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Are women satisfied after prophylactic mastectomy.

6048 Background: Bilateral prophylactic mastectomy in women with increased breast cancer risk and contralateral prophylactic mastectomy in women with unilateral breast cancer dramatically reduce the risk of subsequent breast cancer. However, little is known about long-term satisfaction with the procedure and related quality of life outcomes.


METHODS
We mailed surveys to 816 women with bilateral or contralateral prophylactic mastectomy done at six health maintenance organizations between 1979 and 1999. The survey included validated measures of satisfaction, quality of life and concern about breast cancer. The first survey mailing included a $5 cash incentive. Nonrespondents received a second survey mailing and a telephone reminder call.


RESULTS
We received completed surveys from 661 (81%) women in our sample; 115 women with bilateral and 546 women with contralateral prophylactic mastectomy. For women with bilateral prophylactic mastectomy the mean age at survey was 57 and the mean years since procedure was 12. For women with contralateral prophylactic mastectomy the mean age at survey was 61 and the mean years since procedure was 10. Over 80% of respondents indicated they are very satisfied with their prophylactic mastectomy yet half remain very concerned about their breast cancer risk, with no differences between the two types of prophylactic mastectomy. Among women with bilateral prophylactic mastectomy 65 (61.3%) reported being quite a bit or very much satisfied with their quality of life, versus 391 (76.2%) of women with contralateral prophylactic mastectomy (chi square p=0.03). Younger women were less satisfied with their procedure and quality of life, and had more concern about their breast cancer risk. Results did not vary by time since procedure.


CONCLUSIONS
Satisfaction and quality of life after bilateral and contralateral prophylactic mastectomy is high but not universal. Surprisingly, many women remain concerned about breast cancer despite undergoing a procedure that dramatically reduces their risk. These results may be useful for women considering prophylactic mastectomy and their clinicians, whose discussions should include clear information on risk reduction. [Table: see text].