1
|
Hamid SA, Bakkila B, Schultz KS, Grimshaw AA, Gunderson CG, Godfrey EL, Lee C, Berger E, Rosenberg S, Greenup RA. "Peace of Mind" After Mastectomy: A Scoping Review. Ann Surg Oncol 2024; 31:5168-5179. [PMID: 38717543 DOI: 10.1245/s10434-024-15360-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/09/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Many women eligible for breast conservation therapy (BCT) elect unilateral mastectomy (UM) with or without contralateral prophylactic mastectomy (CPM) and cite a desire for "peace of mind." This study aimed to characterize how peace of mind is defined and measured and how it relates to surgical choice. METHODS Nine databases were searched for relevant articles through 8 October 2023, and data were extracted from articles meeting the inclusion criteria. RESULTS The inclusion criteria were met by 20 studies. Most were prospective cohort studies (65%, 13/20). In the majority of the studies (72%, 13/18), Non-Hispanic white/Caucasian women comprised 80 % or more of the study's sample. Almost half of the studies used the phrase "peace of mind" in their publication (45%, 9/20), and few directly defined the construct (15%, 3/20). Instead, words representing an absence of peace of mind were common, specifically, "anxiety" (85%, 17/20), "fear" (75%, 15/20), and "concern" (75%, 15/20). Most of the studies (90%, 18/20) measured peace of mind indirectly using questionnaires validated for anxiety, fear, worry, distress, or concern, which were administered at multiple postoperative time points (55%, 11/20). Most of the studies (95%, 18/19) reported at least one statistically significant result showing no difference in peace of mind between BCT, UM, and/or CPM at their latest time of assessment. CONCLUSION Peace of mind is largely framed around concepts that suggest its absence, namely, anxiety, fear, and concern. Existing literature suggests that peace of mind does not differ among average-risk women undergoing BCT, UM, or CPM. Shared surgical decisions should emphasize at least comparable emotional and/or psychosocial well-being between CPM and breast conservation.
Collapse
Affiliation(s)
- Safraz A Hamid
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
- Yale National Clinician Scholars Program, New Haven, CT, USA.
| | - Baylee Bakkila
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Kurt S Schultz
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
- Yale Investigative Medicine Program, New Haven, CT, USA
| | - Alyssa A Grimshaw
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Craig G Gunderson
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Clara Lee
- Department of Surgery, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Elizabeth Berger
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | | | - Rachel A Greenup
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
2
|
Singh P, Agnese D, Amin M, Barrio AV, Botty Van den Bruele A, Burke E, Danforth DN, Dirbas FM, Eladoumikdachi F, Kantor O, Kumar S, Lee MC, Matsen C, Nguyen TT, Ozmen T, Park KU, Plichta JK, Reyna C, Showalter SL, Styblo T, Tranakas N, Weiss A, Laronga C, Boughey J. Society of Surgical Oncology Breast Disease Site Working Group Statement on Contralateral Mastectomy: Indications, Outcomes, and Risks. Ann Surg Oncol 2024; 31:2212-2223. [PMID: 38261126 DOI: 10.1245/s10434-024-14893-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/29/2023] [Indexed: 01/24/2024]
Abstract
Rates of contralateral mastectomy (CM) among patients with unilateral breast cancer have been increasing in the United States. In this Society of Surgical Oncology position statement, we review the literature addressing the indications, risks, and benefits of CM since the society's 2017 statement. We held a virtual meeting to outline key topics and then conducted a literature search using PubMed to identify relevant articles. We reviewed the articles and made recommendations based on group consensus. Patients consider CM for many reasons, including concerns regarding the risk of contralateral breast cancer (CBC), desire for improved cosmesis and symmetry, and preferences to avoid ongoing screening, whereas surgeons primarily consider CBC risk when making a recommendation for CM. For patients with a high risk of CBC, CM reduces the risk of new breast cancer, however it is not known to convey an overall survival benefit. Studies evaluating patient satisfaction with CM and reconstruction have yielded mixed results. Imaging with mammography within 12 months before CM is recommended, but routine preoperative breast magnetic resonance imaging is not; there is also no evidence to support routine postmastectomy imaging surveillance. Because the likelihood of identifying an occult malignancy during CM is low, routine sentinel lymph node surgery is not recommended. Data on the rates of postoperative complications are conflicting, and such complications may not be directly related to CM. Adjuvant therapy delays due to complications have not been reported. Surgeons can reduce CM rates by encouraging shared decision making and informed discussions incorporating patient preferences.
Collapse
Affiliation(s)
- Puneet Singh
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | | | | | - Andrea V Barrio
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | | | - Erin Burke
- University of Kentucky, Lexington, KY, USA
| | | | | | | | - Olga Kantor
- Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Shicha Kumar
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | | | | | - Tolga Ozmen
- Massachusetts General Hospital, Boston, MA, USA
| | - Ko Un Park
- Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | - Anna Weiss
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | |
Collapse
|
3
|
Amiri S, Robison J, Pflugeisen C, Monsivais P, Amram O. Travel Burden to Cancer Screening and Treatment Facilities Among Washington Women: Data From an Integrated Healthcare Delivery System. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2023:2752535X231215881. [PMID: 37975231 DOI: 10.1177/2752535x231215881] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE To characterize distance traveled for breast cancer screening and to sites of service for breast cancer treatment, among rural and urban women served by a Washington State healthcare network. METHODS Data for this study came from one of the largest not-for-profit integrated healthcare delivery systems in Washington State. Generalized linear mixed models with gamma log link function were used to examine the associations between travel distance and sociodemographic and contextual characteristics of patients. RESULTS Median travel distance for breast cancer screening facilities, hematologist/oncologists, radiation oncologists, or surgeons was 11, 19, 23, or 11 miles, respectively. Travel distance to breast cancer screening or referral facilities was longer in non-core metropolitan ZIP codes compared to metropolitan ZIP codes. AI/AN and Hispanic women travelled longer distances to reach referral facilities compared to other racial and ethnic groups. CONCLUSION Disparities exist in travel distance to breast cancer screening and treatment. Further research is needed to describe sociodemographic and system level characteristics that contribute to such disparities and to discover novel approaches to alleviate this burden.
Collapse
Affiliation(s)
- Solmaz Amiri
- Institute for Research and Education to Advance Community Health (IREACH), Washington State University, Seattle, WA, USA
| | - Jeanne Robison
- Multicare Deaconess Cancer & Blood Specialty Centers, Spokane, WA, USA
| | | | - Pablo Monsivais
- Department of Nutrition and Exercise Physiology, Washington State University, Spokane, WA, USA
| | - Ofer Amram
- Department of Nutrition and Exercise Physiology, Washington State University, Spokane, WA, USA
| |
Collapse
|
4
|
Nash AL, Bloom DL, Chapman BM, Wheeler SB, McGuire KP, Lee CN, Weinfurt K, Rosenstein DL, Plichta JK, Vann JCJ, Hwang ES. Contralateral Prophylactic Mastectomy Decision-Making: The Partners' Perspective. Ann Surg Oncol 2023; 30:6268-6274. [PMID: 37573282 DOI: 10.1245/s10434-023-14022-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/14/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND The rate of contralateral prophylactic mastectomy (CPM) continues to rise despite no improvement in survival, an increased risk of surgical complications, and negative effects on quality of life. This study explored the experiences of the partners of women who undergo CPM. METHODS This study was part of an investigation into the factors motivating women with early-stage unilateral breast cancer and low genetic risk to opt for contralateral prophylactic mastectomy (CPM). Participating women were asked for permission to invite their partners to take part in interviews. In-depth interviews with partners were conducted using a semi-structured topic guide. A thematic analysis of the data was performed RESULTS: Of 35 partners, all men, 15 agreed to be interviewed. Most perceived their role to be strong and logical. Some hoped their wives would choose a bilateral mastectomy. All felt strongly that the final decision was up to their partners. The partners often framed the decision for CPM as one of life or death. Thus, any aesthetic effects were unimportant by comparison. The male partners had difficulty grasping the physical and emotional changes inherent in mastectomy, which made communicating about sexuality and intimacy very challenging for the couples. In the early recovery period, some noted the stress of managing home life. CONCLUSIONS The experiences of the male partners provide insight into how couples navigate complex treatment decision-making, both together and separately. There may be a benefit to including partners in pre- and post-surgical counseling to mitigate miscommunication regarding the expected oncologic and emotional outcomes related to CPM.
