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Barbee H, Hassan B, Liang F. Postoperative Regret Among Transgender and Gender-Diverse Recipients of Gender-Affirming Surgery. JAMA Surg 2024; 159:125-126. [PMID: 38150263 DOI: 10.1001/jamasurg.2023.6052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
This Viewpoint examines prevalence of and factors associated with surgical regret among transgender and gender-diverse individuals who undergo gender-affirming surgery.
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Affiliation(s)
- Harry Barbee
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, Maryland
| | - Bashar Hassan
- Center for Transgender and Gender Expansive Health, Johns Hopkins University, Baltimore, Maryland
| | - Fan Liang
- Center for Transgender and Gender Expansive Health, Johns Hopkins University, Baltimore, Maryland
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2
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Kautz-Freimuth S, Redaèlli M, Shukri A, Kentenich H, Simic D, Mildenberger V, Schmutzler R, Rhiem K, Stock S. Effectiveness of evidence-based decision aids for women with pathogenic BRCA1 or BRCA2 variants in the german health care context: results from a randomized controlled trial. BMC Med Inform Decis Mak 2023; 23:223. [PMID: 37845719 PMCID: PMC10580583 DOI: 10.1186/s12911-023-02327-9] [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] [Received: 03/06/2023] [Accepted: 10/05/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Women with pathogenic BRCA1 or BRCA2 variants are at high risk for breast and ovarian cancer. Preventive options include risk-reducing breast and ovarian surgeries and intensified breast surveillance. However, individual decision-making is often associated with decisional conflicts. Two evidence-based decision aids have recently been developed for these women (healthy or with unilateral breast cancer) for the German context to support them in their decision-making process. This study evaluated their effectiveness. METHODS In a randomized controlled study, women (aged 18-70 years) with pathogenic BRCA1 or BRCA2 variants were randomly assigned 1:1 to the intervention (IG, n = 230) or control (CG, n = 220) group. All participants received usual care. After baseline survey (t0), IG participants additionally received the DAs. Follow-up surveys were at three (t1) and six (t2) months. Primary outcome was decisional conflict at t1. Secondary analyses included decision status, decision regret, knowledge on risks and preventive options, self-reported psychological symptoms, acceptability of DAs, and preparation for decision-making. RESULTS Of 450 women recruited, 417 completed t0, 398 completed t1 and 386 completed t2. Compared to CG, IG participants had lower decisional conflict scores at t1 (p = 0.049) and t2 (p = 0.006) and higher scores for knowledge (p = 0.004), acceptability (p = 0.000), and preparation for decision-making (p < 0.01). CONCLUSIONS These DAs can help improve key parameters of decision-making in women with pathogenic BRCA1 and BRCA2 variants and, thus, provide a useful add-on to the current counseling and care concept for these women in Germany. TRIAL REGISTRATION German Clinical Trials Register, DRKS-ID: DRKS00015823, retrospectively registered 14/06/2019.
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Affiliation(s)
- Sibylle Kautz-Freimuth
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany.
| | - Marcus Redaèlli
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Arim Shukri
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Hannah Kentenich
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Dusan Simic
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Vanessa Mildenberger
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Rita Schmutzler
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Kerstin Rhiem
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany
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AlHilli MM, Batur P, Hurley K, Al-Hilli Z, Coombs D, Schwarz G, Djohan R, Marquard J, Ashton K, Pederson HJ. Comprehensive Care of Women With Genetic Predisposition to Breast and Ovarian Cancer. Mayo Clin Proc 2023; 98:597-609. [PMID: 36870859 DOI: 10.1016/j.mayocp.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 12/16/2022] [Accepted: 01/03/2023] [Indexed: 03/06/2023]
Abstract
Women at risk for hereditary breast and ovarian cancer syndromes are frequently seen in primary care and gynecology clinics. They present with a distinctive set of clinical and emotional needs that revolve around complex risk management discussions and decision making. The care of these women calls for the creation of individualized care plans that facilitate adjustment to the mental and physical changes associated with their choices. This article provides an update on comprehensive evidence-driven care of women with hereditary breast and ovarian cancer. The aim of this review is to aid clinicians in identifying those at risk for hereditary cancer syndromes and provide practical advice on patient-centered medical and surgical risk management. Topics of discussion include enhanced surveillance, preventive medications, risk-reducing mastectomy and reconstruction, risk-reducing bilateral salpingo-oophorectomy, fertility, sexuality, and menopausal management, with attention to the importance of psychological support. High-risk patients may benefit from a multidisciplinary team that provides realistic expectations with consistent messaging. The primary care provider must be aware of the special needs of these patients and the consequences of their risk management interventions.
