Unukovych Dmytro, Johansson Hemming, Brandberg Yvonne
Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; ; Department of Oncology, Karolinska University Hospital Solna, Stockholm, Sweden.
Gland Surg. 2017 Feb;6(1):64-72. doi: 10.21037/gs.2017.01.04.
Risk-reducing mastectomy (RRM) in patients at high risk has become more available and the rates of both bilateral (BRRM) and contralateral (CRRM) procedures are increasing. For women opting for RRM, psychosocial well-being, body image and sexuality are known to be important patient-reported outcomes. The aim of the present study was to investigate baseline health-related quality of life (HRQoL) and emotional distress (anxiety and depression) as predictors of body image and sexuality two years after RRM in women undergoing CRRM and BRRM.
This is a prospective cohort study including consecutive women opting for BRRM and breast cancer patients considering CRRM at Karolinska University Hospital during 1998-2010. The women were given a set of questionnaires to be completed at baseline before RRM (The Medical Outcomes Study 36-Item Short Form, The Hospital Anxiety and Depression Scale, and The Sexual Activity Questionnaire) and two years after RRM (all the above-mentioned questionnaires along with The Body Image Scale). Mean scores for all questionnaires were analysed using linear regression models and adjusted for age at RRM as well as calendar year.
In total, 253 patients consented to participate in the study. Response rate at baseline and 2 years was 88% and 71%, respectively. In the BRRM group (healthy women), preoperative HRQoL and emotional distress were associated with body image and sexual problems two years after the procedure. No similar associations were found for the patients with breast cancer who underwent CRRM.
The current study suggests that preoperative HRQoL and emotional distress may predict body image and sexual problems two years after RRM in healthy women, but not in breast cancer patients. Baseline psychosocial characteristics may be useful to identify women at risk for long-term body image and sexual problems following BRRM, but not among breast cancer patients opting for CRRM.
高危患者的降低风险乳房切除术（RRM）已越来越普及，双侧（BRRM）和对侧（CRRM）手术的发生率均在上升。对于选择RRM的女性而言，心理社会幸福感、身体形象和性功能是重要的患者报告结局。本研究的目的是调查接受CRRM和BRRM的女性在RRM两年后身体形象和性功能的预测因素，即基线健康相关生活质量（HRQoL）和情绪困扰（焦虑和抑郁）。
这是一项前瞻性队列研究，纳入了1998年至2010年期间在卡罗林斯卡大学医院连续选择BRRM的女性以及考虑接受CRRM的乳腺癌患者。这些女性在RRM前基线时（医学结局研究36项简表、医院焦虑抑郁量表和性活动问卷）以及RRM后两年（上述所有问卷以及身体形象量表）接受了一系列问卷调查。使用线性回归模型分析所有问卷的平均得分，并根据RRM时的年龄和日历年份进行调整。
共有253名患者同意参与本研究。基线和2年时的应答率分别为88%和71%。在BRRM组（健康女性）中，术前HRQoL和情绪困扰与术后两年的身体形象和性问题相关。接受CRRM的乳腺癌患者未发现类似关联。
本研究表明，术前HRQoL和情绪困扰可能预测健康女性RRM两年后的身体形象和性问题，但不能预测乳腺癌患者的情况。基线心理社会特征可能有助于识别BRRM后存在长期身体形象和性问题风险的女性，但对于选择CRRM的乳腺癌患者则不然。
