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AlHilli MM, Batur P, Hurley K, Al-Hilli Z, Coombs D, Schwarz G, Djohan R, Marquard J, Ashton K, Pederson HJ. Comprehensive Care of Women With Genetic Predisposition to Breast and Ovarian Cancer. Mayo Clin Proc 2023; 98:597-609. [PMID: 36870859 DOI: 10.1016/j.mayocp.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 12/16/2022] [Accepted: 01/03/2023] [Indexed: 03/06/2023]
Abstract
Women at risk for hereditary breast and ovarian cancer syndromes are frequently seen in primary care and gynecology clinics. They present with a distinctive set of clinical and emotional needs that revolve around complex risk management discussions and decision making. The care of these women calls for the creation of individualized care plans that facilitate adjustment to the mental and physical changes associated with their choices. This article provides an update on comprehensive evidence-driven care of women with hereditary breast and ovarian cancer. The aim of this review is to aid clinicians in identifying those at risk for hereditary cancer syndromes and provide practical advice on patient-centered medical and surgical risk management. Topics of discussion include enhanced surveillance, preventive medications, risk-reducing mastectomy and reconstruction, risk-reducing bilateral salpingo-oophorectomy, fertility, sexuality, and menopausal management, with attention to the importance of psychological support. High-risk patients may benefit from a multidisciplinary team that provides realistic expectations with consistent messaging. The primary care provider must be aware of the special needs of these patients and the consequences of their risk management interventions.
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Affiliation(s)
- Mariam M AlHilli
- Department of Subspecialty Care for Women's Health, Division of Gynecologic Oncology, Ob/Gyn & Women's Health Institute, Cleveland Clinic, Cleveland, OH; Department of Subspecialty Care for Women's Health, Ob/Gyn & Women's Health Institute, Cleveland Clinic, Cleveland, OH.
| | - Pelin Batur
- Department of Subspecialty Care for Women's Health, Ob/Gyn & Women's Health Institute, Cleveland Clinic, Cleveland, OH
| | - Karen Hurley
- Center for Behavioral Health, Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Zahraa Al-Hilli
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Demetrius Coombs
- Center for Behavioral Health, Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, Cleveland, OH; Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - Graham Schwarz
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - Risal Djohan
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | | | - Kathleen Ashton
- Breast Center, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Holly J Pederson
- Breast Center, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
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Torrisi C. Body Image in BRCA-Positive Young Women Following Bilateral Risk-Reducing Mastectomy: A Review of the Literature. Front Psychol 2021; 12:778484. [PMID: 34975666 PMCID: PMC8716694 DOI: 10.3389/fpsyg.2021.778484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background/Significance: The presence of a breast cancer (BRCA) gene mutation increases a woman’s lifetime risk of developing breast cancer. Bilateral risk-reducing mastectomy is a proactive treatment option which lowers that risk. However, breast removal can create a change in physical appearance. It is unclear if BRCA-positive women undergoing this surgery in young adulthood, a life stage where intimate relationships, families, and careers are being established, have the same experience with body image as women in later stages of life.Purpose: The aim of this literature review is to assess how bilateral risk-reducing mastectomy impacts body image in young BRCA-positive women less than 40 years of age, with no history of breast cancer.Methods: Database searches were performed, yielding 402 results. Studies were considered if participants had an increased lifetime breast cancer risk/BRCA-positive diagnosis and history of bilateral risk-reducing mastectomy, body image was evaluated, and mean age was less than 40 years. A total of three qualitative studies and three quantitative studies were identified as relevant for this review.Results: A dearth of information exists on body image in young women following bilateral risk-reducing mastectomy. It was found in this review that some women experienced a decline in body image following surgery, while in others body image was maintained or improved.Conclusion: Understanding factors that impact body image following this risk-reducing surgery will allow clinicians to support this unique population. Open and informative discussion should be encouraged with young women considering, or who have undergone, bilateral risk-reducing mastectomy.