Collapse
Affiliation(s)
- Amanda L Nash
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.
| | - Diane L Bloom
- Department of Health Policy and Management, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Brittany M Chapman
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Kandace P McGuire
- Department of Surgery, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Clara N Lee
- Division of Health Services Management and Policy, Department of Plastic and Reconstructive Surgery, OSU Comprehensive Cancer Center, College of Medicine, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Kevin Weinfurt
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Donald L Rosenstein
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Julie C Jacobson Vann
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
5
|
Tyner TE, Freysteinson WM, Evans SC, Woo J. "My body, my choice": A qualitative study of women's mastectomy with flat closure experiences. Body Image 2023; 46:419-433. [PMID: 37573764 DOI: 10.1016/j.bodyim.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023]
Abstract
This qualitative study aimed to describe and explore the pre and post-mastectomy experiences of women choosing flat closure after a breast cancer diagnosis. Aesthetic flat closure creates a flat contoured chest wall after a mastectomy. There is limited research on women's flat closure experiences. To fill this gap, we interviewed 19 women (Mage = 53, range 31-72) with breast cancer who underwent a bilateral mastectomy with flat closure, examining decision-making, mirror-viewing, and flat closure experiences. Using a hermeneutic phenomenological design, we generated seven themes. Broadly, women choosing flat closure experienced pressure from their clinicians to undergo breast reconstruction. We found flat closure information to be consistently lacking. Mirror-viewing experiences of women obtaining suboptimal flat closure outcomes led to shattered expectations, mirror avoidance, psychological distress, and body image disturbances. Women negotiated their new reality by discovering ways to feel comfortable with their flat bodies. Regardless of surgical outcome, decision satisfaction was high. These findings illustrate the importance of bodily autonomy and supportive healthcare environments for women making flat closure decisions. Providing comprehensive information on all surgical options and addressing post-operative expectations can improve women's decision-making and mirror-viewing experiences and assist women in adapting to their new body image.
Collapse
Affiliation(s)
- Tracy E Tyner
- College of Nursing, Texas Woman's University, P.O. Box 425498, ASB 216, Denton, TX 76204-5498, USA.
| | - Wyona M Freysteinson
- Nelda C. Stark College of Nursing, Texas Woman's University, 6700 Fannin Street, Houston, TX 77030-2897, USA
| | - Stephanie C Evans
- Houston J. and Florence A. Doswell College of Nursing, Texas Woman's University, 5500 Southwestern Medical Avenue, Dallas, TX 75235-7299, USA
| | - Jennifer Woo
- Houston J. and Florence A. Doswell College of Nursing, Texas Woman's University, 5500 Southwestern Medical Avenue, Dallas, TX 75235-7299, USA
| |
Collapse
|
6
|
Schmidt MK, Kelly JE, Brédart A, Cameron DA, de Boniface J, Easton DF, Offersen BV, Poulakaki F, Rubio IT, Sardanelli F, Schmutzler R, Spanic T, Weigelt B, Rutgers EJT. EBCC-13 manifesto: Balancing pros and cons for contralateral prophylactic mastectomy. Eur J Cancer 2023; 181:79-91. [PMID: 36641897 PMCID: PMC10326619 DOI: 10.1016/j.ejca.2022.11.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/17/2022] [Accepted: 11/26/2022] [Indexed: 12/15/2022]
Abstract
After a diagnosis of unilateral breast cancer, increasing numbers of patients are requesting contralateral prophylactic mastectomy (CPM), the surgical removal of the healthy breast after diagnosis of unilateral breast cancer. It is important for the community of breast cancer specialists to provide meaningful guidance to women considering CPM. This manifesto discusses the issues and challenges of CPM and provides recommendations to improve oncological, surgical, physical and psychological outcomes for women presenting with unilateral breast cancer: (1) Communicate best available risks in manageable timeframes to prioritise actions; better risk stratification and implementation of risk-assessment tools combining family history, genetic and genomic information, and treatment and prognosis of the first breast cancer are required; (2) Reserve CPM for specific situations; in women not at high risk of contralateral breast cancer (CBC), ipsilateral breast-conserving surgery is the recommended option; (3) Encourage patients at low or intermediate risk of CBC to delay decisions on CPM until treatment for the primary cancer is complete, to focus on treating the existing disease first; (4) Provide patients with personalised information about the risk:benefit balance of CPM in manageable timeframes; (5) Ensure patients have an informed understanding of the competing risks for CBC and that there is a realistic plan for the patient; (6) Ensure patients understand the short- and long-term physical effects of CPM; (7) In patients considering CPM, offer psychological and surgical counselling before surgery; anxiety alone is not an indication for CPM; (8) Eliminate inequality between countries in reimbursement strategies; CPM should be reimbursed if it is considered a reasonable option resulting from multidisciplinary tumour board assessment; (9) Treat breast cancer patients at specialist breast units providing the entire patient-centred pathway.
Collapse
Affiliation(s)
- Marjanka K Schmidt
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands.
| | | | - Anne Brédart
- Institut Curie, Paris, France; Psychology Institute, Psychopathology and Health Process Laboratory UR4057, Paris City University, Paris, France
| | - David A Cameron
- Edinburgh University Cancer Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Breast Unit, Capio St. Göran's Hospital, Stockholm, Sweden
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Birgitte V Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital - Aarhus University, Aarhus N, Denmark
| | - Fiorita Poulakaki
- Breast Surgery Department, Athens Medical Center, Athens, Greece; Europa Donna - The European Breast Cancer Coalition, Milan, Italy
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Rita Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University Hospital Cologne, Cologne, Germany
| | - Tanja Spanic
- Europa Donna - The European Breast Cancer Coalition, Milan, Italy; Europa Donna Slovenia, Ljubljana, Slovenia
| | - Britta Weigelt
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emiel J T Rutgers
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| |
Collapse
|
7
|
Psychological factors and the uptake of preventative measures in BRCA1/2 pathogenic variant carriers: results of a prospective cohort study. Hered Cancer Clin Pract 2022; 20:38. [PMID: 36536421 PMCID: PMC9761978 DOI: 10.1186/s13053-022-00244-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Women carrying BRCA1/2 pathogenic variants are exposed to elevated risks of developing breast cancer (BC) and are faced by a complex decision-making process on preventative measures, i.e., risk-reducing mastectomy (RRM), and intensified breast surveillance (IBS). In this prospective cohort study we investigated the effect of anxiety, personality factors and coping styles on the decision-making process on risk management options in women with pathogenic variants in BRCA1/2. METHODS Breast cancer unaffected and affected women with a pathogenic variant in the BRCA1 or BRCA2 gene were psychologically evaluated immediately before (T0), 6 to 8 weeks (T1) and 6 to 8 months (T2) after the disclosure of their genetic test results. Uptake of RRM and IBS was assessed at T2. Psychological data were gathered using questionnaires on risk perception, personality factors, coping styles, decisional conflict, depression and anxiety, including the Hospital Anxiety and Depression Scale (HADS). We performed tests on statistical significance and fitted a logistic regression based on significance level. RESULTS A total of 98 women were included in the analysis. Baseline anxiety levels in women opting for RRM were high but decreased over time, while they increased in women opting for intensified breast surveillance (IBS). Elevated levels of anxiety after genetic test result disclosure (T1) were associated with the decision to undergo RRM (p < 0.01; OR = 1.2, 95% CI = 1.05-1.42), while personal BC history and personality factors seemed to be less relevant. CONCLUSIONS Considering psychosocial factors influencing the decision-making process of women with pathogenic variants in BRCA1/2 may help improving their genetic and psychological counselling. When opting for IBS they may profit from additional medical and psychological counselling. TRIAL REGISTRATION Retrospectively registered at the German Clinical Trials Register under DRKS00027566 on January 13, 2022.
Collapse
|
8
|
Thalji SZ, Cortina CS, Guo MS, Kong AL. Postoperative Complications from Breast and Axillary Surgery. Surg Clin North Am 2022; 103:121-139. [DOI: 10.1016/j.suc.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
9
|
Dai X, Wang X, Yang C, Huang M, Zhou Z, Qu Y, Cui X, Liu R, Chen C. Human fibroblasts facilitate the generation of iPSCs-derived mammary-like organoids. Stem Cell Res Ther 2022; 13:377. [PMID: 35902878 PMCID: PMC9330643 DOI: 10.1186/s13287-022-03023-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/28/2022] [Indexed: 12/18/2022] Open
Abstract
Background Breast cancer is the most common malignancy in women worldwide, and its treatment largely depends on mastectomy. Patients after mastectomy suffer from crippled body image, self-esteem, and quality of life. Post-mastectomy breast reconstruction can improve patients’ psychosocial health. Although silicone and fat have been widely used for breast reconstruction, they have remarkable limitations. Our study aimed to establish an improved method for breast reconstruction from human-induced pluripotent stem cells (iPSCs). Methods We used a two-step procedure to induce mammary-like organoids (MLOs) from iPSCs and applied transcriptome sequencing to analyze the gene expression profiles during the development process from embryoid bodies (mEBs) to MLOs. Moreover, we evaluated the in vitro effect of fibroblasts cell line HFF (human foreskin fibroblasts) on the size and morphology of MLOs and explored the in vivo effect of HFF on regeneration rate of MLOs. Results MLOs had a similar gene expression profile and morphogenesis as the normal mammary glands. Furthermore, the addition of HFF increases the branching ratio and organoid diameters and facilitates the formation of multiple cell layers duct-like structures in MLOs in vitro. Finally, orthotopical transplantation of the MLOs to cleared mammary gland fad pad of NSG mice showed that HFF increases the formation of mammary gland-like structures. Conclusions Fibroblasts facilitate iPSC-derived MLOs to generate mammary gland-like structures in both in vitro and in vivo conditions. Our findings lay a foundation for breast reconstruction by using iPSCs. Supplementary Information The online version contains supplementary material available at 10.1186/s13287-022-03023-7.
