Satisfaction and overall quality of life in BRCA positive women after prophylactic surgeries
Authors:
P. Šašková; D. Pavlišta; L. Dostálek
Authors‘ workplace:
Gynekologicko-porodnická klinika 1. LF Univerzity Karlovy a VFN Praha
přednosta: prof. MUDr. A. Martan, DrSc.
Published in:
Rozhl. Chir., 2017, roč. 96, č. 8, s. 328-333.
Category:
Review
Overview
Introduction:
Genetic mutations are responsible for 5–10% of all breast and ovarian carcinomas, while most of them are caused by a mutation of the BRCA gene. Women with this type of mutation have a lifetime risk of breast and ovarian cancer and therefore, they require very intensive medical care, including surgical prevention. Specifically, prophylactic bilateral mastectomy and prophylactic salpingo-oophorectomy are done, which undoubtedly decrease the riskof cancer. The aim of this review article is to inform healthcare professionals and the general public about the satisfaction of BRCA positive women with their decision to undergo these prophylactic surgeries, and also about the impact of these procedures on sexuality, menopausal symptoms, mental health and the overall quality of life.
Methods:
Search of original studies and review articles onthe influence of prophylactic surgeries on the life of women with BRCA genemutation.
Results:
In general, although some changes are observed after the prophylactic surgeries, the overall quality of life does not change. A significant reduction in anxiety and fear of cancer is observed after both prophylactic bilateral mastectomy andprophylactic bilateral salpingo-oophorectomy, providing great psychological relief to the affected women. However, prophylactic bilateral salpingo-oophorectomy causes premature menopause in premenopausal women at the time of surgery and the associated occurrence of menopausal symptoms. Some of the symptoms can be significantly reduced by hormone replacement therapy but will not be eliminated altogether. In postmenopausal women, no or minimal worsening of menopausal symptoms was reported. After prophylactic bilateral mastectomy, particularly appearance-related problems were observed. In both types of surgery, sexual problems were also observed.
Conclusion:
The relief of reducingthe risk of cancerappears to be so great and so important for women that it outweighs the other negative effects of these prophylactic procedures.
Key words:
BRCA1/2 mutation – breast cancer – ovarian cancer – prophylactic bilateral salpingo-oophorectomy – prophylactic bilateral mastectomy
Sources
1. Schmeler KM, Sun CC, Bodurka DC, et al. Prophylactic bilateral salpingo-oophorectomy compared with surveillance in women with BRCA mutations. Obstet Gynecol 2006;108 (Part 1):515–20.
2. Lifetime risk of developing or dying from cancer 2016. Available from https://www.cancer.org/cancer/cancer-basics/lifetime-probability-of-developing-or-dying-from-cancer.html.
3. Plevová P, Novotný J, Palácová M, et al. Syndrom hereditárního karcinomu prsu a ovarií. Klin Onkol 2009;22,(Supplementum):8–11.
4. Zikán M. Gynekologická prevence a gynekologické aspekty péče u nosiček mutací genů BRCA1 a BRCA2. Klin Onkol 2016;29.(Supplementum 1):22–30.
5. Hartmann LC, Sellers TA, Schaid DJ, et al. Efficacy of bilateral prophylactic mastectomy in BRCA1 and BRCA2 gene mutation carriers. J Natl Cancer inst 2001;93:1633–7.
6. Rebbeck TR, Lynch HT, Neuhausen SL, et al. Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. N Engl J Med 2002;346:1616–22.
7. Casey MJ, Synder C, Bewtra C, et al. Intra-abdominal carcinomatosis after prophylactic oophorectomy in women of hereditary breast ovarian cancer syndrome kindreds associated with BRCA1 and BRCA2 mutations. Gynecol Oncol 2005;97: 457–67.
8. Facing Our Risk of Cancer Empowered (FORCE). Understanding BRCA & HBOC. risk management. Risk management guidelines: NCNN Guidelines for Risk Management for Women with BRCA Mutations 2016. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5134086/
9. Profylaktická mastektomie s rekonstrukcí. In: Dražan L, Měšťák J. Rekonstrukce prsu po mastektomii. Praha, Grada Publishing 2006:119–29.
10. Rekonstrukce prsu po mastektomii. 2014. Available from: http://www.mammahelp.cz/rekonstrukce-prsu-po-mastektomii/.
11. Meijers-Heijboer EJ, Verhoog LC, Brekelmans CT, et al. Presymptomatic DNA testing and prophylactic surgery in families with a BRCA1 or BRCA2 mutation. Lancet 2000;355:2015–20.