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Glassey R, O'Connor M, Ives A, Saunders C, Hardcastle SJ. Influences on Satisfaction with Reconstructed Breasts and Intimacy in Younger Women Following Bilateral Prophylactic Mastectomy: a Qualitative Analysis. Int J Behav Med 2019; 25:390-398. [PMID: 29713993 DOI: 10.1007/s12529-018-9722-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this study was to explore the influences on satisfaction with reconstructed breasts and intimacy following bilateral prophylactic mastectomy (BPM) in younger women (< 35) with a strong family history of breast cancer. METHODS Twenty-six women who had undergone BPM between 1 and6 years ago were recruited from New Zealand and Australia through a genetics clinic, registry, research cohort, and online (Mage = 31). Twenty-three were BRCA mutation carriers. Qualitative interviews guided by interpretative phenomenological analysis were conducted. RESULTS Four themes were identified: satisfaction with breasts before surgery, outcome expectations, type of mastectomy, and open communication. Women who liked their breasts pre-BPM appeared less satisfied with their reconstructed breasts post-surgery, and women who disliked their breasts before BPM were more satisfied with their reconstructed breasts. Women with unrealistic expectations concerning the look and feel of reconstructed breasts were often unhappy with their reconstructed breasts and felt they did not meet their expectations. Unrealistic photos of breast reconstruction and satisfactory communication of realistic outcome expectations by surgeons or psychologists also appeared to influence satisfaction. Communication with partners prior to BPM appeared to improve satisfaction with intimacy post-BPM. CONCLUSIONS The findings suggest that satisfaction with reconstructed breasts for younger women post-BPM appeared to be influenced by realistic outcome expectations and communication with others concerning reconstructed breast appearance and intimacy post-BPM. Implications for practice include discussion of realistic reconstructed breast appearance, referral to a psychologist to discuss sensitive issues, and accurate communication of surgical risks and consequences.
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Affiliation(s)
- Rachael Glassey
- Medical School, The University of Western Australia, Perth, Australia.
| | - Moira O'Connor
- School of Psychology, Curtin University, Perth, Australia
| | - Angela Ives
- Medical School, The University of Western Australia, Perth, Australia
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Bloom DL, Chapman BM, Wheeler SB, McGuire KP, Lee CN, Weinfurt K, Rosenstein DL, Plichta JK, Jacobson Vann JC, Hwang ES. Reframing the conversation about contralateral prophylactic mastectomy: Preparing women for postsurgical realities. Psychooncology 2018; 28:394-400. [PMID: 30500102 DOI: 10.1002/pon.4955] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/20/2018] [Accepted: 11/26/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Women with unilateral, early-stage breast cancer and low genetic risk are increasingly opting for contralateral prophylactic mastectomy (CPM), a concerning trend because CPM offers few clinical benefits while increasing risks of surgical complications. Few qualitative studies have analyzed factors motivating this irreversible decision. Using qualitative methods, this study sought to understand women's decision making and the impact of CPM on self-confidence, sense of femininity, sexual intimacy, and peace of mind. METHODS Women who had CPM within the last 10 years were recruited to participate in the study. We conducted a thematic analysis of the data. RESULTS Forty-five women were interviewed. When making the decision for CPM, most had incomplete knowledge of potential negative outcomes. However, all believed CPM had more benefits than harms and would confer the most peace of mind and the fewest regrets should cancer return. They knew their contralateral breast cancer risk was low but were not persuaded by statistics. They wanted to do everything possible to reduce their risk of another breast cancer, even by a minimal amount, but most reported paying an unexpectedly high price for this small reduction in risk. Nevertheless, 41 of 45 reported that they would make the same decision again. CONCLUSIONS These findings highlight an opportunity for physicians to reframe the conversation to focus on the patient experience of the tradeoffs of CPM rather than statistical odds of future cancers. Our findings suggest that more data may not dissuade women from CPM but may better prepare them for its outcomes.