Collapse
Affiliation(s)
- Xueqin Dai
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, 650223, Yunnan, China.,Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, 650223, Yunnan, China
| | - Xinye Wang
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, 650223, Yunnan, China.,Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, 650223, Yunnan, China
| | - Chuanyu Yang
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, 650223, Yunnan, China
| | - Maobo Huang
- Biomedical Research Center, The First Hospital of Kunming (The Affiliated Calmette Hospital of Kunming Medical University), Kunming, 650224, China
| | - Zhongmei Zhou
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, 650223, Yunnan, China
| | - Ying Qu
- Department of Surgery, Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, 8700 Beverly Boulevard, Davis Building 2065, Los Angeles, CA, 90048, USA
| | - Xiaojiang Cui
- Department of Surgery, Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, 8700 Beverly Boulevard, Davis Building 2065, Los Angeles, CA, 90048, USA
| | - Rong Liu
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, 650223, Yunnan, China. .,Translational Cancer Research Center, Peking University First Hospital, Beijing, 100034, China.
| | - Ceshi Chen
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, 650223, Yunnan, China.
| |
Collapse
|
10
|
Pender K, Covington B. How Contralateral Prophylactic Mastectomy Does the Body, or Why Epistemology Alone Cannot Explain this Controversial Breast Cancer Treatment. THE JOURNAL OF MEDICAL HUMANITIES 2022; 43:141-158. [PMID: 32043198 DOI: 10.1007/s10912-020-09614-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Since the late 1990s, the use of contralateral prophylactic mastectomy (CPM) to treat unilateral breast cancer has been on the rise. Over the past two decades, dozens of studies have been conducted in order to understand this trend, which has puzzled and frustrated physicians who find it at odds with efforts to curb the surgical overtreatment of breast cancer, as well as with evidence-based medicine, which has established that the procedure has little oncologic benefit for most patients. Based on the work of Annemarie Mol and John Law, this paper argues that these efforts to understand increased CPM use are limited by the "epistemology problem" in medicine, or, in other words, the tendency to view healthcare controversies and decision making exclusively through the lenses of objective and subjective forms of knowledge. Drawing on public discourse about rationales for choosing CPM, we argue that this surgical trend cannot adequately be understood in terms of what doctors and patients know about breast cancer risk and how CPM affects that risk. In addition, it must be recognized as the outcome of how specific practices of screening, detection, and treatment do or enact the bodies of patients, producing tensions in their lives that cannot be remedied with better or better communicated information. Recognizing the embodied realities of these enactments and their effects on patient decision making, we maintain, is essential for physicians who want to avoid the paternalism that haunts breast cancer treatment in the US.
Collapse
Affiliation(s)
- Kelly Pender
- Virginia Tech, 232 Shanks Hall (0112), 181 Turner St. NW, Blacksburg, VA, 24061, USA.
| | - Brooke Covington
- Virginia Tech, 232 Shanks Hall (0112), 181 Turner St. NW, Blacksburg, VA, 24061, USA
| |
Collapse
|
11
|
Erdrich J, Cordova-Marks F, Monetathchi AR, Wu M, White A, Melkonian S. Disparities in Breast-Conserving Therapy for Non-Hispanic American Indian/Alaska Native Women Compared with Non-Hispanic White Women. Ann Surg Oncol 2022; 29:1019-1030. [PMID: 34490527 PMCID: PMC8724083 DOI: 10.1245/s10434-021-10730-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/12/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Little is known about the surgical patterns of American Indian/Alaska Native (AI/AN) breast cancer patients. The purpose of this study is to determine whether there are disparities in breast cancer surgery and radiation therapy between non-Hispanic AI/AN (NH-AI/AN) women and non-Hispanic White (NHW) women. METHODS Data from the National Program of Cancer Registries of the Centers for Disease Control and Surveillance, Epidemiology, and End Results were used for this cross-sectional study. Female patients with invasive breast cancer diagnosed 2010-2015 were stratified by race/ethnicity, surgical procedure, radiation, and region. Percentage distributions of mastectomy and lumpectomy were compared overall and by region and stage. RESULTS From 2010 to 2015 there were 3292 NH-AI/AN women and 165,225 NHW women diagnosed with breast cancer. For early stage (AJCC stage 1 and 2), NH-AI/AN women had overall significantly higher percentage of mastectomy (41% vs 34.4%, p < 0.001) and significantly lower percentage of lumpectomy (59% vs 65.6%) compared with NHW women, without significant differences in post-lumpectomy radiation (71% vs 70%). There were regional variations, notably in the Northern Plains, where the percentage of mastectomy for early-stage disease was 48.9% for NH-AI/AN women versus 35.9% for NHW women, and in Alaska with 47% for NH-AI/AN women versus 33.3% for NHW women (p < 0.001). There were no overall significant differences in type of surgery or radiation for late-stage disease between groups. CONCLUSION This is the first study to show disparities in surgical management of NH-AI/AN women with breast cancer. For early-stage disease, NH-AI/AN women undergo a higher percentage of mastectomy. Future clinical directions could focus on the factors that drive awareness, decision-making, and access to breast conservation.
Collapse
Affiliation(s)
- Jennifer Erdrich
- Division of Surgical Oncology, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA.
| | - Felina Cordova-Marks
- Department of Health Promotion Sciences, College of Public Health, University of Arizona, Tucson, USA
| | | | - Manxia Wu
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, USA
| | - Arica White
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, USA
| | - Stephanie Melkonian
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, USA
| |
Collapse
|
12
|
Qian C, Liang Y, Yang M, Bao SN, Bai JL, Yin YM, Yu H. Effect of breast-conserving surgery plus radiotherapy versus mastectomy on breast cancer-specific survival for early-stage contralateral breast cancer. Gland Surg 2021; 10:2978-2996. [PMID: 34804885 DOI: 10.21037/gs-21-413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/02/2021] [Indexed: 11/06/2022]
Abstract
Background Breast-conserving surgery followed by radiotherapy is recommended in most women with early-stage unilateral breast cancer. However, its role in contralateral breast cancer (CBC) patients remains unclear. This retrospective study aimed to evaluate the breast cancer-specific survival (BCSS) outcomes after breast-conserving surgery plus radiotherapy compared with mastectomy in women with early-stage (T1-2N0-1M0) CBC. Methods Data were extracted from the Surveillance, Epidemiology, and End Results database. BCSS was analyzed using the log-rank method, competing risks regression model, and propensity score matching method. Results A total of 9,336 early-stage CBC patients were included. After multivariable adjustment, no significant difference in BCSS was found between early-stage CBC patients undergoing breast-conserving surgery plus radiotherapy and those undergoing mastectomy [hazard ratio (HR) 1.11, 95% confidence interval (CI): 0.90-1.37, P=0.329]. BCSS was similar in both treatment groups and in the subgroups stratified by age at first primary breast cancer or CBC diagnosis (≤50, 51-60, and >60 years), time interval between cancers (<0.25, 0.25-4, 5-9, and ≤10 years), stage of first primary breast cancer, T classification of CBC, histology and hormone receptors status of both cancers (all P>0.05). Among patients with N1 disease at CBC diagnosis, breast-conserving surgery plus radiotherapy was associated with a boundary significantly improved BCSS (HR 1.45, 95% CI: 1.00-2.12, P=0.050). Among patients who underwent breast-conserving surgery for first primary cancer, bilateral mastectomy for contralateral cancer did not improve BCSS compared with breast-conserving surgery plus radiotherapy (P>0.05). There was no significant difference in BCSS between breast-conserving surgery plus radiotherapy and mastectomy plus radiotherapy (P>0.05). Stable results were obtained after propensity score matching. Conclusions Breast-conserving surgery plus radiotherapy did not significantly influence BCSS outcomes of patients with early-stage CBC. Bilateral mastectomy and mastectomy plus radiotherapy did not confer a survival advantage over breast-conserving surgery plus radiotherapy in these patients. Future prospective studies are necessary to expand on these results.
