title: Quality of life after bilateral prophylactic mastectomy.
abstract: BACKGROUND
  Bilateral prophylactic mastectomy in women with increased breast cancer risk dramatically reduces breast cancer occurrence but little is known about psychosocial outcomes.
  
  
  METHODS
  To examine long-term quality of life after bilateral prophylactic mastectomy, we mailed surveys to 195 women who had the procedure from 1979 to 1999 and to a random sample of 117 women at increased breast cancer risk who did not have the procedure. Measures were modeled on or drawn directly from validated instruments designed to assess quality of life, body image, sexuality, breast cancer concerns, depression, health perception, and demographic characteristics. We used logistic regression to examine associations between quality of life and other domains.
  
  
  RESULTS
  The response rate was 58%, with 106 women with and 62 women without prophylactic mastectomy returning complete surveys. Among women who underwent bilateral prophylactic mastectomy, 84% were satisfied with their decision to have the procedure; 61% reported high contentment with quality of life compared with an identical 61% of women who did not have the procedure (P = 1.0). Among all subjects, diminished contentment with quality of life was not associated with bilateral prophylactic mastectomy but with dissatisfaction with sex life (adjusted ratio [OR] = 2.5, 95% confidence interval [CI] = 1.0-6.2), possible depression (CES-D > 16, OR = 4.9, CI = 2.0-11.8), and poor or fair general health perception (OR = 8.3, 95% CI = 2.4-29.0).
  
  
  CONCLUSIONS
  The majority of women reported satisfaction with bilateral prophylactic mastectomy and experienced psychosocial outcomes similar to women with similarly elevated breast cancer risk who did not undergo prophylactic mastectomy. Bilateral prophylactic mastectomy appears to neither positively nor negatively impact long-term psychosocial outcomes.
authors.affiliation: Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena, California 91188, USA. ageiger@wfubmc.edu
authors.forename: Ann M
authors.initials: AM
authors.lastname: Geiger
authors.forename: Larissa
authors.initials: L
authors.lastname: Nekhlyudov
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Herrinton
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Rolnick
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Greene
authors.forename: Carmen N
authors.initials: CN
authors.lastname: West
authors.forename: Emily L
authors.initials: EL
authors.lastname: Harris
authors.forename: Joann G
authors.initials: JG
authors.lastname: Elmore
authors.forename: Andrea
authors.initials: A
authors.lastname: Altschuler
authors.forename: In-Liu A
authors.initials: IL
authors.lastname: Liu
authors.forename: Suzanne W
authors.initials: SW
authors.lastname: Fletcher
authors.forename: Karen M
authors.initials: KM
authors.lastname: Emmons
mesh_terms: D000328:Adult; D000368:Aged; D001941:Breast Diseases / Q000601:surgery; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008408:Mastectomy / Q000523:psychology*; D008875:Middle Aged; D011788:Quality of Life; D011897:Random Allocation; D012307:Risk Factors