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Annals of Oncology Advance Access originally published online on July 28, 2007
Annals of Oncology 2007 18(10):1641-1645; doi:10.1093/annonc/mdm274
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© 2007 European Society for Medical Oncology

breast cancer

Who is prone to high levels of distress after prophylactic mastectomy and/or salpingo-ovariectomy?

P. J. C. Bresser1, A. R. Van Gool2, C. Seynaeve3, H. J. Duivenvoorden1, M. F. Niermeijer4, A. N. van Geel5, M. Menke5, J. G. M. Klijn3 and A. Tibben6,*

1 Department of Medical Psychology and Psychotherapy, Erasmus Medical Centre
2 Department of Psychiatry, Rotterdam Family Cancer Clinic, Erasmus Medical Centre–Daniel den Hoed Cancer Centre
3 Department of Medical Oncology, Rotterdam Family Cancer Clinic, Erasmus Medical Centre–Daniel den Hoed Cancer Centre, Rotterdam
4 Department of Human Genetics, Clinical Genetics Section, University Medical Centre St Radboud, Nijmegen
5 Department of Surgery, Rotterdam Family Cancer Clinic, Erasmus Medical Centre–Daniel den Hoed Cancer Centre, Rotterdam
6 Centre for Human and Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands

* Correspondence to: Professor A. Tibben, Leiden University Medical Centre Albinusdreef 2, 2333 ZA Leiden, The Netherlands. Tel: +31-(0)7-1526-8033; Fax: +31-(0)7-1526-6749; E-mail: a.tibben{at}lumc.nl

Background: The present study aimed to assess predictors of distress after ’prophylactic mastectomy (PM) and salpingo-ovariectomy (PSO), in order to enable the early identification of patients who could benefit from psychological support.

Patients and methods: General distress and cancer-related distress were assessed in 82 women at increased risk of hereditary breast and/or ovarian cancer undergoing PM and/or PSO, before and 6 and 12 months after prophylactic surgery. Neurotic lability and coping were assessed before surgery.

Results: Cancer-related distress and general distress at both follow-up moments were best explained by the level of cancer-related and general distress at baseline. Being a mutation carrier was predictive of increased cancer-related distress at 6-month follow-up (but not at 12 months), and of lower general distress 12 months after prophylactic surgery. Also, coping by having comforting thoughts was predictive of less cancer-related distress at 6-month follow-up.

Conclusions: Genetically predisposed women who are at risk of post-surgical distress can be identified using one or more of the predictors found in this study. Exploration of and/or attention to cancer-related distress and coping style before prophylactic surgery may help physicians and psychosocial workers to identify women who might benefit from additional post-surgical support.

Key words: BRCA1/2, mastectomy, salpingo-ovariectomy, prophylactic surgery, psychology

Received for publication December 4, 2006. Revision received May 4, 2007. Accepted for publication May 4, 2007.


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A Lesser Evil: Prophylactic Mastectomy for Women at High Risk for Breast Cancer
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