Professional Documents
Culture Documents
for yourself,” she says, “You need to support the They are likely to have better symmetry; breast
patient and help her get the facts straight. reconstruction may be more difficult when per-
“Nurses are often the first-line people that formed on only one side. “In focus groups, women
patients see, so our role is extremely important. But have reported that it [reconstruction] was one of the
nurses need to be aware of the literature and work reasons [for prophylactic contralateral mastectomy],
with patients to manage their anxiety, lower their although not the predominant reason,” says Geiger.
risk, and improve lifestyle factors.” “Clearly, many factors go into making this decision.”
The majority of women who undergo contralat- Decision Making Process. Tuttle and colleagues
eral prophylactic mastectomy tend to be satisfied reported on a review of the National Prophylactic
with that decision. Geiger and colleagues, as pub- Mastectomy Registry that found the most common
lished in the Journal of Clinical Oncology in March reason patients selected prophylactic contralateral
2006, surveyed 519 women who underwent con- mastectomy was physician advice. However, a 2005
tralateral prophylactic mastectomy and found that survey by Nekhlyudov and colleagues in the Journal
86.5% were satisfied with their decision. More than of the National Cancer Institute Monographs
three-quarters reported a high level of contentment showed that 45% of respondents (N = 431) made
regarding quality of life, and psychosocial outcomes the decision to have contralateral prophylactic
were generally similar to those in breast cancer sur- mastectomy on their own. Another 37% reported
vivors who had not undergone the procedure. that they considered the opinion of their physician,
“Being satisfied doesn’t mean that everything is while only 3% reported that the physician “pri-
perfect,” says Geiger. “But most women really marily made the decision.”
believe it was a good decision for them.” Geiger suspects that the rates of contralateral
However, Geiger also points out that their data mastectomy may continue to rise, especially if
showed that women who chose contralateral pro- magnetic resonance imaging (MRI) of the breast
phylactic mastectomy were not at a particularly increases in popularity. “An MRI scan is more sen-
higher risk for recurrence. “Their risk was not sitive than a mammogram and more likely to pick
greater as compared with women who didn’t have up small irregularities in the unaffected breast. The
it done,” she says. “They may have just had more American Cancer Society is looking at expanding
anxiety about breast cancer.” its guidelines for breast MRI, and if that comes to
Women have also reported a better cosmetic out- pass, we are likely to see this trend continue.”
come when a bilateral mastectomy is performed. —Roxanne Nelson, BSN, RN ▼