Prophylactic bilateral mastectomy in Ontario

Introduction. Prophylactic mastectomy is an option for women who are at high-risk of developing breast cancer. The purposes of this study were; to describe the patterns of practice of bilateral prophylactic mastectomy in Ontario; to compare the perceptions of breast cancer risk with objective estimates of risk in women following preventive surgery; to assess the current psychosocial functioning of women who had previously had a bilateral prophylactic mastectomy; and to determine the predictors of quality of life following surgery.; Methods. Women in the province of Ontario who had undergone prophylactic mastectomy between 1991 and 2000 were identified. Indications and details regarding the surgery were collected during a medical chart review. The women were contacted and asked to complete questionnaires that examined risk assessment and current levels of psychosocial functioning.; Results. Annual frequencies of prophylactic mastectomy in Ontario range from six to nineteen women. Some of the women who had the surgery performed were not at a significantly high risk of developing breast cancer. Most of the women greatly over-estimated their risk of developing breast cancer, with the exception of BRCA1/2 mutation carriers. Overall, the women were satisfied with their decision to have preventive breast surgery. The majority of women were within normal ranges for the various domains of psychosocial functioning that were measured (sexual functioning, psychological distress, cancer-related distress, and body image). Women who continued to over-estimate their risk of developing breast cancer were more likely to be experiencing psychological distress. The mean level of quality of life was slightly above the mean level for the general population. The two most important predictors of quality of life were psychological distress and vulnerability.; Conclusions. Prophylactic bilateral mastectomy is a relatively rare procedure in Ontario. The indications for surgery were not always adequate, but the decision to have surgery may have been the result of an exaggerated personal risk of developing breast cancer. Women who have prophylactic bilateral mastectomy are not experiencing decreased quality of life or low levels of psychosocial functioning.