BMJ 2001;322:76 ( 13 January )

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The psychosocial impact of bilateral prophylactic mastectomy: prospective study using questionnaires and semistructured interviews

Mal Bebbington Hatcher, research psychologist, ^a Lesley Fallowfield, professor of psycho-oncology, ^a Roger A'Hern, statistician. ^b

^a Cancer Research Campaign Psychosocial Oncology Group, Bland Sutton Institute, Royal Free and University College Medical School, London W1P 7PL, ^b Mulberry House, Royal Marsden NHS Trust, London SW3 6JJ

Correspondence to: L Fallowfield l.fallowfield{at}ucl.ac.uk

Objectives: To investigate the psychosocial impact of bilateral prophylactic mastectomy for women with increased risk of breast cancer and to identify, preoperatively, risk factors for postoperative distress.
Design: Prospective study using interviews and questionnaire assessments.
Setting: Participants' homes throughout the United Kingdom.
Participants: 143 women with increased risk of developing breast cancer who were offered bilateral prophylactic mastectomy and who accepted or declined the surgery; a further 11 were offered surgery but deferred making a decision.
Main outcome measures: Psychological and sexual morbidity.
Results: Psychological morbidity decreased significantly over time for the 79 women who chose to have surgery (accepters): 58% (41/71) preoperatively v 41% (29/71) 6 months postoperatively (difference in percentages 17%, 95% confidence interval 2% to 32%; P=0.04) and 60% (39/65) preoperatively v 29% (19/65) 18 months postoperatively (31%, 15% to 47%; P<0.001). Psychological morbidity in the 64 women who declined surgery (decliners) did not decrease significantly: 57% (31/54) at baseline v 43% (23/54) at 6 months (14%, 0% to 29%; P=0.08) and 57% (29/52) at baseline v 41% (21/52) at 18 months (16%; 2% to 33%; P=0.11). Greater than normal proneness to anxiety was more common in the decliners than in the accepters: 78% (45/58) v 56% (41/73) (22%, 6% to 38%; P=0.006). Accepters were more likely than decliners to believe it inevitable that they would develop breast cancer (32% (24/74) v 10% (6/58) (difference in percentages 22%, 9% to 35%; P=0.003)), and decliners were more likely to believe that screening could help (92% (55/60) v 74% (55/74) (18%, 5% to 31%; P=0.007)). Level of sexual discomfort and degree of sexual pleasure did not change significantly over time in either of the two groups.
Conclusions: Bilateral prophylactic mastectomy may provide psychological benefits in women with a high risk of developing breast cancer.

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