P11: Satisfaction and well-being after contralateral prophylactic mastectomy among BRCA mutation carriers and non-carriers: a longitudinal analysis of BREAST-Q domains

Friday, March 24, 2023

12:41 PM – 12:46 PM

Location: SSO HUB: Breast & Endocrine Zone

Poster Presenter(s)

Sara P. Myers, MD, PhD

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.

Author(s)

Sara P. Myers, MD, PhD

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
Audree Tadros, MD MPH

Assistant Attending
Memorial Sloan Kettering Cancer Center
New York, NY, United States

Disclosure information not submitted.
VS

Varadan Sevilimedu, MBBS, DrPH

Biostatistics Service, Department of Epidemiology and Biostatistics
Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
JN

Jonas A. Nelson, MD, MPH

Plastic and Reconstructive Surgical Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
TL

Tiana Le, BS

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
PG

Paula Garcia, MHA

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
Monica Morrow, MD, FACS

Chief, Breast Surgical Service; Anne Burnet Windfohr Chair of Clinical Oncology, Memorial Sloan Kettering Cancer Center; Professor of Surgery Weill Cornell Medical College
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure(s): No financial relationships to disclose
Minna K. Lee, MD

Assistant Attending
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure information not submitted.

Disclosure(s):

Monica Morrow, MD, FACS: No financial relationships to disclose

Introduction: Contralateral prophylactic mastectomy (CPM) is often performed for risk reduction in BRCA mutation carriers, whereas in non-carriers it is driven by patient choice. As it is unclear if psychosocial consequences vary by BRCA status, we characterized differences in satisfaction and well-being in BRCA carriers and non-carriers after CPM using the validated BREAST-Q patient reported outcome metric.

Methods: We analyzed BREAST-Q data obtained preoperatively and postoperatively at 6 months, and at 1, 2, and 3 years, from breast cancer patients who underwent bilateral mastectomy with immediate reconstruction at a single institution from 2016 to 2022. Associations between BRCA status and satisfaction with breasts, psychosocial well-being, and sexual well-being (all scored from 0-100) were assessed, adjusting for baseline scores and relevant confounders using general estimating equations with a Bonferroni correction.

Results: 149 BRCA carriers and 842 non-carriers were included. Response rates were 56%, 78%, 51%, 52%, and 59% preoperatively, at 6 months, and at 1, 2, and 3 years, respectively. BRCA carriers were younger (p < 0.01) and more often received neoadjuvant chemotherapy (p < 0.01) than non-carriers. Non-carriers had a higher proportion of hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2-) tumors (p < 0.01) and more frequently received endocrine therapy (p < 0.01). BRCA carriers differed in median baseline score for satisfaction (70 [53 82] vs. 58 [48 70] non-carriers; p< 0.01) but not for psychosocial (p=0.14) and sexual well-being (p=0.20). Compared to non-carriers, BRCA carriers had a greater decrease from baseline to 6 months postoperatively for satisfaction (p=0.04) and psychological well-being (p=0.05). but not sexual well-being (p=0.38). Incorporating all timepoints, BRCA status did not influence satisfaction with breasts, sexual well-being, and psychosocial well-being on univariate or multivariable analyses (Figure).

Conclusions: Relative to non-carriers, BRCA carriers experience a greater decline in satisfaction with breasts and psychological well-being at 6 months after CPM. Overall, bilateral mastectomy resulted in comparable satisfaction and well-being between BRCA carriers and non-carriers despite differences in primary indication for CPM.

Learning Objectives:

Upon completion, participants will be able to compare satisfaction after mastectomy with immediate reconstruction between BRCA carriers and noncarriers.
Upon completion, participants will be able to compare sexual well-being after mastectomy with immediate reconstruction between BRCA carriers and noncarriers.
Upon completion, participants will be able to compare psychosocial well-being after mastectomy with immediate reconstruction between BRCA carriers and noncarriers.