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Intention to Undergo Prophylactic Bilateral Mastectomy in Women at Increased Risk of Developing Hereditary Breast Cancer

From the Hereditary Cancer Clinic and Department of Liaison Psychiatry, Prince of Wales Hospital; Medical Psychology Unit, University of Sydney; Familial Cancer Clinic, Westmead Hospital, Sydney; Queensland Clinical Genetics Service, Brisbane; and South Australian Clinical Genetics Service, Women’s and Children’s Hospital, Adelaide, Australia.

Address reprint requests to Katherine Tucker, MD, Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, New South Wales 2031, Australia; email tuckerk{at}sesahs.nsw.gov.au

PURPOSE: To assess intention to undergo prophylactic bilateral mastectomy and psychologic determinants in unaffected women at increased risk of developing hereditary breast cancer.

PATIENTS AND METHODS: Three hundred thirty-three women who were awaiting their initial appointments for risk assessment, advice about surveillance, and prophylactic options at one of 14 familial cancer clinics participated in a cross-sectional, questionnaire-based survey.

RESULTS: Nineteen percent of women would consider and 47% would not consider a prophylactic mastectomy, should genetic testing identify a mutation in a breast cancer–predisposing gene, whereas 34% were unsure and 1% had already undergone a prophylactic mastectomy. In a bivariate analysis, women at a moderately increased risk of developing breast cancer had the highest proportion of subjects reporting that they would consider a prophylactic mastectomy (25%), compared with women at high risk (16%) (² = 7.79; P = .051). In multivariate analyses, consideration of prophylactic mastectomy strongly correlated with high levels of breast cancer anxiety (odds ratio [OR] = 17.4; 95% confidence interval [CI], 4.35 to 69.71; P = .0001) and overestimation of one’s breast cancer risk (OR = 3.01; 95% CI, 1.43 to 6.32; P = .0036), whereas there was no association with objective breast cancer risk (P = .60).

CONCLUSION: A significant proportion of women at increased risk of developing hereditary breast cancer would consider prophylactic mastectomy. Although prophylactic mastectomy may be appropriate in women at high risk of developing breast cancer, it is perhaps less so in those who have a moderately increased risk. Such moderate-risk women are likely to benefit from interventions aimed at reducing breast cancer anxiety and correcting exaggerated breast cancer risk perceptions.

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