January 23, 2007

QoL similar after prophylactic mastectomy, more conservative surgery

The quality of life (QoL) of breast cancer patients who opt for contralateral prophylactic mastectomy (CPM) is similar to those who choose unilateral mastectomy (UM) or breast-conserving therapy (BCT), according to study results.

"There is accumulating evidence that CPM is an effective strategy for managing contralateral breast cancer risk among BRCA1/2 mutation carriers," say the scientists.

"Recent studies suggest that 50% or more of new breast cancer patients who carry a BRCA1/2 mutation opt for prophylactic mastectomy of the unaffected breast. However, to adequately counsel newly diagnosed patients, data addressing the psychosocial impact of CPM are critical," they add.

To this end, Marc Schwartz, from Georgetown University Medical Center in Washington, DC, USA, and colleagues measured the quality of life of 149 high-risk women who had undergone genetic counseling and testing for alterations in the BRCA1/2 genes.

At 1 month, 41% of patients had initiated chemotherapy, and 44% had received chemotherapy by 12 months. By the same timepoints, 20% and 29% of the sample had received a CPM. Overall, 48% of BRCA1/2 carriers and 24% of those with uninformative results chose CPM.

Results revealed that, compared with women who chose BCT or UM, those who chose mastectomy of their affected breast and CPM of their unaffected breast did not experience diminished QoL or elevated distress.

"This report provides the first prospective evidence that newly diagnosed breast cancer patients who opt for CPM report comparable psychosocial outcomes to patients who choose UM or BCT," comment the team.

"These findings may be useful in informing patient decisions about genetic testing at the time of diagnosis and the types of medical management options most consistent with patients' goals and values."

J Clin Oncol 2007; 25: 285-291


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