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Affiliation(s)
- Mariam M AlHilli
- Department of Subspecialty Care for Women's Health, Division of Gynecologic Oncology, Ob/Gyn & Women's Health Institute, Cleveland Clinic, Cleveland, OH; Department of Subspecialty Care for Women's Health, Ob/Gyn & Women's Health Institute, Cleveland Clinic, Cleveland, OH.
| | - Pelin Batur
- Department of Subspecialty Care for Women's Health, Ob/Gyn & Women's Health Institute, Cleveland Clinic, Cleveland, OH
| | - Karen Hurley
- Center for Behavioral Health, Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Zahraa Al-Hilli
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Demetrius Coombs
- Center for Behavioral Health, Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, Cleveland, OH; Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - Graham Schwarz
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - Risal Djohan
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | | | - Kathleen Ashton
- Breast Center, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Holly J Pederson
- Breast Center, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
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4
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McNamara N, Feeney M, Giltenane M, Dowling M. Breast cancer genetic mutation: Synthesis of women's experience. J Clin Nurs 2022. [PMID: 36016506 DOI: 10.1111/jocn.16498] [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: 04/29/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To systematically identify and synthesise the experiences reported by women with a breast cancer mutation who do not have cancer as reported in qualitative research published between 2013 and 2020. BACKGROUND Women carrying a BReast CAncer (BRC) genetic mutation have an increased risk for breast and ovarian cancer. They must engage in emotional decision-making regarding risk management strategies to prevent cancer, including risk-reducing bilateral mastectomy and bilateral salpingo-oophorectomy. DESIGN AND METHODS The ENTREQ statement guided this review. Eight databases were systematically searched (CINAHL, Pubmed, Embase, Psychinfo [Ovid], Web of Science, Scopus, Proquest and Lenus). Synthesis was guided by "best fit" framework. The Critical Appraisal Skills Programme guided assessment of methodological limitations and confidence in the review findings was informed by GRADE-CERQual. RESULTS Twenty studies met the inclusion criteria for synthesis. Six themes were synthesised from the included studies (anxiety; family planning; it's a family affair; empowerment; actions; pragmatic adjustments). CONCLUSIONS The multidimensional experiences of women living with a BRCA1/2 mutation require an individualised response based on women's needs at their life stages. A decision coaching model adopted during consultations could support women to guide decision-making regarding cancer risk-reducing strategies.
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Affiliation(s)
- Nichola McNamara
- Symptomatic Breast Unit, University Hospital Limerick, Limerick, Ireland
| | - Meghan Feeney
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Martina Giltenane
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Maura Dowling
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
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Satisfaction with Long-Term Aesthetic and 10 Years Oncologic Outcome following Risk-Reducing Mastectomy and Implant-Based Breast Reconstruction with or without Nipple Preservation. Cancers (Basel) 2022; 14:cancers14153607. [PMID: 35892866 PMCID: PMC9331253 DOI: 10.3390/cancers14153607] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/09/2022] [Accepted: 07/16/2022] [Indexed: 11/17/2022] Open
Abstract
Incidence of bilateral risk-reducing mastectomies (RRMs) is increasing. The aim of this study was to compare satisfaction, aesthetic and oncological outcomes in women undergoing RRM with implant-based reconstruction comparing nipple-sparing mastectomy (NSM) with skin-sparing mastectomy (SSM) (sacrificing the nipple +/− nipple reconstruction). Women who had undergone bilateral RRM between 1997 and 2016 were invited. Aesthetic outcome and nipple symmetry were evaluated using standardized anthropometric measurements. The oncological outcome was assessed at last documented follow up. Ninety-three women (186 breasts) participated, 60 (64.5%) had NSM, 33 (35.5%) SSM. Median time between surgery and participation was 98.4 months (IQR: 61.7−133.9). Of the women, 23/33 (69.7%) who had SSM underwent nipple reconstruction. Nipple projection was shorter in the reconstructed SSM group than the maintained NSM group (p < 0.001). There was no significant difference in overall symmetry (p = 0.670), satisfaction regarding nipple preservation (p = 0.257) or overall nipple satisfaction (p = 0.074). There were no diagnoses of breast cancer at a median follow up of 129 months (IQR: 65−160.6). Women who undergo nipple-sparing RRM maintain long-term nipple symmetry. Nipple projection was less maintained after nipple reconstruction. Although satisfaction with the nipples was higher in the NSM group, this did not reach statistical significance. No breast cancers developed after RRM with long-term follow up.