Collapse
Affiliation(s)
- Chao Qian
- Department of General Surgery, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Yan Liang
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Yang
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Sheng-Nan Bao
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian-Ling Bai
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yong-Mei Yin
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Yu
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| |
Collapse
|
13
|
Peipins LA, Dasari S, Rodriguez JL, White MC, Hodgson ME, Sandler DP. Employment After Breast Cancer Diagnosis and Treatment Among Women in the Sister and the Two Sister Studies. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:543-551. [PMID: 33387171 PMCID: PMC8485879 DOI: 10.1007/s10926-020-09951-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
Purpose Women undergoing diagnosis and treatment for breast cancer may face challenges in employment. We investigated the impact of demographic, clinical, workplace, and psychosocial characteristics on loss of employment after a breast cancer diagnosis and treatment. We further describe changes in work status and work environment for cancer survivors who sustain employment. Methods We analyzed responses from a survey of breast cancer survivors from the Sister Study and the Two Sister Study cohorts who reported being employed at the time of their breast cancer diagnosis and who reported employment status (lost vs. sustained employment) at the time of survey administration. Multivariate logistic regression was used to identify the effects of lymphedema, neuropathy, problems with memory or attention, social support, health insurance, and sick leave on lost employment, adjusting for demographic characteristics, cancer stage, treatment, and general health. Results Of the 1675 respondents who reported being employed at the time of diagnosis, 83.5% reported being 'currently' employed at the time of the survey. Older age, peripheral neuropathy, lack of sick leave, late stage at diagnosis, a recurrence or a new cancer, problems with memory or attention, and poor general health were significantly associated with lost employment. Conclusions The long-term effects of breast cancer treatment and workplace provisions for leave and accommodation may have a substantial effect on women's ability to sustain employment. The findings from this study highlight challenges reported by cancer survivors that may inform clinical and occupational interventions to support survivors' return to work.
Collapse
Affiliation(s)
- Lucy A Peipins
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- NCCDPHP/DCPC, Mailstop S-107-4, 4770 Buford Hwy, NE, Chamblee, GA, 30341-3717, USA.
| | | | - Juan L Rodriguez
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary C White
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| |
Collapse
|
14
|
Izydorczyk B, Walenista W, Kamionka A, Lizińczyk S, Ptak M. Connections Between Perceived Social Support and the Body Image in the Group of Women With Diastasis Recti Abdominis. Front Psychol 2021; 12:707775. [PMID: 34434150 PMCID: PMC8381222 DOI: 10.3389/fpsyg.2021.707775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The psychological features of the body image and the role of perceived social support for women with diastasis recti abdominis (DRAM) is significant for the treatment of this group of patients, but it is difficult to identify research on this topic. We aimed to search for similarities and differences between postpartum women with DRAM in terms of their psychological features of the body image and perceived social support from the partner, family and friends. Methods: Three hundred forty-five Polish women with DRAM were asked to fill the The Multidimensional Body-Self Relations Questionnaire (MBSRQ), The Multidimensional Scale of Perceived Social Support (MSPSS) and The Drawing Self-Assessment Sheet. Data analysis included the stepwise regression analysis and k-cluster analysis. Results: We identified several predictors in the group of women with DRAM. Social support of partner, family, and friends are the predictors of self-assessment of general body appearance. Social support of family is a predictor of self-assessment of the health of the body. Social support of friends is a predictor of self-esteem of weight and fear of gaining weight. Moreover, three clusters of women with DRAM were found. Type 1-women with DRAM with one child and low self-esteem of the general appearance of the body, low self-esteem of health condition of the body, high self-esteem of weight, and fear of weight gain, and low level of social support; Type 2-women with DRAM with three or more children and low self-esteem of the general appearance of the body, low self-esteem of health condition of the body, high self-esteem of weight and fear of weight gain, and high level of social support; and Type 3-women with DRAM with two children and high self-esteem for the general appearance of the body, high level of self-esteem for health of the body, low self-esteem of weight and fear of weight gain, and high levels of social support. Conclusions: Social support is a predictor of body image in women with DRAM, but there are other factors that influence body acceptance more in this group of women. Furthermore the three clusters featured in the study may help in treating women with DRAM.
Collapse
Affiliation(s)
- Bernadetta Izydorczyk
- Faculty of Management and Social Communication, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
| | - Wiktoria Walenista
- Faculty of Management and Social Communication, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
| | - Agata Kamionka
- Department of Psychology, Faculty of Physical Culture, Gdansk University of Physical Education and Sport, Gdańsk, Poland
| | - Sebastian Lizińczyk
- Katowice Faculty of Psychology, SWPS University of Social Sciences and Humanities, Katowice, Poland
| | - Magdalena Ptak
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, Szczecin, Poland
| |
Collapse
|
15
|
Lim DW, Metcalfe KA. ASO Author Reflections: Psychosocial Outcomes After Breast Cancer Treatment. Ann Surg Oncol 2021; 28:5999-6000. [PMID: 33950312 DOI: 10.1245/s10434-021-10017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 11/18/2022]
Affiliation(s)
- David W Lim
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada. .,Department of Surgery, Women's College Hospital, Toronto, ON, Canada.
| | - Kelly A Metcalfe
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
16
|
Lim DW, Retrouvey H, Kerrebijn I, Butler K, O'Neill AC, Cil TD, Zhong T, Hofer SOP, McCready DR, Metcalfe KA. Longitudinal Study of Psychosocial Outcomes Following Surgery in Women with Unilateral Nonhereditary Breast Cancer. Ann Surg Oncol 2021; 28:5985-5998. [PMID: 33821345 DOI: 10.1245/s10434-021-09928-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/18/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Rates of bilateral mastectomy are rising in women with unilateral, nonhereditary breast cancer. We aim to characterize how psychosocial outcomes evolve after breast cancer surgery. PATIENTS AND METHODS We performed a prospective cohort study of women with unilateral, sporadic stage 0-III breast cancer at University Health Network in Toronto, Canada between 2014 and 2017. Women completed validated psychosocial questionnaires (BREAST-Q, Impact of Event Scale, Hospital Anxiety & Depression Scale) preoperatively, and at 6 and 12 months following surgery. Change in psychosocial scores was assessed between surgical groups using linear mixed models, controlling for age, stage, and adjuvant treatments. P < .05 were significant. RESULTS A total of 475 women underwent unilateral lumpectomy (42.5%), unilateral mastectomy (38.3%), and bilateral mastectomy (19.2%). There was a significant interaction (P < .0001) between procedure and time for breast satisfaction, psychosocial and physical well-being. Women having unilateral lumpectomy had higher breast satisfaction and psychosocial well-being scores at 6 and 12 months after surgery compared with either unilateral or bilateral mastectomy, with no difference between the latter two groups. Physical well-being declined in all groups over time; scores were not better in women having bilateral mastectomy. While sexual well-being scores remained stable in the unilateral lumpectomy group, scores declined similarly in both unilateral and bilateral mastectomy groups over time. Cancer-related distress, anxiety, and depression scores declined significantly after surgery, regardless of surgical procedure (P < .001). CONCLUSIONS Psychosocial outcomes are not improved with contralateral prophylactic mastectomy in women with unilateral breast cancer. Our data may inform women considering contralateral prophylactic mastectomy.
Collapse
Affiliation(s)
- David W Lim
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada. .,Department of Surgery, Women's College Hospital, Toronto, ON, Canada. .,Division of General Surgery, University Health Network (Princess Margaret Cancer Centre), Toronto, ON, Canada.
| | - Helene Retrouvey
- Division of Plastic Surgery, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada
| | - Isabel Kerrebijn
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Kate Butler
- Division of Plastic Surgery, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada
| | - Anne C O'Neill
- Division of Plastic Surgery, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada
| | - Tulin D Cil
- Department of Surgery, Women's College Hospital, Toronto, ON, Canada.,Division of General Surgery, University Health Network (Princess Margaret Cancer Centre), Toronto, ON, Canada
| | - Toni Zhong
- Division of Plastic Surgery, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada
| | - Stefan O P Hofer
- Division of Plastic Surgery, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada
| | - David R McCready
- Division of General Surgery, University Health Network (Princess Margaret Cancer Centre), Toronto, ON, Canada
| | - Kelly A Metcalfe
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
17
|
Lim DW, Metcalfe KA, Narod SA. Bilateral Mastectomy in Women With Unilateral Breast Cancer: A Review. JAMA Surg 2021; 156:569-576. [PMID: 33566074 DOI: 10.1001/jamasurg.2020.6664] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Rates of bilateral mastectomy continue to increase in average-risk women with unilateral in situ and invasive breast cancer. Contralateral prophylactic mastectomy rates increased from 5% to 12% of all operations for breast cancer in the US from 2004 to 2012. Among women having mastectomy, rates of contralateral prophylactic mastectomy have increased from less than 2% in 1998 to 30% in 2012. Observations The increased use of breast magnetic resonance imaging and genetic testing has marginally increased the number of candidates for bilateral mastectomy. Most bilateral mastectomies are performed on women who are at no special risk for contralateral cancer. The true risk of contralateral breast cancer is not associated with the decision for contralateral prophylactic mastectomy; rather, the clinical factors associated with the probability of distant recurrence are associated with bilateral mastectomy. Several changes in society and health care delivery appear to act concurrently and synergistically. First, the anxiety engendered by a fear of cancer recurrence is focused on the contralateral cancer because this is most easily conceptualized and provides a ready target that can be acted upon. Second, the modern woman with breast cancer is supported by the surgeon and the social community of breast cancer survivors. Surgeons want to respect patient autonomy, despite guidelines discouraging bilateral mastectomy, and most women have their expenses covered by a third-party payer. Satisfaction with the results is high, but the association with improved psychosocial well-being remains to be fully understood. Conclusions and Relevance Reducing the use of medically unnecessary contralateral prophylactic mastectomy in women with nonhereditary, unilateral breast cancer requires a social change that addresses patient-, physician-, cultural-, and systems-level enabling factors. Such a transformation begins with educating clinicians and patients. The concerns of women who want preventive contralateral mastectomy must be explored, and women need to be informed of the anticipated benefits (or lack thereof) and risks. Areas requiring further study are considered.
