Support needs and acceptability of psychological and peer consultation: attitudes of 108 women who had undergone or were considering prophylactic mastectomy.
OBJECTIVE
Prophylactic mastectomy (PM) offers 90% or greater reduction in risk of breast cancer to women at increased hereditary risk. Nonetheless, acceptance in North America is low (0-27%) and 25-50% of women electing surgery report psychological distress and/or difficulty adapting following PM. Most women also report reduced cancer worry postoperatively. Psychological consultation to aid decision-making and post-surgical coping is not routinely offered. This retrospective, cross-sectional study explored interest in and acceptability of psychological consultation for issues related to PM among 108 women who had undergone or were considering surgery.


METHODS
Qualitative interviews were conducted with 26 healthy women who had undergone prophylactic mastectomy of both (bilateral) breasts (BPM), 45 women who had undergone prophylactic mastectomy of one breast (unilateral contralateral) (UPM) after diagnosis of invasive breast cancer in the other breast or ductal carcinoma in situ (DCIS), and 37 women who were considering having PM surgery.


RESULTS
Of the women who had undergone PM, more than half felt pre-surgical psychological consultation was advisable; nearly 2/3 thought post-surgical psychological consultation would be helpful. All women currently considering PM believed psychological consultation would aid decision-making and preparation for surgery. Strong support was reported in all groups for the emotional and informational value of speaking with a woman who had previously undergone PM.


CONCLUSIONS
Narratives illustrate the nature and intensity of the need for psychological support and describe preferences for the role of the psychologist. Suggestions are offered for integration of psychological services for women deciding about or adapting to PM.
Patenaude
Andrea F
AF
Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA. andrea patenaude@dfci.harvard.edu
Orozco
Sara
S
Li
Xiaochun
X
Kaelin
Carolyn M
CM
Gadd
Michelle
M
Matory
Yvedt
Y
Mayzel
Kathleen
K
Roche
Constance A
CA
Smith
Barbara L
BL
Farkas
Walden
W
Garber
Judy E
JE
D000223:Adaptation, Psychological; D000328:Adult; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000235:genetics / Q000517:prevention & control*; D003657:Decision Making; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006801:Humans; D007398:Interpersonal Relations; D008408:Mastectomy / Q000523:psychology*; D008875:Middle Aged; D033262:Narration; D010379:Peer Group; D017354:Point Mutation / Q000235:genetics; D040242:Risk Reduction Behavior; D012944:Social Support; D011795:Surveys and Questionnaires