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Liu J, Hunter S, Zhu J, Lee RLT, Chan SWC. Decision regret regarding treatments among women with early-stage breast cancer: a systematic review protocol. BMJ Open 2022; 12:e058425. [PMID: 35301213 PMCID: PMC8932263 DOI: 10.1136/bmjopen-2021-058425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Women with early-stage breast cancer (EBC) are commonly required to make treatment decisions. Decision regret regarding treatments is an adverse outcome that negatively affects women's psychological well-being and quality of life. A systematic review will be conducted to synthesise evidence about decision regret among women regarding treatments for EBC. The study will focus on levels of decision regret, what is regretted, and the factors associated with decision regret. METHODS AND ANALYSIS A systematic review will be conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 checklist. Electronic databases, including CINAHL Complete, Embase, PubMed, Medline and Web of Science, will be searched for relevant articles published from 2000 to 2021. The reference lists of eligible studies will also be manually searched. All types of quantitative, qualitative and mixed-methods studies that report on decision regret regarding treatments among women with EBC will be included. The primary outcome of this review will be women's levels of decision regret regarding breast cancer treatments. The secondary outcomes will include the content of their regrets, and the factors contributing to decision regret. The methodological quality of the studies will be assessed using the Joanna Briggs Institute appraisal tools. Meta-analysis and thematic synthesis approaches will be used to synthesise quantitative and qualitative data, respectively. A convergent parallel approach will be used to integrate quantitative and qualitative findings. ETHICS AND DISSEMINATION Ethical approval is not required for this systematic review. The findings of this work will be disseminated at international conferences and peer-reviewed journals. The findings of this systematic review will inform the development of decision interventions to improve the decision outcomes of breast cancer treatments. PROSPERO REGISTRATION NUMBER CRD42021260041.
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Affiliation(s)
- Jing Liu
- School of Nursing and Midwifery, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Sharyn Hunter
- School of Nursing and Midwifery, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Jiemin Zhu
- Department of Nursing, School of Medicine, Xiamen University, Xiamen, Fujian, People's Republic of China
| | - Regina Lai-Tong Lee
- School of Nursing and Midwifery, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Sally Wai-Chi Chan
- President Office, Tung Wah College, Hong Kong, People's Republic of China
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Mathelin C, Barranger E, Boisserie-Lacroix M, Boutet G, Brousse S, Chabbert-Buffet N, Coutant C, Daraï E, Delpech Y, Duraes M, Espié M, Golfier F, Hamy AS, Kermarrec E, Lavoué V, Lodi M, Luporsi É, Maugard C, Molière S, Seror JY, Taris N, Uzan C, Vaysse C, Fritel X. [Techniques and complications of non-genetic risk reducing mastectomies: Guidelines of the National College of French Gynecologists and Obstetricians (CNGOF)]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:121-129. [PMID: 34922037 DOI: 10.1016/j.gofs.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Based on an updated review of the international literature covering the different surgical techniques and complications of risk reducing mastectomies (RRM) in non-genetic context, the Commission of Senology (CS) of the College National des Gynécologues Obstétriciens Français (CNGOF) aimed to establish recommendations on the techniques to be chosen and their implementation. DESIGN The CNGOF CS, composed of 24 experts, developed these recommendations. A policy of declaration and monitoring of links of interest was applied throughout the process of making the recommendations. Similarly, the development of these recommendations did not benefit from any funding from a company marketing a health product. The CS adhered to and followed the AGREE II (Advancing guideline development, reporting and evaluation in healthcare) criteria and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method to assess the quality of the evidence on which the recommendations were based. The potential drawbacks of making recommendations in the presence of poor quality or insufficient evidence were highlighted. METHODS The CS considered 6 questions in 4 thematic areas, focusing on oncologic safety, risk of complications, aesthetic satisfaction and psychological impact, and preoperative modalities. RESULTS The application of the GRADE method resulted in 7 recommendations, 6 with a high level of evidence (GRADE 1±) and 1 with a low level of evidence (GRADE 2±). CONCLUSION There was significant agreement among the CS members on recommendations for preferred surgical techniques and practical implementation.
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Affiliation(s)
- C Mathelin
- CHRU, avenue Molière, 67200 Strasbourg, France; ICANS, 17, rue Albert-Calmette, 67033 Strasbourg cedex, France.
