Psychological and Social Effects of Removing the Opposite Breast in Nonhereditary Breast Cancer

After cancer is detected in one breast, concern that cancer may develop in the opposite breast, or the presence of hereditary cancer, may lead to surgical removal of the other healthy breast, a procedure called prophylactic contralateral mastectomy. Journal of Clinical Oncologypublished a study of women who, despite not carrying hereditary breast cancer, chose to have both breasts removed, examining their concerns about breast cancer and physical appearance and their quality of life. The study found that women choosing contralateral removal had greater cancer and body image concerns. After such surgery, body image-related distress was higher and quality of life lower.

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Study Details

The study at MD Anderson Cancer Center in Houston involved women with a mean age of 56, totaling 288. Of these breast cancer patients, 50 chose prophylactic contralateral mastectomy (removal of the healthy breast). Surveys were conducted before surgery and at months 1, 6, 12 and 18. Primary psychosocial measures were cancer worry and cancer-specific distress.

Psychosocial Measures Before and After Surgery

• Before and after breast cancer surgery, women undergoing prophylactic contralateral mastectomy (CPM) had higher cancer distress, cancer worry and body image concerns.
• CPM was associated with greater body image distress and worse quality of life after surgery.
• However, cancer worry was highest before surgery in patients choosing CPM. It decreased over time and, in the long term, became similar to that of patients who did not choose CPM.
• Quality of life was similar before surgery in both groups, but from month 1 afterward, it was lower and remained lower in patients choosing healthy breast removal. 

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The researchers concluded: "The findings of this prospective study are relevant to clinical practice and should better inform discussions between women and doctors about prophylactic contralateral mastectomy. Fear and anxiety during surgical decision-making may prevent women with breast cancer from anticipating CPM's psychological and social effects. Discussing psychosocial outcomes such as cancer worry, quality of life and concerns about body image changes, alongside clinical outcomes, may help women fully consider CPM's psychosocial impact. For women with excessive cancer worry, psychological support directly addressing this worry may help manage body image concerns."

Conclusion

Before surgery, women choosing contralateral prophylactic mastectomy had greater concerns about cancer and physical appearance. They also had greater appearance concerns and lower quality of life after surgery. Psychological support may help manage these anxieties and concerns.

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