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Contentment With Quality of Life Among Breast Cancer Survivors With and Without Contralateral Prophylactic Mastectomy

Ann M. Geiger, Carmen N. West, Larissa Nekhlyudov, Lisa J. Herrinton, In-Liu A. Liu, Andrea Altschuler, Sharon J. Rolnick, Emily L. Harris, Sarah M. Greene, Joann G. Elmore, Karen M. Emmons, Suzanne W. Fletcher

From the Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena; Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles; Division of Research, Kaiser Permanente Northern California, Oakland, CA; Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care; Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA; HealthPartners Research Foundation, Minneapolis, MN; Center for Health Research, Kaiser Permanente Northwest, Portland, OR; Center for Health Studies, Group Health Cooperative; Division of General Internal Medicine, University of Washington, Seattle, WA

Address reprint requests to Ann M. Geiger, PhD, Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, 27157; e-mail: ageiger{at}wfubmc.edu

PURPOSE: To understand psychosocial outcomes after prophylactic removal of the contralateral breast in women with unilateral breast cancer.

METHODS: We mailed surveys to women with contralateral prophylactic mastectomy after breast cancer diagnosis between 1979 and 1999 at six health care delivery systems, and to a smaller random sample of women with breast cancer without the procedure. Measures were modeled on instruments developed to assess contentment with quality of life, body image, sexual satisfaction, breast cancer concern, depression, and health perception. We examined associations between quality of life and the other domains using logistic regression.

RESULTS: The response rate was 72.6%. Among 519 women who underwent contralateral prophylactic mastectomy, 86.5% were satisfied with their decision; 76.3% reported high contentment with quality of life compared with 75.4% of 61 women who did not undergo the procedure (P = .88). Among all case subjects, less contentment with quality of life was not associated with contralateral prophylactic mastectomy or demographic characteristics, but was associated with poor or fair general health perception (odds ratio [OR], 7.0; 95% CI, 3.4 to 14.1); possible depression (OR, 5.4; 95% CI, 3.1 to 9.2); dissatisfaction with appearance when dressed (OR, 3.5; 95% CI, 2.0 to 6.0); self-consciousness about appearance (OR, 2.0; 95% CI, 1.1 to 3.7); and avoiding thoughts about breast cancer (modest: OR, 2.2; 95% CI, 1.1 to 4.5; highest: OR, 1.7; 95% CI, 0.9 to 3.2).

CONCLUSION: Most women undergoing contralateral prophylactic mastectomy report satisfaction with their decision and experience psychosocial outcomes similar to breast cancer survivors without the procedure.

Supported by the National Cancer Institute (Grants No. U19 CA79689 and R01 CA090323).

Presented in part at the Annual Meeting of the American Psychosocial Oncology Society, Phoenix AZ, January 29, 2005; the International Society for Quality of Life Research Symposium, Boston, MA, June 27, 2004; the 40th Annual Meeting of the American Society of Clinical Oncology, New Orleans, LA, June 5-8, 2004; and the 6th World Congress of Psycho-Oncology, Banff, Canada, April 25, 2003.

This article presents the original work of the authors and is not under review elsewhere.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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