| | - E Barranger
- Centre Antoine-Lacassagne, 36, avenue de Valombrose, 06189 Nice, France
| | | | - G Boutet
- AGREGA, service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalier universitaire de Bordeaux, groupe hospitalier Pellegrin, place Amélie-Raba-Léon, 33 000 Bordeaux, France
| | - S Brousse
- CHU de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France
| | | | - C Coutant
- Département d'oncologie chirurgicale, centre Georges-François-Leclerc, 1, rue du Pr Marion, 21079 Dijon cedex, France
| | - E Daraï
- Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Y Delpech
- Centre Antoine Lacassagne, 33, avenue de Valombrose, 06189 Nice, France
| | - M Duraes
- CHU de Montpellier, 191, avenue du Doyen-Giraud, 34295 Montpellier cedex, France
| | - M Espié
- Hôpital St Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - F Golfier
- Centre hospitalier Lyon Sud, bâtiment 3B, 165, chemin du Grand-Revoyet, 69495 Pierre Benite, France
| | - A S Hamy
- Institut Curie, 26, rue d'Ulm, 75248 Paris, France
| | - E Kermarrec
- Service de radiologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - V Lavoué
- Service de gynécologie, CHU, 16, boulevard de Bulgarie, 35200 Rennes, France
| | - M Lodi
- CHU, avenue Molière, 67200 Strasbourg, France
| | - É Luporsi
- Oncologie médicale et oncogénétique, hôpital de Mercy, CHR Metz-Thionville, 1, allée du Château, 57085 Metz, France
| | - C Maugard
- Service de génétique oncologique clinique et unité de génétique oncologique moléculaire, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg
| | - S Molière
- Imagerie du sein, CHRU, avenue Molière 67200 Strasbourg, France
| | - J-Y Seror
- Cabinet privé, 9 ter boulevard Montparnasse, 75006 Paris, France
| | - N Taris
- Oncogénétique, ICANS, 17, rue Albert Calmette, 67033 Strasbourg, France
| | - C Uzan
- Hôpital Pitié-Salpetrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - C Vaysse
- Service de chirurgie oncologique, CHU de Toulouse, institut universitaire du cancer de Toulouse-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - X Fritel
- Centre hospitalo-universitaire de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
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Courtney EP, Goldenberg JL. Adaptive self-objectification in the context of breast cancer: A theoretical integration of the terror management health model and research on objectification. Appl Psychol Health Well Being 2021; 14:1211-1227. [PMID: 34935298 DOI: 10.1111/aphw.12331] [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: 05/17/2021] [Accepted: 12/06/2021] [Indexed: 11/28/2022]
Abstract
Integrating theorizing from the terror management health model with research on the objectification of women's bodies, we present a novel framework for understanding reactions to breasts in the context of breast cancer: adaptive self-objectification. We suggest that, despite evidence that objectifying the body has harmful consequences for women, viewing the breasts as objects has the potential to lead to positive outcomes in the context of breast health and cancer. We find evidence for this in the context of mass communication about breast cancer screening, in women's willingness and comfort with engagement in breast cancer screening, and in the decisions women make with respect to cancer treatment (e.g. mastectomy). We conclude with a call to action for research to examine the impact of objectification of the breasts on screening behavior and treatment decisions, and consider how adaptive self-objectification can be encouraged, with the aim of saving lives.
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Affiliation(s)
- Emily P Courtney
- Department of Psychology, University of South Florida, Tampa, Florida, USA
| | - Jamie L Goldenberg
- Department of Psychology, University of South Florida, Tampa, Florida, USA
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9
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Tyner TE, Freysteinson WM. A concept analysis of decision regret in women with breast cancer. Nurs Forum 2021; 57:112-120. [PMID: 34431105 DOI: 10.1111/nuf.12642] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 11/27/2022]
Abstract
The aim of this article is to understand the components of decision regret for women making breast cancer treatment decisions. Patient-centered care models encourage women to become more active in the decision-making process, inadvertently exposing them to the risk of experiencing decision regret. Enhancing the understanding of the concept of decision regret can offer insight into ways to mitigate this phenomenon. The Walker and Avant method was used to analyze this concept. Using PubMed, CINAHL, ERIC, Academic Search Complete, PsychINFO, SocINDEX, Joanna Briggs Institute of EBP Database, and an online dictionary, articles from 2011 to 2021 were analyzed to identify concept uses, attributes, antecedents, and consequences. Decision regret in women making breast cancer healthcare decisions is a negative cognitive-emotional response to a treatment decision that involves counterfactual thinking with three targets of regret: outcome regret, chosen option regret, and process regret. Experiencing decision regret can reduce a woman's quality of life, inflict psychological distress, and impact future decision-making. Unfavorable outcomes, decision uncertainty, and breakdowns in the decision-making process can lead to decision regret. Findings provide information on identifying women experiencing decision regret and illustrate opportunities to address causative factors through patient education and support to promote optimal patient outcomes.
