomy versus mastectomy, and we also know that can influence how a woman feels about herself afterwards.”

Next, the researchers plan to look at women who did not have surgery, those who had a bilateral mastectomy, those who underwent unilateral lumpectomy and those who had a unilateral mastectomy.

“We’re trying to answer the question that a lot of women ask: Are they going to feel better about themselves after their surgery? And a lot of that relates to breast satisfaction,” Lim said. “We know that the decision is very complex. Some women do it because they just want to do 2everything they can to prevent a recurrence from the breast cancer from ever coming back. Other women are doing it because their plastic surgeon recommends them to do it to get the best outcomes in terms of breast cosmetics. It's a very complex decision, and we hope to add to that by providing that psychosocial data.”