Kwong Ava, Chu Annie T W
Division of Breast Surgery, The University of Hong Kong, Hong Kong.
Asian Pac J Cancer Prev. 2012;13(5):2241-7. doi: 10.7314/apjcp.2012.13.5.2241.
This qualitative study retrospectively examined the experience and psychological impact of contralateral prophylactic mastectomy (CPM) among Southern Chinese females with unilateral breast cancer history who underwent BRCA1/2 genetic testing. Limited knowledge is available on this topic especially among Asians; therefore, the aim of this study was to acquire insight from Chinese females' subjective perspectives.
A total of 12 semi-structured in-depth interviews, with 11 female BRCA1/BRCA 2 mutated gene carriers and 1 non-carrier with a history of one-sided breast cancer and genetic testing performed by the Hong Kong Hereditary Breast Cancer Family Registry, who subsequently underwent CPM, were assessed using thematic analysis 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 a prospective database was also performed.
All participants opted for prophylaxis due to their reservations concerning the efficacy of surveillance and worries of recurrent breast cancer risk. Most participants were satisfied with the overall results and their decision. One-fourth expressed different extents of regrets. Psychological relief and decreased breast cancer risk were stated as major benefits. Spouses' reactions and support were crucial for post-surgery sexual satisfaction and long-term adjustment.
Our findings indicate that thorough education on cancer risk and realistic expectations of surgery outcomes are crucial for positive adjustment after CPM. Appropriate genetic counseling and pre-and post-surgery psychological counseling were necessary. This study adds valuable contextual insights into the experiences of living with breast cancer fear and the importance of involving spouses when counseling these patients.
本定性研究回顾性调查了有单侧乳腺癌病史且接受了BRCA1/2基因检测的中国南方女性行对侧预防性乳房切除术（CPM）的经历及心理影响。关于这一主题的知识有限，尤其是在亚洲人群中；因此，本研究的目的是从中国女性的主观视角获取见解。
通过香港遗传性乳腺癌家族登记处对12名女性进行了半结构式深入访谈，其中11名是BRCA1/BRCA 2基因突变携带者，1名是非携带者，她们均有单侧乳腺癌病史并接受了基因检测，随后接受了CPM，采用主题分析和阶段概念模型进行评估。讨论了乳腺癌病史、所进行的手术、美容满意度、疼痛、身体形象和性方面的问题以及癌症风险认知。还使用前瞻性数据库检索了医疗记录。
所有参与者因对监测效果有所保留以及担心复发性乳腺癌风险而选择了预防性手术。大多数参与者对总体结果和自己的决定感到满意。四分之一的参与者表达了不同程度的遗憾。心理缓解和降低乳腺癌风险被认为是主要益处。配偶的反应和支持对于术后性满意度和长期适应至关重要。
我们的研究结果表明，对癌症风险进行全面教育以及对手术结果抱有现实期望对于CPM术后的积极调整至关重要。适当的遗传咨询以及术前和术后心理咨询是必要的。本研究为恐惧乳腺癌的生活经历以及在为这些患者提供咨询时让配偶参与的重要性增添了有价值的背景见解。