Collapse
Affiliation(s)
- David W Lim
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Kelly A Metcalfe
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Steven A Narod
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
18
|
Rosenberg SM, Dominici LS, Gelber S, Poorvu PD, Ruddy KJ, Wong JS, Tamimi RM, Schapira L, Come S, Peppercorn JM, Borges VF, Partridge AH. Association of Breast Cancer Surgery With Quality of Life and Psychosocial Well-being in Young Breast Cancer Survivors. JAMA Surg 2021; 155:1035-1042. [PMID: 32936216 DOI: 10.1001/jamasurg.2020.3325] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Importance Young women with breast cancer are increasingly choosing bilateral mastectomy (BM), yet little is known about short-term and long-term physical and psychosocial well-being following surgery in this population. Objective To evaluate the differential associations of surgery with quality of life (QOL) and psychosocial outcomes from 1 to 5 years following diagnosis. Design, Setting, and Participants Cohort study. Setting Multicenter, including academic and community hospitals in North America. Participants Women age ≤40 when diagnosed with Stage 0-3 with unilateral breast cancer between 2006 and 2016 who had surgery and completed QOL and psychosocial assessments. Exposures (for observational studies) Primary breast surgery including breast-conserving surgery (BCS), unilateral mastectomy (UM), and BM. Main Outcomes and Measures Physical functioning, body image, sexual health, anxiety and depressive symptoms were assessed in follow-up. Results Of 826 women, mean age at diagnosis was 36.1 years; most women were White non-Hispanic (86.7%). Regarding surgery, 45% had BM, 31% BCS, and 24% UM. Of women who had BM/UM, 84% had reconstruction. While physical functioning, sexuality, and body image improved over time, sexuality and body image were consistently worse (higher adjusted mean scores) among women who had BM vs BCS (body image: year 1, 1.32 vs 0.64; P < .001; year 5, 1.19 vs 0.48; P < .001; sexuality: year 1, 1.66 vs 1.20, P < .001; year 5, 1.43 vs 0.96; P < .001) or UM (body image: year 1, 1.32 vs 1.15; P = .06; year 5, 1.19 vs 0.96; P = .02; sexuality: year 1, 1.66 vs 1.41; P = .02; year 5, 1.43 vs 1.09; P = .002). Anxiety improved across groups, but adjusted mean scores remained higher among women who had BM vs BCS/UM at 1 year (BM, 7.75 vs BCS, 6.94; P = .005; BM, 7.75 vs UM, 6.58; P = .005), 2 years (BM, 7.47 vs BCS, 6.18; P < .001; BM, 7.47 vs UM, 6.07; P < .001) and 5 years (BM, 6.67 vs BCS, 5.91; P = .05; BM, 6.67 vs UM, 5.79; P = .05). There were minimal between-group differences in depression levels in follow-up. Conclusions and Relevance While QOL improves over time, young breast cancer survivors who undergo more extensive surgery have worse body image, sexual health, and anxiety compared with women undergoing less extensive surgery. Ensuring young women are aware of the short-term and long-term effects of surgery and receive support when making surgical decisions is warranted.
Collapse
Affiliation(s)
| | | | - Shari Gelber
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | - Julia S Wong
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | - Steven Come
- Beth Israel Deaconess, Boston, Massachusetts
| | | | | | | |
Collapse
|
19
|
Kuang XW, Sun ZH, Song JL, Zhu Z, Chen C. Comparison of the ductal carcinoma in situ between White Americans and Chinese Americans. Medicine (Baltimore) 2021; 100:e24136. [PMID: 33546026 PMCID: PMC7837883 DOI: 10.1097/md.0000000000024136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022] Open
Abstract
Currently, the wide-spread use of screening mammography has led to dramatic increases in ductal carcinoma in situ (DCIS). However, DCIS of Chinese Americans, the largest Asian subgroup in American, has rarely been comprehensively studied over the past decade. This work compared the DCIS characteristics and prognosis of Chinese American patients with White Americans in the USA to determine the characteristics and prognosis of DCIS patients of Chinese Americans.The data were obtained using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) data. The diagnosis and treatment variables between the two groups were compared by means of Chi-square tests. Survival was determined with the use of the Kaplan-Meier method and the multivariable Cox proportional hazard regression model.From 1975 to 2016, 81,745 White Americans and 2069 Chinese Americans were diagnosed with ductal carcinoma in situ. Compared with the white patients, the Chinese Americans were younger (P < .001) with smaller tumors (P < .001) and higher family income (P < .001). DCIS patients of Chinese American group accounted for a higher percentage of all breast cancers than the whites (P < .001). In the multivariable Cox proportional hazard regression analysis, Chinese American was an independent favorable prognostic factor in terms of overall survival (OS) (HR, 0.684; 95% CI, 0.593-0.789; P < .001) compared with the white group.In conclusion, DCIS characteristics of the Chinese group, which exhibited a higher proportion of younger age, a higher DCIS ratio, and a better prognosis, were distinct from those of the White Americans.
Collapse
Affiliation(s)
| | | | | | - Zhanyong Zhu
- Department of Plastic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, P.R. China
| | | |
Collapse
|
20
|
Tyner TE, Lee MA. Satisfaction Outcomes in Women Who "Choose to Go Flat" After Mastectomy: An Integrative Review. ANS Adv Nurs Sci 2021; 44:31-51. [PMID: 32956091 DOI: 10.1097/ans.0000000000000329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A considerable number of women undergoing mastectomies are "choosing to go flat," forgoing reconstruction. This integrative review sought to identify satisfaction outcomes and relevant factors among these women. Using variations of the key word "going flat," a systematic search of 7 databases was conducted. Fifteen articles met the inclusion criteria and were reviewed. Decisional and breast/chest appearance satisfaction in women who did not have reconstruction was mixed when compared with other surgical options. Body image, body mass index, radiation therapy, and access to information/resources affected satisfaction. Nurses are in a pivotal role to address the communication and informational needs of these women to support optimal surgical decision-making processes and improve patient satisfaction and clinical outcomes.
Collapse
|
21
|
Pesce C, Jaffe J, Kuchta K, Yao K, Sisco M. Patient-reported outcomes among women with unilateral breast cancer undergoing breast conservation versus single or double mastectomy. Breast Cancer Res Treat 2020; 185:359-369. [PMID: 33033966 DOI: 10.1007/s10549-020-05964-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/01/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE More women with unilateral early stage breast cancer are electing bilateral mastectomy (BM). Many cite anxiety, fear of recurrence, and certain aesthetic desires in their decision-making. Yet conflicting data exist regarding how these factors both inform and are modulated by medical decision-making, especially among women eligible for breast conservation (BCT). This study sought to assess the trajectories of women undergoing various surgical procedures for breast cancer. METHODS We performed a prospective longitudinal study of women with unilateral, non-hereditary breast cancer who underwent BCT, unilateral mastectomy (UM), or BM. Women completed surveys before surgery and at 1, 9, and 15 months postop. Surveys included questions about treatment preferences, decisional control, the HADS-A anxiety scale, the Fear of Relapse/Recurrence Scale (FRRS), and the BREAST-Q. The Kruskal-Wallis test was used to compare outcomes between BCT, UM, and BM groups at each time point. RESULTS 203 women were recruited and 177 (87.2%) completed 15-month follow-up. Of these, 101 (57.0%) underwent BCT, 33 (18.6%) underwent UM, and 43 (24.2%) underwent BM. Generalized anxiety and FRRS scores were similar between BCT, UM, and BM groups and declined uniformly after surgery. Although baseline breast satisfaction was similar between groups, at 15 months, it was significantly lower in BM patients than in BCT patients. Women who felt "very" confident and "very" informed before surgery had lower anxiety, lower fear of recurrence, better psychosocial well-being (PSWB), and greater breast satisfaction at 15 months. CONCLUSION While patients who undergo mastectomy have less long-term breast satisfaction, all patients can expect to experience similar improvements in anxiety and PSWB. Efforts should be made to ensure that patients are informed and confident regardless of which surgery is chosen, for this is the greatest predictor of better outcomes.