12. Metcalfe KA, Birenbaum-Carmeli D, Lubinski J, et al. International variation in rates of uptake of preventive options in BRCA1 and BRCA2 mutation carriers. Int J Cancer 2008;122:2017–22.
13. Gopie JP, Mureau MA, Seynaeve C, et al. Body image issues after bilateral prophylactic mastectomy with breast reconstruction in healthy women at risk for hereditary breast cancer. Fam Cancer 2013;12:479–87.
14. Brandberg Y, Sandelin K, Erikson S, et al. Psychological reactions, quality of life, and body image after bilateral prophylactic mastectomy in women at high risk for breast cancer: a prospective 1-year follow-up study. J Clin Oncol 2008;26:3943–9.
15. Bresser PJ, Saenaeve C, Van Gool AR, et al. Satisfaction with prophylactic mastectomy and breast reconstruction in genetically predisposed women. Plast Reconstr 2006;117:1675–82.
16. Lodder LN, Frets PG, Trijsburq RW, et al. One year follow-up of women opting for presymptomatic testing for BRCA1 and BRCA2: emotional impact of the test outcome and decisions on risk management (surveillance or prophylactic surgery). Breast Cancer Res Treat 2002;73:97–112.
17. van Oostrom I, Meijers-Heijboer H, Lodder LN, et al. Long-term psychological impact of carrying a BRCA1/2 mutation and prophylactic surgery: a 5-year follow-up study. J Clin Oncol 2003; 21:3867–74.
18. Metcalfe KA, Esplen MJ, Goel V, et al. Psychosocial functioning in women who have undergone bilateral prophylactic mastectomy. Psychooncology 2004;13:14–25.
19. Madalinska JB, Hollenstein J, Bleiker E, et al. Quality-of-life effects of prophylactic salpingo-oophorectomy versus gynecologic screening among women at increased risk of hereditary ovarian cancer. J Clin Oncol 2005;23:6890–8.
20. Finch A, Metcalfe KA, Chianq JK, et al. The impact of prophylactic salpingo-oophorectomy on menopausal symptoms and sexual function in women who carry a BRCA mutation. Gynecol Oncol 2011;121:163–8.
21. Bonadies DC, Moyer A, Matloff ET. What I wish I’d known before surgery: BRCA carriers’ perspectives after bilateral salpingo-oophorectomy. Fam Cancer 2011;10:79–85.
22. Madalinska JB, van BeurdenM, Bleiker EM, et al. The impact of hormone replacement therapy on menopausal symptoms in younger high-risk women after prophylactic salpingo-oophorectomy. J Clin Oncol 2006;24:3576–82.
23. Elit L, Esplen MJ, Narod S. Quality of life and psychosexual adjustment after prophylactic oophorectomy for a family history of ovarian cancer. Fam Cancer 2001;1:149–56.
24. Robson M, Hensley M, Barakat R, et al. Quality of life in women at risk for ovarian cancer who have undergone risk-reducing oophorectomy. Gynecol Oncol 2003;89:281–7.
25. Bresser PJ, Seynaeve C, Van Gool AR, et al. The course of distress in women at increased risk of breast and ovarian cancer due to an (identified) genetic susceptibility who opt for prophylactic mastectomy and/or salpingo-oophorectomy. Eur J Cancer 2007;43:95–103.
26. Finch A, Metcalfe KA, Chianq J, et al. The impact of prophylactic salpingo-oophorectomy on quality of life and psychological distress in women with a BRCA mutation. Psychooncology 2013; 22:212–9.
27. Weaver AD, Byers ES. The relationships among body image, body mass index, exercise, and sexual functioning in heterosexual women. Psychol Women Quart 2006;30:333–9.
28. Belloc NB, Breslow L, Hochstim JR. Measurement of physical health in a general population survey. Am J Epidemiol 1971;93:328–36.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2017 Issue 8
Most read in this issue
- A new perspective on axillary dissection in situations of metastatic sentinel node
- Is it possible to avoid axillary dissection?
- Satisfaction and overall quality of life in BRCA positive women after prophylactic surgeries
- Magnetic resonance imaging in preoperative diagnosis of invasive lobular carcinomas of the breast – analysis of 230 cases