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Affiliation(s)
- Tracy E Tyner
- College of Nursing, Texas Woman's University, Denton, Texas, USA
| | - Wyona M Freysteinson
- Nelda C. Stark College of Nursing, Texas Woman's University, Houston, Texas, USA
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Luque Suárez S, Olivares Crespo ME, Brenes Sánchez JM, Herrera de la Muela M. Psychological implications of risk-reducing mastectomies in BRCA1/2 mutation carriers. Cir Esp 2021; 100:7-17. [PMID: 34217636 DOI: 10.1016/j.cireng.2021.06.014] [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: 03/08/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
Risk-reducing surgeries decrease the risk of developing breast cancer by 95%. But this type of surgery can be life-changing. This systematic review analyzed anxiety/depressive symptomatology, body image and quality of life on BRCA1/2 mutation carriers with or without a previous oncological history who have undergone risk-reducing mastectomy. PRISMA method was used to conduct this review. The initial search identified 234 studies. However, only 7 achieved the inclusion criteria. No statistically significant differences were found in terms of anxious symptomatology. One study found that depressive symptomatology had increased significantly in women without previous oncological history at the long-term follow-up measure. Women who underwent bilateral risk-reducing mastectomy and implant-based breast reconstruction tended to be satisfied with their body image/cosmetic outcome. No differences were reported at long-term follow-ups, independently of the surgery performed.
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11
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Luque Suárez S, Olivares Crespo ME, Brenes Sánchez JM, Herrera de la Muela M. Psychological implications of risk-reducing mastectomies in BRCA1/2 mutation carriers. Cir Esp 2021; 100:S0009-739X(21)00180-9. [PMID: 34140136 DOI: 10.1016/j.ciresp.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 12/21/2022]
Abstract
Risk-reducing surgeries decrease the risk of developing breast cancer by 95%. But this type of surgery can be life-changing. This systematic review analyzed anxiety/depressive symptomatology, body image and quality of life on BRCA1/2 mutation carriers with or without a previous oncological history who have undergone risk-reducing mastectomy. PRISMA method was used to conduct this review. The initial search identified 234 studies. However, only 7 achieved the inclusion criteria. No statistically significant differences were found in terms of anxious symptomatology. One study found that depressive symptomatology had increased significantly in women without previous oncological history at the long-term follow-up measure. Women who underwent bilateral risk-reducing mastectomy and implant-based breast reconstruction tended to be satisfied with their body image/cosmetic outcome. No differences were reported at long-term follow-ups, independently of the surgery performed.
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12
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Gaba F, Goyal S, Marks D, Chandrasekaran D, Evans O, Robbani S, Tyson C, Legood R, Saridogan E, McCluggage WG, Hanson H, Singh N, Evans DG, Menon U, Manchanda R. Surgical decision making in premenopausal BRCA carriers considering risk-reducing early salpingectomy or salpingo-oophorectomy: a qualitative study. J Med Genet 2021; 59:122-132. [PMID: 33568437 PMCID: PMC8788252 DOI: 10.1136/jmedgenet-2020-107501] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Acceptance of the role of the fallopian tube in 'ovarian' carcinogenesis and the detrimental sequelae of surgical menopause in premenopausal women following risk-reducing salpingo-oophorectomy (RRSO) has resulted in risk-reducing early-salpingectomy with delayed oophorectomy (RRESDO) being proposed as an attractive alternative risk-reducing strategy in women who decline/delay oophorectomy. We present the results of a qualitative study evaluating the decision-making process among BRCA carriers considering prophylactic surgeries (RRSO/RRESDO) as part of the multicentre PROTECTOR trial (ISRCTN:25173360). METHODS In-depth semistructured 1:1 interviews conducted using a predeveloped topic-guide (development informed by literature review and expert consultation) until informational saturation reached. Wording and sequencing of questions were left open with probes used to elicit additional information. All interviews were audio-recorded, transcribed verbatim, transcripts analysed using an inductive theoretical framework and data managed using NVIVO-v12. RESULTS Informational saturation was reached following 24 interviews. Seven interconnected themes integral to surgical decision making were identified: fertility/menopause/cancer risk reduction/surgical choices/surgical complications/sequence of ovarian-and-breast prophylactic surgeries/support/satisfaction. Women for whom maximising ovarian cancer risk reduction was relatively more important than early menopause/quality-of-life preferred RRSO, whereas those more concerned about detrimental impact of menopause chose RRESDO. Women managed in specialist familial cancer clinic settings compared with non-specialist settings felt they received better quality care, improved hormone replacement therapy access and were more satisfied. CONCLUSION Multiple contextual factors (medical, physical, psychological, social) influence timing of risk-reducing surgeries. RRESDO offers women delaying/declining premenopausal oophorectomy, particularly those concerned about menopausal effects, a degree of ovarian cancer risk reduction while avoiding early menopause. Care of high-risk women should be centralised to centres with specialist familial gynaecological cancer risk management services to provide a better-quality, streamlined, holistic multidisciplinary approach.
