Sexual abuse in childhood and postoperative depression in women with breast cancer who opt for immediate reconstruction after mastectomy.
BACKGROUND
Breast reconstruction is routinely offered to women who undergo mastectomy for breast cancer. However, patient-reported outcomes are mixed. Child abuse has enduring effects on adults' well-being and body image. As part of a study into damaging effects of abuse on adjustment  to breast cancer, we examined: (i) whether women with history of abuse would be more likely than other women to opt for reconstruction; and (ii) whether mood problems in women opting for reconstruction can be explained by greater prevalence of abuse.


METHODS
We recruited 355  women within 2-4 days after surgery for primary breast cancer; 104 had mastectomy alone and 29 opted for reconstruction. Using standardised questionnaires, women self-reported emotional distress and recollections of childhood sexual abuse. Self-report of distress was repeated 12 months  later.


RESULTS
Women who had reconstruction were younger than those who did not. Controlling for this, they reported greater prevalence of abuse and more distress than those having mastectomy alone. They were also more depressed postoperatively, and this effect remained significant after  controlling for abuse.


CONCLUSIONS
One interpretation of these findings is that history of abuse influences women's decisions about responding to the threat of mastectomy, but it is premature to draw inferences for practice until the findings are replicated. If they are replicated, it  will be important to recognise increased vulnerability of some patients who choose reconstruction. Studying the characteristics and needs of women who opt for immediate reconstruction and examining the implications for women's adjustment should be a priority for research.
Breast Unit, Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital Trust, Brownlow Hill, Liverpool, UK. l.k.clark@liv.ac.uk
Louise
L
Clark
Christopher
C
Holcombe
Jonathan
J
Hill
Margorit Rita
MR
Krespi-Boothby
Jean
J
Fisher
Joanna
J
Seward
Peter
P
Salmon
D000328:Adult; D001008:Anxiety Disorders / Q000209:etiology; D001943:Breast Neoplasms / Q000523:psychology / Q000601:surgery*; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology*; D002755:Choice Behavior; D003866:Depressive Disorder / Q000523:psychology*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000523:psychology*; D008408:Mastectomy / Q000523:psychology; D008875:Middle Aged; D011183:Postoperative Complications / Q000523:psychology*; D013997:Time Factors