What Made Her Give Up Her Breasts: a Qualitative Study on Decisional Considerations for Contralateral Prophylactic Mastectomy among Breast Cancer Survivors Undergoing BRCA1/2 Genetic Testing

Abstract

<br/><b>Objective</b>: This qualitative study retrospectively examined the experience and psychological impact ofcontralateral prophylactic mastectomy (CPM) among Southern Chinese females with unilateral breast cancerhistory who underwent BRCA1/2 genetic testing. Limited knowledge is available on this topic especially amongAsians; therefore, the aim of this study was to acquire insight from Chinese females’ subjective perspectives.<br/><b>Methods</b>: A total of 12 semi-structured in-depth interviews, with 11 female BRCA1/BRCA 2 mutated gene carriersand 1 non-carrier with a history of one-sided breast cancer and genetic testing performed by the Hong KongHereditary Breast Cancer Family Registry, who subsequently underwent CPM, were assessed using thematicanalysis and a Stage Conceptual Model. Breast cancer history, procedures conducted, cosmetic satisfaction, pain,body image and sexuality issues, and cancer risk perception were discussed. Retrieval of medical records using aprospective database was also performed. <br/><b>Results</b>: All participants opted for prophylaxis due to their reservationsconcerning the efficacy of surveillance and worries of recurrent breast cancer risk. Most participants were satisfiedwith the overall results and their decision. One-fourth expressed different extents of regrets. Psychological reliefand decreased breast cancer risk were stated as major benefits. Spouses’ reactions and support were crucial forpost-surgery sexual satisfaction and long-term adjustment. <br/><b>Conclusions</b>: Our findings indicate that thorougheducation on cancer risk and realistic expectations of surgery outcomes are crucial for positive adjustment afterCPM. Appropriate genetic counseling and pre-and post-surgery psychological counseling were necessary. Thisstudy adds valuable contextual insights into the experiences of living with breast cancer fear and the importanceof involving spouses when counseling these patients.