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Affiliation(s)
- Faiza Gaba
- Wolfson Institute of Preventive Medicine, Barts CRUK Centre, Queen Mary University of London-Charterhouse Square Campus, London, UK.,Gynaecological Oncology, Barts Health NHS Trust, London, UK
| | - Shivam Goyal
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Dalya Marks
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Dhivya Chandrasekaran
- Wolfson Institute of Preventive Medicine, Barts CRUK Centre, Queen Mary University of London-Charterhouse Square Campus, London, UK.,Gynaecological Oncology, Barts Health NHS Trust, London, UK
| | - Olivia Evans
- Wolfson Institute of Preventive Medicine, Barts CRUK Centre, Queen Mary University of London-Charterhouse Square Campus, London, UK.,Gynaecological Oncology, Barts Health NHS Trust, London, UK
| | - Sadiyah Robbani
- Centre for Experimental Cancer Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, London, UK
| | - Charlotte Tyson
- Centre for Experimental Cancer Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, London, UK
| | - Rosa Legood
- Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ertan Saridogan
- Department of Gynaecology, University College London Hospitals NHS Foundation Trust, London, UK
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
| | - Helen Hanson
- South West Thames Regional Genetics Service, South West Thames Regional Genetic Services, London, UK
| | - Naveena Singh
- Department of Pathology, Barts Health NHS Trust, London, UK
| | - D Gareth Evans
- Centre for Genomic Medicine, University of Manchester, Manchester, UK
| | - Usha Menon
- MRC Clinical Trials Unit, University College London, London, UK
| | - Ranjit Manchanda
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK .,Department of Gynaecological Oncology, Barts Health NHS Trust, London, UK
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13
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Hickey I, Jha S, Wyld L. The psychosexual effects of risk-reducing bilateral salpingo-oophorectomy in female BRCA1/2 mutation carriers: A systematic review of qualitative studies. Gynecol Oncol 2020; 160:763-770. [PMID: 33317909 DOI: 10.1016/j.ygyno.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION It is estimated that up to 20% of ovarian cancers have an inherited genetic etiology with the most common being BRCA1/2 mutations. For women with these mutations risk-reducing bilateral salpingo-oophorectomy (RRBSO) to reduce the risk of primary ovarian cancer is often performed, however the surgery results in immediate onset of surgical menopause. AIM The aim of this systematic review was to explore the psychosexual impacts of risk reducing bilateral salpingo oophorectomy in the published qualitative literature. METHODS PubMed, Medline, Web of Science and PsycInfo were searched for qualitative papers that looked at the psychosexual impact of RRBSO on individuals who were pre-menopausal at the time of surgery. Studies were quality assessed using Mixed Method Appraisal Tool (MMAT) and Standard for Reporting Qualitative Research (SRQR) checklists and data were extracted. Thematic synthesis of the results was performed. RESULTS Of 143 papers identified in searching, 5 qualitative papers were identified relating to interviews with 115 women after RRBSO published between 2000 and 2020. The quality of the papers was moderate. Five different themes were identified related to individual experiences with RRBSO: (1) information needs, (2) psychological impact, (3) psychosexual impact, (4) partner support and (5) hormone replacement therapy (HRT). CONCLUSION Individual experiences of RRBSO were varied and influenced by multiple factors but psychosexual problems were common, often caused significant distress to the women and their partners and were often poorly explained before surgery. Women do not feel adequately prepared for the psychological and sexual side effects of RRBSO. The qualitative data provides invaluable insight into the individual experiences of women and can be used to better help women mitigate the effects of the surgery.
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Affiliation(s)
- India Hickey
- University of Sheffield, Department of Oncology and Metabolism, Academic Unit of Reproductive and Developmental Medicine, UK.
