A qualitative study on psychosocial impact of contralateral prophylactic mastectomy among breast cancer female patients who underwent BRCA1 and BRCA2genetic testing in Hong Kong China

Abstract

Introduction: To thoroughly examine the psycho-social impact of contralateral prophylactic mastectomy (CPM) among Hong Kong Chinese females with contralateral breast cancer history who underwent BRCA1/2 genetic testing. This aims to be first study of its kind in Chinese patients.

Material and Methods: 11 female BRCA1/BRCA 2 mutated gene carriers and 1 non-carrier with history of contralateral breast cancer and genetic testing performed by the Hong Kong Hereditary Breast Cancer Family Registry subsequently underwent CPM. They were surveyed by a face-to-face or telephone interview. Breast cancer history, types of prophylactic mastectomy and reconstruction, overall and cosmetic satisfaction, pain, body image and sexuality issues, cancer risk perception, with emphasis on exploring their perceptions were discussed. Retrieval of medical record using a prospective database was also obtained.

Results: Half of the participants who had CPM also underwent reconstruction. Most participants were satisfied with the overall results and 75% (9/12) thought they made the right decision. Onefourth of participants (3/12) expressed different extent of regrets. All opted for prophylaxis due to their reservation on the efficacy of surveillance. Most participants rated psychological relief and decreased breast cancer risk as major benefits. Sexually-inactive single participants appeared to adjust better to the cosmetic results of the surgery. Spouses’ reactions and support were crucial for postsurgery sexual satisfaction.

Conclusions: Thorough education on cancer risk and realistic expectation of surgery outcomes are crucial for positive adjustment after CPM. Proper genetic and pre-and post-surgery psychological counseling were necessary and beneficial from patients’ point of view. It may be helpful to involve spouses when counseling these patients.