Collapse
Affiliation(s)
- Catherine Pesce
- Department of Surgery, Division of Surgical Oncology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Jennifer Jaffe
- Department of Surgery, Division of Surgical Oncology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Kristine Kuchta
- Biostatistical Core, NorthShore University HealthSystem Research Institute, Evanston, IL, USA
| | - Katharine Yao
- Department of Surgery, Division of Surgical Oncology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Mark Sisco
- Department of Surgery, Division of Plastic Surgery, NorthShore University HealthSystem, Northbrook, IL, USA.
| |
Collapse
|
22
|
D’Agostino TA, Brewster AM, Peterson SK, Bedrosian I, Parker PA. Discussions about contralateral prophylactic mastectomy among surgical oncology providers and women with sporadic breast cancer: a content analysis. Transl Behav Med 2020; 10:347-354. [PMID: 30561744 PMCID: PMC7237543 DOI: 10.1093/tbm/iby098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Rates of contralateral prophylactic mastectomy (CPM) have risen substantially, yet little is known about how and to what extent CPM is discussed within surgical oncology visits at the time of treatment decision-making. We examined CPM discussions in naturally occurring interactions between sporadic breast cancer patients and their surgical oncology providers. Women with early-stage unilateral disease were recruited before their first surgical visit and completed brief questionnaires to determine study eligibility and interest in treatment options. After their visits, enrolled patients and their providers completed questionnaires assessing discussion of and interest in CPM. Audio-recorded visits from 36 unique patients were randomly selected, transcribed, and analyzed. A CPM discussion was present in 28 transcripts. Approximately half of CPM discussions were initiated by the patient or the oncology provider. The topic of CPM was most frequently introduced while reviewing available treatment options. Patients were most interested in pursuing CPM to reduce the risk of future breast cancer. Providers most frequently responded by offering information (e.g., about risk of contralateral disease). A high level of agreement was found among patient, provider, and observer ratings of whether or not CPM was discussed. CPM discussions were consistently present within our sample. Results can be used to build providers' skills and bring provider-patient communication more in line with best practices and recommendations from leading professional medical societies.
Collapse
Affiliation(s)
- Thomas A D’Agostino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Albany Stratton VA Medical Center, Albany, NY, USA
| | - Abenaa M Brewster
- Department of Clinical Cancer Prevention, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan K Peterson
- Department of Behavioral Science, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Isabelle Bedrosian
- Department of Breast Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
23
|
Abstract
In the past decades the demand for prophylactic mastectomies has increased substantially. For healthy non high risk germ line mutation carriers there is no real objective justification for such a procedure, and screening according established evidence based guidelines is strongly advised. More demand for contralateral prophylactic mastectomy is coming from women diagnosed with breast cancer. First counseling and appropriate germ line gene mutation testing has to be established. In absence of high risk mutations, breast conservation therapy for the diagnosed breast cancer is as good as mastectomy, and the risk of a contralateral breast cancer is low (0.3-0.6% per annum follow up). So bilateral mastectomy will not provide any survival benefit and is associated with worsened body image and QoL, and more complications and re-operations as compared to breast conservation followed by screening. The patient asking for a CPM deserves careful counseling and a shared decision process.
Collapse
Affiliation(s)
- Emiel J T Rutgers
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands.
| |
Collapse
|
24
|
Srethbhakdi A, Brennan ME, Hamid G, Flitcroft K. Contralateral prophylactic mastectomy for unilateral breast cancer in women at average risk: Systematic review of patient reported outcomes. Psychooncology 2020; 29:960-973. [PMID: 32201988 DOI: 10.1002/pon.5379] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/23/2020] [Accepted: 03/03/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The rate of contralateral prophylactic mastectomy (CPM) in women with early, unilateral cancer is relatively high and is increasing around the world a previous study. Women choose this option for many reasons other than reducing their risk of future cancer, including symmetry, reasons related to breast reconstruction and attempting to manage fear of recurrence. This systematic review evaluated patient-reported quality of life outcomes following CPM. METHODS A literature search of MEDLINE, PubMed and PsycINFO was performed to February 2019. Abstracts and full-text articles were assessed for eligibility according to pre-determined criteria. Data were extracted into evidence tables for analysis. RESULTS A total of 19 articles met eligibility criteria and were included in analysis. These included patient-reported data from 6088 women undergoing CPM. They reported high levels of satisfaction with the decision for surgery, low levels of decisional regret and high satisfaction with cosmesis and reconstruction. Breast-specific and general quality of life was high overall but was even better in women choosing breast reconstruction after surgery. Fear of cancer recurrence was high after CPM. Depression, distress and a negative impact on body image were evident; however, levels were high in both CPM and non-CPM groups. CONCLUSIONS This study provides information that can be used by surgeons and psychologists when counselling women about the potential benefits and harms of CPM. This process must include discussion about the trade-offs such as body image issues and ongoing fear of recurrence in addition to the positive aspect of cancer risk reduction. Women are unlikely to regret their decision for CPM.
Collapse
Affiliation(s)
- Amilee Srethbhakdi
- School of Medicine, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Meagan E Brennan
- School of Medicine, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- School of Medicine, Sydney, University of Notre Dame, Chippendale, New South Wales, Australia
| | - Geaty Hamid
- Westmead Breast Cancer Institute, Westmead Hospital, Westmead, New South Wales, Australia
| | - Kathy Flitcroft
- School of Medicine, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| |
Collapse
|
25
|
Kurian AW, Canchola AJ, Ma CS, Clarke CA, Gomez SL. Magnitude of reduction in risk of second contralateral breast cancer with bilateral mastectomy in patients with breast cancer: Data from California, 1998 through 2015. Cancer 2019; 126:958-970. [PMID: 31750934 DOI: 10.1002/cncr.32618] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/08/2019] [Accepted: 10/21/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Increasingly, patients with breast cancer undergo bilateral mastectomy (BLM). To the authors' knowledge, the magnitude of benefit is unknown. METHODS The authors used data from the Surveillance, Epidemiology, and End Results (SEER) program regarding all women diagnosed with American Joint Committee on Cancer stage 0 to stage III unilateral breast cancer in California from 1998 through 2015 and treated with BLM versus breast-conserving therapy including surgery and radiotherapy (BCT) or unilateral mastectomy (ULM). The authors measured relative risks of second contralateral breast cancer (CBC) and breast cancer death using Fine and Gray multivariable regression modeling adjusted for the competing risk of death and death from another cause, respectively, and potential confounding factors. Absolute excess risk of CBC was measured as the observed minus expected number of breast cancers in the general population divided by 10,000 person-years at risk. RESULTS Among 245,418 patients with a median follow-up of 6.7 years, 7784 patients (3.2%) developed CBC. Relative risks were lower after BLM (hazard ratio [HR], 0.10; 95% CI, 0.07-0.14) and higher after ULM (HR, 1.07; 95% CI, 1.02-1.13) versus BCT. Absolute excess risks were higher after BCT and ULM (5.0 and 13.6 more cases, respectively) compared with BLM (28.6 fewer cases). BLM reduced risk more among older women (38.0 fewer cases for women aged ≥50 years vs 17.9 fewer cases among women aged <50 years) but provided similar risk reduction across categories of tumor grade and tumor hormone receptor status. Compared with BCT, the risk of breast cancer death was equivalent after BLM (HR, 1.03; 95% CI, 0.96-1.11) and higher after ULM (HR, 1.21; 95% CI, 1.17-1.25). CONCLUSIONS BLM may reduce second breast cancer risk by 34 to 43 cases per 10,000 person-years compared with other surgical procedures, but is not associated with a lower risk of death. Second breast cancers are rare, and their reduction should be weighed against the harms associated with BLM.
Collapse
Affiliation(s)
- Allison W Kurian
- Department of Medicine, Stanford University School of Medicine, Stanford, California.,Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Alison J Canchola
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California
| | - Cindy S Ma
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Christina A Clarke
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California.,GRAIL, Menlo Park, California
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California
| |
Collapse
|
26
|
Effect of decision-making resources on satisfaction with decision to undergo contralateral prophylactic mastectomy (CPM). Am J Surg 2019; 219:1036-1038. [PMID: 31570198 DOI: 10.1016/j.amjsurg.2019.09.021] [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: 08/21/2019] [Revised: 09/15/2019] [Accepted: 09/18/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Rates of contralateral prophylactic mastectomy (CPM) are increasing, and there are many resources available to help patients with decision-making. We sought to determine how often these were used, and whether their use influenced satisfaction with decision to pursue CPM. METHODS CPM patients at a large academic institution were surveyed regarding factors associated with their CPM decision, and their satisfaction with the same. RESULTS Of 58 CPM patients approached to participate, 55 completed the survey with a mean SWD score of 4.85 (range 3.00-5.00). Partner opinion (47.3%), family opinion (45.5%), other cancer patients' experiences (38.2%), and informational websites (38.2%) were the most frequently cited resources used by CPM patients. On multivariate analysis, controlling for other factors affecting SWD, use of other cancer patients' experiences predicted above average SWD (p = 0.049). CONCLUSION Those who use other cancer patients' experiences to aid in their surgical decision-making enjoy a higher satisfaction with their decision.
