Preventive Mastectomy Offers Women Relief

Preventive Mastectomy Offers Women Relief
By Kathleen Doheny
HealthDay Reporter
FRIDAY, March 17 (HealthDay News) -- Most women diagnosed with breast cancer who choose to have their unaffected breast removed along with the diseased one say they don't regret their decision, a new study finds.
Furthermore, their quality of life equals that of women who chose not to have a preventive mastectomy, say researchers reporting in the March 20 issue of the Journal of Clinical Oncology.
Those who chose the preventive mastectomy were also a little less concerned about cancer recurring, the study found.
"Overall, we think these are reassuring results, in that women who have preventive mastectomy don't appear to suffer any ill psychological effects compared to those who [just] had the breast cancer treated," said Ann Geiger, lead author of the study and an associate professor of public health sciences at the Wake Forest University Baptist Medical Center School of Medicine in Winston-Salem, N.C.
Her team surveyed 580 women: 519 underwent a preventive mastectomy on the unaffected breast after learning they had cancer; 61 did not.
Women answered questions about their quality of life, body image, sexual satisfaction, concern about breast cancer recurrence, depression and their perception of their health.
Respondents to the survey received care from six healthcare systems within the National Cancer Institute-funded Cancer Research Network. They had been diagnosed between the years of 1979 to 1999. Of the 519 who chose preventive mastectomy, 86.5 percent said they were satisfied with their decision, and 76.3 percent reported "high contentment" with their quality of life.
Of the 61 who did not undergo the preventive mastectomy, a similar number (75.4 percent) reported high contentment with their quality of life.
This latest study adds to a body of knowledge about preventive mastectomies, an area that has garnered little research, Geiger said. Some preventive mastectomies are done bilaterally if a woman is at high risk of breast cancer due to strong family history; other studies have involved the unaffected breast when breast cancer is diagnosed in the other breast. "Most research has been done on bilateral preventive mastectomy -- when no cancer is present," she said.
The study results came as no surprise to Dr. Julia Smith, director of the New York University Cancer Institute's Breast Cancer Screening and Prevention Program and director of the Lynne Cohen Breast Cancer Preventive Care Program at the NYU Cancer Institute and Bellevue Hospital in New York City. "It's totally consistent with our experience with patients," she said of the survey findings.
Making the decision is not easy, she added, whatever the woman's medical history.
"These are very important decisions," Smith said. She said it's crucial that women head to a center known for its skill in high-risk assessment. This may be a university center or a center that does research and is known for its high-risk management programs, she said. "If women go to these programs, and they get their own individual risk profile assessed, then they can understand, with the help of a good medical oncologist and his or her team, what the risks and benefits for this preventive surgery are for them," she added.
The key to making this decision is, "given the risks and the benefits, what will allow this woman to live her life fully?" Smith said.
Whatever the decision, Geiger said, concern about recurrent cancer remains, although it may be lessened.
In the study, "about half of those who had the prophylactic [preventive] mastectomy on the other breast that wasn't cancerous still remained concerned about the possibility of recurrent cancer, compared to 75 percent of those who left the healthy breast alone," the Wake Forest researcher said. While preventive procedures reduce the risk of recurrent cancer by up to about 95 percent, Geiger said, a risk always remains, because it is impossible to remove all breast tissue.
SOURCES: Ann Geiger, Ph.D., associate professor, public health sciences, Wake Forest University Baptist Medical Center School of Medicine, Winston-Salem, N.C; Julia Smith, M.D., Ph.D., director, New York University Cancer Institute's Breast Cancer Screening and Prevention Program, and director, Lynne Cohen Breast Cancer Preventive Care Program, NYU Cancer Institute and Bellevue Hospital, New York City; March 20, 2006, Journal of Clinical Oncology
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