Contralateral prophylactic mastectomy (CPM): A systematic review of patient reported factors and psychological predictors influencing choice and satisfaction

Brittany Ager; Phyllis Butow; Jesse Jansen; Kelly-Anne Phillips; David Porter; CPM DA Advisory Group

doi:10.1016/j.breast.2016.04.005

Contralateral prophylactic mastectomy (CPM): A systematic review of patient reported factors and psychological predictors influencing choice and satisfaction

Breast. 2016 Aug:28:107-20. doi: 10.1016/j.breast.2016.04.005. Epub 2016 Jun 9.

Authors

Brittany Ager¹, Phyllis Butow², Jesse Jansen³, Kelly-Anne Phillips⁴, David Porter⁵; CPM DA Advisory Group

Affiliations

¹ School of Psychology, The University of Sydney, Australia. Electronic address: bage4508@uni.sydney.edu.au.
² Centre for Medical Psychology and Evidence Based Decision-Making, The University of Sydney, Australia; Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Australia.
³ Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Australia; Sydney Medical School, The University of Sydney, Australia.
⁴ Division of Cancer Medicine, Peter MacCallum Cancer Centre, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.
⁵ Dept of Medical Oncology, Auckland Hospital, Auckland, New Zealand; Faculty of Medical and Health Sciences, The University of Auckland, New Zealand.

PMID: 27290619
DOI: 10.1016/j.breast.2016.04.005

Abstract

Objective: Conduct a systematic review of quantitative and qualitative studies exploring patient reported factors and psychological variables influencing the decision to have contralateral prophylactic mastectomy (CPM), and satisfaction with CPM, in women with early stage breast cancer.

Methods: Studies were identified via databases: Medline, CINAHL, Embase and PsycINFO. Data were extracted by one author and crosschecked by two additional authors for accuracy. The quality of included articles was assessed using standardised criteria by three authors.

Results: Of the 1346 unique citations identified, 17 were studies that met the inclusion criteria. Studies included were primarily cross-sectional and retrospective. No study utilised a theoretical framework to guide research and few studies considered psychological predictors of CPM. Fear of breast cancer was the most commonly cited reason for CPM, followed by cosmetic reasons such as desire for symmetry. Overall, women appeared satisfied with CPM, however, adverse/diminished body image, poor cosmetic result, complications, diminished sense of sexuality, emotional issues and perceived lack of education regarding alternative surveillance/CPM efficacy were cited as reasons for dissatisfaction.

Conclusion: Current literature has begun to identify patient-reported reasons for CPM; however, the relative importance of different factors and how these factors relate to the process underlying the decision to have CPM are unknown. Of women who considered CPM, limited information is available regarding differences between those who proceed with or ultimately decline CPM.

Keywords: Contralateral prophylactic mastectomy; Patient attitudes; Systematic review.

Publication types

Review
Systematic Review

MeSH terms

Body Image / psychology
Breast Neoplasms / prevention & control*
Breast Neoplasms / psychology*
Breast Neoplasms / surgery
Choice Behavior*
Emotions
Fear
Female
Humans
Patient Education as Topic
Patient Satisfaction*
Prophylactic Mastectomy / adverse effects
Prophylactic Mastectomy / psychology*
Sexuality / psychology