Collapse
|
27
|
Hooper RC, Hsu J, Duncan A, Bensenhaver JM, Newman LA, Kidwell KM, Chung KC, Momoh AO. Breast Cancer Knowledge and Decisions Made for Contralateral Prophylactic Mastectomy: A Survey of Surgeons and Women in the General Population. Plast Reconstr Surg 2019; 143:936e-945e. [PMID: 31033815 DOI: 10.1097/prs.0000000000005523] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Decisions made to undergo contralateral prophylactic mastectomy, in women at low risk for bilateral disease, are often attributed to a lack of knowledge. This study examines the role knowledge plays in determining surgical treatment for unilateral breast cancer made by laywomen and surgeons for themselves or loved ones. METHODS The study cohort had three groups: (1) laywomen in the general population, (2) breast surgeons, and (3) plastic surgeons. Laywomen were recruited using Amazon Mechanical Turk Crowd Sourcing. Breast and plastic surgeons from nine states were sent electronic surveys. Demographic and contralateral prophylactic mastectomy-specific data on decisions and knowledge were collected and analyzed. RESULTS Surveys from 1333 laywomen, 198 plastic surgeons, and 142 breast surgeons were analyzed. A significantly greater proportion of laywomen in the general population favored contralateral prophylactic mastectomy (67 percent) relative to plastic (50 percent) and breast surgeons (26 percent) (p < 0.0001). Breast surgeons who chose contralateral prophylactic mastectomy were younger (p = 0.044) and female (0.012). On assessment of knowledge, 78 percent of laywomen had a low level of breast cancer knowledge. Laywomen with higher levels of breast cancer knowledge had lower odds of choosing contralateral prophylactic mastectomy (OR, 0.37; 95 percent CI, 0.28 to 0.49). CONCLUSIONS Fewer women are likely to make decisions in favor of contralateral prophylactic mastectomy with better breast cancer-specific education. A knowledge gap likely explains the lower rates with which surgeons choose contralateral prophylactic mastectomy for themselves or loved ones; however, some surgeons who were predominantly young and female favor contralateral prophylactic mastectomy. Improving patient education on surgical options for breast cancer treatment is critical, with well-informed decisions as the goal.
Collapse
Affiliation(s)
- Rachel C Hooper
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System; the Department of Surgery, Henry Ford Health System; and the Department of Biostatistics, University of Michigan School of Public Health
| | - Jessica Hsu
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System; the Department of Surgery, Henry Ford Health System; and the Department of Biostatistics, University of Michigan School of Public Health
| | - Anthony Duncan
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System; the Department of Surgery, Henry Ford Health System; and the Department of Biostatistics, University of Michigan School of Public Health
| | - Jessica M Bensenhaver
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System; the Department of Surgery, Henry Ford Health System; and the Department of Biostatistics, University of Michigan School of Public Health
| | - Lisa A Newman
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System; the Department of Surgery, Henry Ford Health System; and the Department of Biostatistics, University of Michigan School of Public Health
| | - Kelly M Kidwell
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System; the Department of Surgery, Henry Ford Health System; and the Department of Biostatistics, University of Michigan School of Public Health
| | - Kevin C Chung
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System; the Department of Surgery, Henry Ford Health System; and the Department of Biostatistics, University of Michigan School of Public Health
| | - Adeyiza O Momoh
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System; the Department of Surgery, Henry Ford Health System; and the Department of Biostatistics, University of Michigan School of Public Health
| |
Collapse
|
28
|
Huang J, Chagpar A. Active Participation in Decision-Making in Contralateral Prophylactic Mastectomy for Patients With Breast Cancer. J Surg Res 2019; 242:129-135. [PMID: 31075657 DOI: 10.1016/j.jss.2019.04.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 04/01/2019] [Accepted: 04/09/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND We sought to determine how patient-physician communication affects patients' decision-making when choosing between contralateral prophylactic mastectomy (CPM) and unilateral mastectomy (UM). METHODS atients with breast cancer who underwent mastectomy at our institution were approached with a survey regarding patient-physician communication in CPM. RESULTS Of 101 patients who completed the survey, 55 underwent CPM (54.5%). Thirty-three patients (33%) stated that their physician recommended UM, six (6%) stated their physician recommended CPM, and 61 (61%) stated they engaged in active participation in decision-making. Most patients whose doctors recommended UM chose UM (78.8%); similarly, 83.3% of those whose doctors recommended CPM chose CPM. Of 39 patients whose doctors recommended a particular surgical option, eight (20.5%) did not follow their doctor's advice. These patients were equally as satisfied with their decisions as those who followed their doctor's advice (P = 0.441). Patients engaging in active participation in decision-making tended to choose CPM (68.3% versus 30.8%, P < 0.001). Patients who did not engage in active participation were similarly satisfied with their decision as those who did (P = 0.286). Twelve patients (12%) stated they preferred their doctor to provide a recommendation, seven (7%) preferred to make the decision on their own, and 81 (81%) preferred to actively participate in their decision-making with the physician. CONCLUSIONS Patients tend to follow physicians' recommendation of UM or CPM; patients engaging in SDM tend to choose CPM. Most patients prefer to engage in active participation in decision-making with their physician but were equally satisfied with their surgical decision whether they engaged in active participation or not.
Collapse
Affiliation(s)
- Julian Huang
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Anees Chagpar
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
| |
Collapse
|
29
|
Chen H, Zhang P, Zhang M, Wang M, Bai F, Wu K. Growing Trends of Contralateral Prophylactic Mastectomy and Reconstruction in Young Breast Cancer. J Surg Res 2019; 239:224-232. [PMID: 30856515 DOI: 10.1016/j.jss.2019.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 01/29/2019] [Accepted: 02/01/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the trends of surgical treatments among young patients in T1N0-1M0 stage based on the Surveillance, Epidemiology, and End Results database. MATERIALS AND METHODS Patients aged less than 40 y diagnosed between 1998 and 2015 were enrolled, with tumors in T1N0-1M0 stage and not located in the central area. Differences in clinical-pathological characteristics were evaluated using chi-square tests. Multivariate logistic regression was used to measure the various factors associated with contralateral prophylactic mastectomy (CPM). Independent prognostic factors were evaluated by Cox model. RESULTS The total rate of breast-conserving surgery (BCS) was 51.6%, which declined from 64.5% in 1998 to 39.6% in 2015. The total rate of CPM was 22.7%, which increased from 3.7% in 1998 to 38.7% in 2014 despite a decline to 32.7% in 2015. Meanwhile, the rate of reconstruction increased in line with that of CPM, from 9.4% in 1998 to 35.0% in 2015. There was a trend of increasing use of implant-based reconstruction. Significant higher odds of CPM were found in recent year of diagnosis between 2010 and 2015 and in implant-based reconstruction. Patients undergoing CPM had similar survival outcomes compared with those undergoing BCS and unilateral mastectomy, whereas those undergoing BCS had better survival outcomes compared with those undergoing unilateral mastectomy. CONCLUSIONS A trend of growing preference for CPM and reconstruction was observed among young patients in early stage in recent years without survival benefits. Efforts should be made to promote efficient communication and evidence-based decision-making.
Collapse
Affiliation(s)
- Hongliang Chen
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Peng Zhang
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Mingdi Zhang
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Maoli Wang
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Fang Bai
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Kejin Wu
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
| |
Collapse
|
30
|
Jerome-D'Emilia B, Trinh H. Socioeconomic Factors Associated with the Receipt of Contralateral Prophylactic Mastectomy in Women with Breast Cancer. J Womens Health (Larchmt) 2019; 29:220-229. [PMID: 30759049 DOI: 10.1089/jwh.2018.7350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Contralateral prophylactic mastectomy (CPM) treatments have been on the rise among white women with early stage unilateral breast cancer who have a higher socioeconomic status (SES) and private insurance. Low income and uninsured women are not choosing CPM at the same rate. The purpose of this study was to evaluate the socioeconomic factors related to the choice of surgical treatment in women diagnosed with unilateral breast cancer in the state of New Jersey. Materials and Methods: This retrospective study of 10 years of breast cancer data abstracted from the New Jersey State Cancer Registry utilized bivariate analyses and two multivariate logistic regression models to analyze the effect of socioeconomics on choice of surgical treatment. Results: In New Jersey, 52,529 women were treated for breast cancer from 2004 to 2014. CPM rates increased gradually over time from 3.72% in 2004 to 10.82% in 2014 with women more likely to choose CPM if they were younger, white, and had private insurance (p < 0.001). The single factor that was most predictive of choosing CPM was access to immediate reconstruction (odds ratio 2.36, confidence interval 2.160-2.551). Women with low SES were much less likely to choose CPM. Conclusions: Results of this study may provide incentive for researchers to assess the impact of culture, race/ethnicity, and socioeconomics on a woman's interactions with health care providers so as to allow all women regardless of SES to express their needs, concerns, and wishes when confronted with a breast cancer diagnosis.
