Women reveal only mild anxiety after double mastectomy

ABSTRACT: Actress Christina Applegate publicly discusses her decision to undergo preventive bilateral mastectomy.

Deciding on a bilateral mastectomy is a bold move for any woman. But for a Hollywood actress, whose very livelihood depends in large part on her being attractive, such a drastic step could verge on foolhardy. It was both heartening and surprising when 36-year-old actress Christina Applegate, star of the ABC TV show Samantha Who?, announced that she had undergone a double mastectomy.

Ms. Applegate revealed that as a BRCA1 carrier, and as the daughter of a mother treated for breast cancer, she felt bilateral mastectomy “seemed most logical” after looking at various treatment options.

She began mammography screening at age 30 and had the MRI study as a follow-up to a biopsy in 2007.

“This was the choice that I made, and it was a tough one,” she said. Ms. Applegate is slated to undergo reconstructive surgery over the next few months (People, August 19, 2008).

Decreasing anxiety

Based on a prospective study done at the Karolinska Institutet in Stockholm and the Central Hospital in Vsters, Ms. Applegate’s pragmatic attitude is not necessarily uncommon among women who opt for bilateral prophylactic mastectomy in a similar situation.

Yvonne Brandberg, PhD, from the department of oncology-pathology at the Karolinska Institutet, and her surgical colleagues administered questionnaires to 98 women who had undergone prophylactic mastectomy between 1997 and 2005.

Data were collected before the operation in 81 cases, 6 months later in 71 cases, and a year later in 65 subjects.

According to the results, anxiety decreased over time (P = .0004). No corresponding difference was found for depression.

No differences in health-related quality of life over time were found, with one exception: A substantial proportion of the women reported problems with body image 1 year after bilateral prophylactic mastectomy, such as feeling self-consciousness (48%), feeling less sexually attractive (48%), and having dissatisfaction with the scars (44%).

Sexual pleasure was rated lower 1-year post-bilateral mastectomy as compared with before operation (P = .005), but no differences over time in habit, discomfort, or activity were found.

The authors concluded that there were no negative effects on anxiety, depression, and quality of life despite some negative impact.