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Affiliation(s)
- Diane L Bloom
- Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brittany M Chapman
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Stephanie B Wheeler
- Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kandace P McGuire
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Clara N Lee
- Department of Plastic Surgery, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Kevin Weinfurt
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Donald L Rosenstein
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, North Carolina.,Department of Surgery, Duke Cancer Institute, Durham, North Carolina
| | - Julie C Jacobson Vann
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina.,Department of Surgery, Duke Cancer Institute, Durham, North Carolina
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Esposto DS, Palinkas M, Gonçalves LMN, Vasconcelos PBD, Ferreira VTK, Guirro ECDO, Siéssere S, Regalo SCH. Effect of Breast Cancer Treatment on the Stomatognathic System. Braz Dent J 2018; 29:368-373. [PMID: 30462763 DOI: 10.1590/0103-6440201801791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/15/2018] [Indexed: 11/21/2022] Open
Abstract
Breast cancer is the most common cancer affecting women in the world and provides functional changes in the human body. Evaluate women submitted to unilateral mastectomy, through electromyographic activity (mandibular rest, right and left laterality, protrusion, maximum voluntary contraction with and without Parafilm, habitual and non-habitual mastication) and thickness (rest and maximum voluntary contraction) of the right temporal muscle (RT), left temporal (LT), right masseter (RM) and left masseter (LM), also the molar bite force (right and left) and compare the data with healthy women. Material and Methods: 32 women were divided into two groups: unilateral mastectomy group (MG), average ± standard deviation 56.50±14.50 years (n=16) and without the disease group (CG), average ± standard deviation 56.56±14.15 years (n=16). The normalized electromyographic data, muscle thickness and maximal molar bite force were tabulated and submitted to statistical analysis (SPSS 21.0; student t test, p≤0.05). Significant statistical differences between MG and CG were found in right laterality, for RM (p=0.02); left laterality, for LT (p=0.01); chewing with peanuts, for RM (p=0.04); chewing with raisins, for LM (p=0.04) and right molar bite force (p=0.03). There was no statistically significant difference between MG and CG for muscle thickness. The results of this study suggest that women undergoing unilateral mastectomy may present functional changes, with emphasis on muscular hyperactivity, lower masticatory efficiency and lower maxillary bite force.
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Affiliation(s)
- Danilo Stefani Esposto
- Department of Biomechanics, Medicine and Locomotive Apparatus Rehabilitation, Ribeirão Preto Medical School, USP- Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Marcelo Palinkas
- Department Morphology, Physiology and Basic Pathology, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Ligia Maria Napolitano Gonçalves
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Paulo Batista de Vasconcelos
- Department Morphology, Physiology and Basic Pathology, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Elaine Caldeira de Oliveira Guirro
- Department of Biomechanics, Medicine and Locomotive Apparatus Rehabilitation, Ribeirão Preto Medical School, USP- Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Selma Siéssere
- Department Morphology, Physiology and Basic Pathology, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Simone Cecilio Hallak Regalo
- Department Morphology, Physiology and Basic Pathology, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Braude L, Kirsten L, Gilchrist J, Juraskova I. The development of a template for psychological assessment of women considering risk-reducing or contralateral prophylactic mastectomy: A national Delphi consensus study. Psychooncology 2018; 27:2349-2356. [PMID: 29966172 DOI: 10.1002/pon.4830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/18/2018] [Accepted: 06/21/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Risk-reducing mastectomies (RRM) and contralateral prophylactic mastectomies (CPM) are increasingly prevalent strategies to reduce breast cancer risk. Given the associated physical and emotional challenges, presurgical psychological assessment is frequently recommended for this population, yet limited research exists to guide this. This study aimed to reach a consensus on the most relevant content and format of a psychological consultation prior to RRM/CPM. METHODS A modified two-round online Delphi study was conducted Australia-wide. Expert participants (n = 25), including psychologists, surgeons, nurses, oncologists, genetic specialists, and researchers completed a round-one survey, informed by a literature review, previous qualitative study and expert clinicians' input. This required participants to rate their agreement with 36 statements regarding potential content of a psychological consultation and provide feedback on format/structure. A round-two survey comprised items that had not reached consensus and six new items suggested by participants. Parameters for statement consensus were set a priori at >75% agreement. RESULTS Expert participants indicated agreement with the majority of statements (39/42, 92.8%), endorsing that the assessment should include (1) patient understanding of the RRM/CPM procedure/cancer risk, (2) potential physical/emotional impact of surgery, (3) informed decision-making, and (4) past/current psychological issues (anxiety and body image). A provisional assessment template and user manual is provided. CONCLUSIONS This research culminated in a consensus-based template to guide psychological assessment of women considering RRM/CPM. This enables health professionals to assess suitability for surgery and preempt challenges within a standardised framework. Future evaluation of the acceptability and effectiveness of the template in clinical settings is warranted.
