Patient-Reported Outcomes After Choice for Contralateral Prophylactic Mastectomy

• Published in: Journal of clinical oncology Vol. 34; no. 13; pp. 1518 - 1527
• Main Authors: Hwang, E Shelley, Locklear, Tracie D, Rushing, Christel N, Samsa, Greg, Abernethy, Amy P, Hyslop, Terry, Atisha, Dunya M
• Format: Journal Article
• Language: English
• Published: United States 01.05.2016
• Subjects: Age Factors; Breast Neoplasms - epidemiology; Breast Neoplasms - prevention & control; Breast Neoplasms - psychology; Cohort Studies; Female; Humans; Middle Aged; Patient Satisfaction; Prophylactic Mastectomy - methods; Prophylactic Mastectomy - psychology; Prophylactic Mastectomy - statistics & numerical data; Self Report; Surveys and Questionnaires; Treatment Outcome
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2015.61.5427

The rate of contralateral prophylactic mastectomies (CPMs) continues to rise, although there is little evidence to support improvement in quality of life (QOL) with CPM. We sought to ascertain whether patient-reported outcomes and, more specifically, QOL differed according to receipt of CPM. Volunteers recruited from the Army of Women with a history of breast cancer surgery took an electronically administered survey, which included the BREAST-Q, a well-validated breast surgery outcomes patient-reporting tool, and demographic and treatment-related questions. Descriptive statistics, hypothesis testing, and regression analysis were used to evaluate the association of CPM with four BREAST-Q QOL domains. A total of 7,619 women completed questionnaires; of those eligible, 3,977 had a mastectomy and 1,598 reported receipt of CPM. Women undergoing CPM were younger than those who did not choose CPM. On unadjusted analysis, mean breast satisfaction was higher in the CPM group (60.4 v 57.9, P < .001) and mean physical well-being was lower in the CPM group (74.6 v 76.6, P < .001). On multivariable analysis, the CPM group continued to report higher breast satisfaction (P = .046) and psychosocial well-being (P = .017), but no difference was reported in the no-CPM group in the other QOL domains. Choice for CPM was associated with an improvement in breast satisfaction and psychosocial well-being. However, the magnitude of the effect may be too small to be clinically meaningful. Such patient-reported outcomes data are important to consider when counseling women contemplating CPM as part of their breast cancer treatment.