Collapse
Affiliation(s)
| | - Hanh Trinh
- Department of Health Informatics & Administration, University of Wisconsin, Madison, Wisconsin
| |
Collapse
|
31
|
Direct-to-implant Breast Reconstruction with Autoderm. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 6:e2027. [PMID: 30656114 PMCID: PMC6326604 DOI: 10.1097/gox.0000000000002027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/21/2018] [Indexed: 11/26/2022]
Abstract
Background: Traditional transverse mastectomies yield suboptimal results in women with higher body mass index, wide breast footprint, and ptotic breasts. An option for this patient population is a reduction-pattern style mastectomy, and recruiting an inferiorly based dermal flap using the lower mastectomy flap. This is analogous to a vascularized dermal matrix supporting the lower pole of the implant, termed “Autoderm” breast reconstruction. This allows for aesthetically appealing skin reduction mastectomies with the added safety of a vascularized dermal flap to facilitate an immediate direct-to-implant breast reconstruction. This study assesses patient satisfaction using the validated BRECON-31 questionnaire to enhance shared-decision making with women contemplating breast reconstruction. Methods: A 2-year retrospective review of women who underwent Autoderm direct-to-implant breast reconstruction comparing patients who underwent unilateral and bilateral reconstruction in terms of characteristics, complications, and BRECON-31 scoring. Results: Overall patient scores were high (81.6 of 100). In particular, women scored very high on self-image (85.0), arm concerns (86.4), intimacy (87.4), satisfaction (88.3), and expectations subscales (85.5). Women choosing bilateral reconstruction outperformed unilateral reconstruction in every subgroup, but only attained statistical significance in the “self-consciousness” subgroup. Compared with a historical cohort of a mix of implant reconstruction types, Autoderm patients showed improved satisfaction (88.3 versus 82.5; P = 0.07) and breast appearance (73.9 versus 66.8; P = 0.06), approaching significance. Safety was demonstrated by low major complications (4.7%) and low implant loss rates (2.3%). Conclusions: Autoderm breast reconstruction is a safe option in women with large, ptotic breasts, with patients reporting high satisfaction using a validated instrument.
Collapse
|
32
|
Huang J, Chagpar A. Factors associated with decision to undergo contralateral prophylactic mastectomy versus unilateral mastectomy. Am J Surg 2018; 218:170-174. [PMID: 30554666 DOI: 10.1016/j.amjsurg.2018.11.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/13/2018] [Accepted: 11/29/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Factors associated with the decision to pursue unilateral mastectomy (UM) versus contralateral prophylactic mastectomy (CPM) in unilateral breast cancer (UBC) patients, and satisfaction with this decision, remain to be elucidated. METHODS UBC patients who underwent mastectomy were surveyed regarding factors affecting their surgical decision and satisfaction with the same. RESULTS Both UM (n = 46) and CPM (n = 55) patients were satisfied with their surgical decision (mean 4.72 and 4.85 out of 5 on Satisfaction With Decision scale, respectively, p = 0.078). Most CPM patients cited the desire to lower their risk of contralateral breast cancer (96.4%) and the desire for peace of mind (94.5%) as "very important" drivers of their decision; whereas most UM patients felt not wanting to remove a normal breast (67.4%) was a "very important" driver for their decision. CONCLUSIONS Both UM and CPM patients reported high satisfaction with their surgical decisions, despite differing reasons for their respective surgeries.
Collapse
Affiliation(s)
- Julian Huang
- Department of Surgery, Yale University School of Medicine, 20 York Street, 1st Floor, Suite A, New Haven, CT, 06510, USA.
| | - Anees Chagpar
- Department of Surgery, Yale University School of Medicine, 20 York Street, 1st Floor, Suite A, New Haven, CT, 06510, USA.
| |
Collapse
|
33
|
Parker PA, Peterson SK, Shen Y, Bedrosian I, Black DM, Thompson AM, Nelson JC, DeSnyder SM, Cook RL, Hunt KK, Volk RJ, Cantor SB, Dong W, Brewster AM. Prospective Study of Psychosocial Outcomes of Having Contralateral Prophylactic Mastectomy Among Women With Nonhereditary Breast Cancer. J Clin Oncol 2018; 36:2630-2638. [PMID: 30044695 DOI: 10.1200/jco.2018.78.6442] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose The incidence of contralateral prophylactic mastectomy (CPM) has continued to increase. We prospectively examined psychosocial outcomes before and up to 18 months after surgery in women who did or did not have CPM. Methods Women with unilateral, nonhereditary breast cancer completed questionnaires before and 1, 6, 12, and 18 months after surgery. Primary psychosocial measures were cancer worry and cancer-specific distress. Secondary measures were body image, quality of life (QOL), decisional satisfaction, and decisional regret. Results A total of 288 women (mean age, 56 years; 58% non-Hispanic white) provided questionnaire data, of whom 50 underwent CPM. Before surgery, women who subsequently received CPM had higher cancer distress ( P = .04), cancer worry ( P < .001), and body image concerns ( P < .001) than women who did not have CPM. In a multivariable repeated measures model adjusted for time, age, race/ethnicity, and stage, CPM was associated with more body image distress ( P < .001) and poorer QOL ( P = .02). There was a significant interaction between time point and CPM group for cancer worry ( Pinteraction < .001), suggesting that CPM patients had higher presurgery cancer worry, but their postsurgery worry decreased over time and was similar to the worry of patients who did not have CPM. QOL was similar between CPM groups before surgery but declined 1 month after surgery and remained lower than patients who did not have CPM after surgery ( Pinteraction = .05). Conclusion These results may facilitate informed discussions between women and their physicians regarding CPM. Fear and worry may be foremost concerns at the time surgical decisions are made, when women may not anticipate the adverse future effect of CPM on body image and QOL.
Collapse
Affiliation(s)
- Patricia A Parker
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Susan K Peterson
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Yu Shen
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Isabelle Bedrosian
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Dalliah M Black
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Alastair M Thompson
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Jonathan C Nelson
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Sarah M DeSnyder
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Robert L Cook
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Kelly K Hunt
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Robert J Volk
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Scott B Cantor
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Wenli Dong
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Abenaa M Brewster
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| |
Collapse
|
34
|
Huang J, Chagpar AB. Quality of Life and Body Image as a Function of Time from Mastectomy. Ann Surg Oncol 2018; 25:3044-3051. [PMID: 29947006 DOI: 10.1245/s10434-018-6606-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND We sought to determine the impact of time after surgery on quality of life (QoL) and body image in breast cancer patients undergoing mastectomy. METHODS Female patients with unilateral breast cancer who had undergone mastectomy were surveyed regarding their body image (Body Image After Breast Cancer Questionnaire; BIBCQ) and QoL (FACT-B). Data were analyzed using nonparametric statistics (SPSS version 24). RESULTS Ninety-four of the 109 patients approached completed both surveys (86.2% response rate). Median patient age at the time of surgery was 49.5 (range 29-82); the survey was administered at a median of 14.2 months postoperatively (range 0.3-192.1 months). Seventy-four patients (78.7%) had reconstruction, and 52 patients (55.3%) chose to undergo contralateral prophylactic mastectomy. Patients who reported an above average overall body image perception on the BIBCQ tended to be further out from their surgery than those who reported a below average perception (median 20.9 vs. 8.1 months, respectively, p = 0.009). Patients who reported above average QoL also tended to be further out from their surgery compared with those with below average overall QoL (median 21.8 vs. 6.4 months, respectively, p = 0.004). Receipt of reconstruction, contralateral prophylactic mastectomy, disease stage, patient race, education, insurance type, income, marital status, employment status, and age at surgery did not significantly affect body image nor QoL in this cohort. CONCLUSIONS Better body image perception and higher QoL were associated with being further out from surgery. These findings suggest that body image and QoL may improve with time, as patients acclimatize to their "new normal."
Collapse
Affiliation(s)
- Julian Huang
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Anees B Chagpar
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
| |
Collapse
|
35
|
Rosenberg SM, Greaney ML, Patenaude AF, Sepucha KR, Meyer ME, Partridge AH. "I don't want to take chances.": A qualitative exploration of surgical decision making in young breast cancer survivors. Psychooncology 2018; 27:1524-1529. [PMID: 29476578 DOI: 10.1002/pon.4683] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 02/01/2018] [Accepted: 02/14/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Young women with unilateral breast cancer are increasingly choosing contralateral prophylactic mastectomy (CPM), despite its limited medical benefit for most women. The purpose of this study was to better understand this choice through a qualitative exploration of surgical decision-making in young survivors, including how issues particular to younger women affected their decision and the post-surgical experience. METHODS Women age ≤ 40 years with stage 0 to III breast cancer, 1 to 3 years from diagnosis who had undergone breast cancer surgery were recruited to participate. Four focus groups were conducted: 2 with women who had bilateral mastectomy and 2 with women who kept their contralateral breast. Focus groups were recorded and transcribed with identifiers removed. Emergent themes were identified by thematic content analysis using NVivo 11. RESULTS Of the 20 participants, median age at diagnosis was 37 years. Emergent themes were categorized into the following domains: (1) emotions/feelings surrounding surgery/decision about surgery; (2) factors affecting the decision; (3) communication and interaction with the healthcare team; (4) impact on post-surgical life and recovery; and (5) support needs. Young women who chose CPM often were concerned about a future breast event, despite this low risk, suggesting some gain peace of mind by choosing CPM. Young survivors also had many physical and emotional concerns after surgery for which they did not always feel prepared. CONCLUSIONS Informational resources and decision aids may enhance patient-doctor communication and help young survivors better understand risk and manage expectations surrounding short and longer-term physical and emotional effects after surgery.
Collapse
|