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Affiliation(s)
- Lucy Braude
- School of Psychology, The University of Sydney, Camperdown, NSW, Australia
| | - Laura Kirsten
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Camperdown, NSW, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Camperdown, NSW, Australia.,Nepean Cancer Care Centre, Sydney West Cancer Network, Kingswood, NSW, Australia
| | - Jemma Gilchrist
- Mind My Health Clinical Psychology, Norwest Private Hospital, NSW, Australia
| | - Ilona Juraskova
- School of Psychology, The University of Sydney, Camperdown, NSW, Australia.,Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Camperdown, NSW, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Camperdown, NSW, Australia
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Glassey R, Hardcastle SJ, O'Connor M, Ives A, Saunders C. Perceived influence of psychological consultation on psychological well-being, body image, and intimacy following bilateral prophylactic mastectomy: A qualitative analysis. Psychooncology 2017; 27:633-639. [PMID: 28945295 DOI: 10.1002/pon.4558] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/14/2017] [Accepted: 09/15/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study explored whether psychological consultation offered to women prior to bilateral prophylactic mastectomy (BPM) appeared to provide psychosocial benefit to younger women (<35 years) at high risk of developing breast cancer due to a mutation or family history. METHODS Qualitative interviews guided by interpretative phenomenological analysis were conducted retrospectively with 26 women who had undergone BPM. Participants were recruited from New Zealand and Australia, via a genetics clinic, registry, research cohort, and online. RESULTS Three themes were identified: psychological well-being and adjustment, satisfaction with intimacy, and body image. Participants that had seen a psychologist reported being more prepared for BPM and appeared to adjust positively post-surgery. They appeared to have improved psychological well-being, reported satisfaction with intimacy, and a more positive body image, compared with those who had no support. CONCLUSIONS Women who undergo psychological consultation prior to BPM appear to adjust positively after surgery. Implications for practice include standard psychological consultation for younger women (>35 years) considering BPM.
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Affiliation(s)
- Rachael Glassey
- Medical School, The University of Western Australia, Perth, Australia
| | - Sarah J Hardcastle
- Health Psychology and Behavioural Medicine Research Group, School of Psychology, Curtin University, Perth, Australia
| | - Moira O'Connor
- Health Psychology and Behavioural Medicine Research Group, School of Psychology, Curtin University, Perth, Australia
| | - Angela Ives
- Medical School, The University of Western Australia, Perth, Australia
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- kConFab, Research Department, Peter MacCallum Cancer Center, Melbourne, Australia.,The Sir Peter MacCallum Department of Oncology University of Melbourne, Parkville, Australia
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Bahcivan O, Altundag K. Possible external factors in Australia when referring patients who consider risk-reducing mastectomies (RRM) and contralateral prophylactic mastectomies (CPM) to psychologists in oncology care. Breast 2017; 35:222. [PMID: 28209255 DOI: 10.1016/j.breast.2017.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/05/2017] [Indexed: 11/26/2022] Open
Affiliation(s)
- Ozan Bahcivan
- Family Haven/SA Pregnancy & Parenting Counselling Services, Adelaide, Australia.
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