| | - Swati Jha
- Sheffield Teaching Hospitals NHS Foundation Trust, Jessop Hospital for Women, Sheffield, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield S10 2RX, UK; Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Armthorpe Road, Doncaster, UK
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Long-Term Evaluation of Women Referred to a Breast Cancer Family History Clinic (Manchester UK 1987-2020). Cancers (Basel) 2020; 12:cancers12123697. [PMID: 33317064 PMCID: PMC7763143 DOI: 10.3390/cancers12123697] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/02/2020] [Accepted: 12/05/2020] [Indexed: 12/20/2022] Open
Abstract
Simple Summary This study reports the management of women at high risk for breast cancer over a 33 years period. The aim was to summarize the numbers seen and to report the results of our studies on gene testing, the outcomes of screening and the success of preventive methods including lifestyle change, chemoprevention and risk-reducing mastectomy. We also discuss how the clinical Family History Service may be improved in the future. Abstract Clinics for women concerned about their family history of breast cancer are widely established. A Family History Clinic was set-up in Manchester, UK, in 1987 in a Breast Unit serving a population of 1.8 million. In this review, we report the outcome of risk assessment, screening and prevention strategies in the clinic and propose future approaches. Between 1987–2020, 14,311 women were referred, of whom 6.4% were from known gene families, 38.2% were at high risk (≥30% lifetime risk), 37.7% at moderate risk (17–29%), and 17.7% at an average/population risk who were discharged. A total of 4168 (29.1%) women were eligible for genetic testing and 736 carried pathogenic variants, predominantly in BRCA1 and BRCA2 but also other genes (5.1% of direct referrals). All women at high or moderate risk were offered annual mammographic screening between ages 30 and 40 years old: 646 cancers were detected in women at high and moderate risk (5.5%) with a detection rate of 5 per 1000 screens. Incident breast cancers were largely of good prognosis and resulted in a predicted survival advantage. All high/moderate-risk women were offered lifestyle prevention advice and 14–27% entered various lifestyle studies. From 1992–2003, women were offered entry into IBIS-I (tamoxifen) and IBIS-II (anastrozole) trials (12.5% of invitees joined). The NICE guidelines ratified the use of tamoxifen and raloxifene (2013) and subsequently anastrozole (2017) for prevention; 10.8% women took up the offer of such treatment between 2013–2020. Since 1994, 7164 eligible women at ≥25% lifetime risk of breast cancer were offered a discussion of risk-reducing breast surgery and 451 (6.2%) had surgery. New approaches in all aspects of the service are needed to build on these results.
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15
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The relationship between contralateral prophylactic mastectomy and breast reconstruction, complications, breast-related procedures, and costs: A population-based study of health insurance data. Surgery 2020; 168:859-867. [DOI: 10.1016/j.surg.2020.06.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/09/2020] [Accepted: 06/18/2020] [Indexed: 12/20/2022]
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de Silva TS, Russell VR, Henry FP, Thiruchelvam PTR, Hadjiminas DJ, Al-Mufti R, Hogben RK, Hunter J, Wood S, Jallali N, Leff DR. Streamlining Decision Making in Contralateral Risk-Reducing Mastectomy: Impact of PREDICT and BOADICEA Computations. Ann Surg Oncol 2018; 25:3057-3063. [PMID: 30019305 PMCID: PMC6132413 DOI: 10.1245/s10434-018-6593-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Indexed: 01/04/2023]
Abstract
Introduction Patients with sporadic breast cancer (BC) have low contralateral breast cancer risk (CLBCR; approximately 0.7% per annum) and contralateral prophylactic mastectomy (CPM) offers no survival advantage. CPM with autologous reconstruction (AR) has major morbidity and resource implications. Objective The aim of this study was to review the impact of PREDICT survival estimates and lifetime CLBCR scores on decision making for CPM in patients with unilateral BC. Methods Of n = 272 consecutive patients undergoing mastectomy and AR, 252 were included. Five- and 10-year survival was computed with the PREDICT(V2) online prognostication tool, using age and clinicopathological factors. Based on family history (FH) and tumor biology, CLBCR was calculated using validated BODICEA web-based software. Survival scores were correlated against CLBCR estimates to identify patients receiving CPM with ‘low’ CLBCR (< 30% lifetime risk) and poor prognosis (5-year survival < 80%). Patients with ‘high’ CLBCR receiving unilateral mastectomy (UM) were similarly identified (UK National Institute of Health and Care Excellence [NICE] criteria for CPM, ≥ 30% lifetime BC risk). Justifications motivating CPM were investigated. Results Of 252 patients, 215 had UM and 37 had bilateral mastectomy and AR. Only 23 (62%) patients receiving CPM fulfilled the NICE criteria. Of 215 patients, 5 (2.3%) failed to undergo CPM despite high CLBCR and good prognosis. CPMs were performed, at the patient’s request, for no clear justification (n = 8), contralateral non-invasive disease, and/or FH (n = 5), FH alone (n = 4) and ipsilateral cancer recurrence-related anxiety (n = 3). Conclusion In the absence of prospective risk estimates of CLBCR and prognosis, certain patients receive CPM and reconstruction despite modest CLBCR, yet a proportion of patients with good prognoses and substantial risk are not undergoing CPM.
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Affiliation(s)
| | | | - Francis Patrick Henry
- Plastics and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London, UK
| | | | | | | | | | - Judith Hunter
- Plastics and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Simon Wood
- Plastics and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Navid Jallali
- Plastics and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Daniel Richard Leff
- Breast Unit, Imperial College Healthcare NHS Trust, London, UK. .,Department of Surgery and Cancer, BioSurgery and Surgical Technology, 10th Floor, QEQM Wing, St Mary's Hospital, Paddington, London, W2 1NY, UK.
