title: Long-term outcomes of risk-reducing surgery in unaffected women at increased familial risk of breast and/or ovarian cancer.
abstract: This study prospectively investigated long-term psychosocial outcomes for women who opted for risk-reducing mastectomy (RRM) and/or risk-reducing salpingo-oophorectomy (RRSO). Unaffected women from high-risk breast cancer families who had completed baseline questionnaires for an existing study and subsequently underwent RRM and/or RRSO, completed measures of perceived breast and ovarian cancer risk, anxiety, depression, cancer-related anxiety, body image, sexual functioning, menopausal symptoms, use of hormone replacement therapy and decision regret 3 years post-surgery. Outcomes were compared to age- and risk-matched controls. Participants (N = 233) were 17 women who had RRM (39 controls), 38 women who had RRSO (94 controls) and 15 women who had RRM + RRSO (30 controls). Women who underwent RRM and those who underwent RRM + RRSO reported reductions in perceived breast cancer risk and perceived breast and ovarian cancer risk respectively, compared to their respective controls. RRM women reported greater reductions in cancer-related anxiety compared with both controls and RRSO women. RRSO women reported more sexual discomfort than controls and more urogenital menopausal symptoms than controls and RRM only women. No differences in general anxiety, depression or body image were observed. Regret was associated with greater reductions in body image since surgery and more sexual discomfort, although overall regret levels were low. Women who undergo RRM experience psychological benefits associated with reduced breast cancer risk. Although women who undergo RRSO experience some deterioration in sexual and menopausal symptoms, they do not regret their surgery decision. It is vital that women considering these procedures receive detailed information about potential psychosocial consequences.
authors.affiliation: Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Heiniger
authors.forename: Phyllis N
authors.initials: PN
authors.lastname: Butow
authors.forename: Joseph
authors.initials: J
authors.lastname: Coll
authors.forename: Tracey
authors.initials: T
authors.lastname: Bullen
authors.forename: Judy
authors.initials: J
authors.lastname: Wilson
authors.forename: Brandi
authors.initials: B
authors.lastname: Baylock
authors.forename: Bettina
authors.initials: B
authors.lastname: Meiser
authors.forename: Melanie A
authors.initials: MA
authors.lastname: Price
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000235:genetics / Q000517:prevention & control*; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects / Q000523:psychology; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000235:genetics / Q000517:prevention & control*; D010052:Ovariectomy / Q000009:adverse effects / Q000523:psychology; D065286:Prophylactic Surgical Procedures / Q000009:adverse effects / Q000523:psychology*; D058994:Salpingectomy / Q000009:adverse effects / Q000523:psychology; D013995:Time