title: Standard psychological consultations and follow up for women at increased risk of hereditary breast cancer considering prophylactic mastectomy.
abstract: BACKGROUND
  Women at increased (genetic) risk of breast cancer have to weigh the personal pros and cons of prophylactic mastectomy (PM) as an option to reduce their cancer risk. So far, no routine referral to a psychologist has been investigated for women considering PM. Aim of this study was to asses: 1) the acceptance of the offer of a standard psychological consultation as part of pre-surgical decision-making in high-risk women, 2) reasons for PM and reasons for postponing it, 3) the need for additional psychological interventions, and factors associated, and 4) the frequency of psychiatric/psychological treatment history.
  
  
  METHODS
  During a 30 months period, women at high risk considering PM were offered a psychological consultation. The content of these, and follow-up, consultations were analyzed.
  
  
  RESULTS
  Most women (70 out of 73) accepted the psychological consultation, and 81% proceeded with PM. Main reasons for undergoing PM were to reduce anxiety about cancer, and to reduce the cancer risk. Uncertainty about surgery and the need for further information were the reasons given most frequently for postponing PM. Additional psychological support was given to 31% before and 14% after PM. The uptake of additional support was significantly higher in women with a BRCA1/2 mutation. A history of psychiatric/psychological treatment was present in 36%, mainly consisting of depression and grief after death of a mother.
  
  
  CONCLUSIONS
  The uptake-rate of the standard psychological consultation indicates a high level of acceptability of this service for women deciding about PM. Since anxiety is one of the main reasons for considering PM, and depression and grief were present in a third, a standard consultation with a psychologist for high-risk women considering PM may be indicated. This may help them arrive at an informed decision, to detect and manage psychological distress, and to plan psychological support services.
authors.affiliation: Department of Psychosocial Care, Family Cancer Clinic, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands. m.tan@erasmusmc.nl
authors.forename: Murly B M
authors.initials: MB
authors.lastname: Tan
authors.forename: Eveline M A
authors.initials: EM
authors.lastname: Bleiker
authors.forename: Marian B E
authors.initials: MB
authors.lastname: Menke-Pluymers
authors.forename: Arthur R
authors.initials: AR
authors.lastname: Van Gool
authors.forename: Silvia
authors.initials: S
authors.lastname: van Dooren
authors.forename: Bert N
authors.initials: BN
authors.lastname: Van Geel
authors.forename: Madeleine M A
authors.initials: MM
authors.lastname: Tilanus-Linthorst
authors.forename: Karina C M
authors.initials: KC
authors.lastname: Bartels
authors.forename: Jan G M
authors.initials: JG
authors.lastname: Klijn
authors.forename: Cecile T M
authors.initials: CT
authors.lastname: Brekelmans
authors.forename: Caroline
authors.initials: C
authors.lastname: Seynaeve