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Braude L, Kirsten L, Gilchrist J, Juraskova I. The development of a template for psychological assessment of women considering risk-reducing or contralateral prophylactic mastectomy: A national Delphi consensus study. Psychooncology 2018; 27:2349-2356. [PMID: 29966172 DOI: 10.1002/pon.4830] [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: 04/05/2018] [Revised: 06/18/2018] [Accepted: 06/21/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Risk-reducing mastectomies (RRM) and contralateral prophylactic mastectomies (CPM) are increasingly prevalent strategies to reduce breast cancer risk. Given the associated physical and emotional challenges, presurgical psychological assessment is frequently recommended for this population, yet limited research exists to guide this. This study aimed to reach a consensus on the most relevant content and format of a psychological consultation prior to RRM/CPM. METHODS A modified two-round online Delphi study was conducted Australia-wide. Expert participants (n = 25), including psychologists, surgeons, nurses, oncologists, genetic specialists, and researchers completed a round-one survey, informed by a literature review, previous qualitative study and expert clinicians' input. This required participants to rate their agreement with 36 statements regarding potential content of a psychological consultation and provide feedback on format/structure. A round-two survey comprised items that had not reached consensus and six new items suggested by participants. Parameters for statement consensus were set a priori at >75% agreement. RESULTS Expert participants indicated agreement with the majority of statements (39/42, 92.8%), endorsing that the assessment should include (1) patient understanding of the RRM/CPM procedure/cancer risk, (2) potential physical/emotional impact of surgery, (3) informed decision-making, and (4) past/current psychological issues (anxiety and body image). A provisional assessment template and user manual is provided. CONCLUSIONS This research culminated in a consensus-based template to guide psychological assessment of women considering RRM/CPM. This enables health professionals to assess suitability for surgery and preempt challenges within a standardised framework. Future evaluation of the acceptability and effectiveness of the template in clinical settings is warranted.
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Affiliation(s)
- Lucy Braude
- School of Psychology, The University of Sydney, Camperdown, NSW, Australia
| | - Laura Kirsten
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Camperdown, NSW, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Camperdown, NSW, Australia.,Nepean Cancer Care Centre, Sydney West Cancer Network, Kingswood, NSW, Australia
| | - Jemma Gilchrist
- Mind My Health Clinical Psychology, Norwest Private Hospital, NSW, Australia
| | - Ilona Juraskova
- School of Psychology, The University of Sydney, Camperdown, NSW, Australia.,Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Camperdown, NSW, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Camperdown, NSW, Australia
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18
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Glassey R, O'Connor M, Ives A, Saunders C, kConFab Investigators, O'Sullivan S, Hardcastle SJ. Patients' perspectives and experiences concerning barriers to accessing information about bilateral prophylactic mastectomy. Breast 2018; 40:116-122. [PMID: 29758504 DOI: 10.1016/j.breast.2018.05.003] [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: 12/16/2017] [Revised: 04/17/2018] [Accepted: 05/07/2018] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To explore the barriers and experiences of accessing information for women who have received genetic risk assessment/testing results for breast cancer (BC) and are considering a bilateral prophylactic mastectomy (BPM) and, exploring participants' preferences concerning information and support needs. METHODS A qualitative retrospective study guided by interpretative phenomenological analysis was utilised. Semi-structured interviews were conducted with forty-six women who were either considering BPM or had already undergone the surgery. RESULTS Three themes identified barriers to accessing information; difficulties accessing information, inconsistent information and clinical focus/medicalized information. A fourth theme - preferences of information and support needs, identified three subthemes; these were, psychological support, clearly defined processes and photos of mastectomies/reconstruction surgeries. CONCLUSIONS Barriers to accessing information appeared to be widespread. A lack of integrated services contributed to inconsistent information, and medicalized terminology/clinical focus of consultations further complicated understanding. Preferences for information include clearly defined processes, so women know the pathways after confirmation of familial BC risk. Clinical implications include a multidisciplinary team approach, and a protocol that reflects current practice.
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Affiliation(s)
- Rachael Glassey
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia.
| | - Moira O'Connor
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Angela Ives
- CaPCREU, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| | - Christobel Saunders
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| | - kConFab Investigators
- KConFab, Research Department, Peter MacCallum Cancer Centre, Melbourne, Australia; The Sir Peter MacCallum Department of Oncology University of Melbourne, Parkville, Australia
| | | | - Sarah J Hardcastle
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
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Finset A. Special Section: Review articles on decision making and patient education interventions. PATIENT EDUCATION AND COUNSELING 2017; 100:2157-2158. [PMID: 29032951 DOI: 10.1016/j.pec.2017.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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