Prophylaktische Chirurgie bei Brust- und Eierstockkrebsrisiko. Ein Überblick über die internationale Forschungsliteratur zu Einstellungen, Inanspruchnahmeverhalten und Lebensqualität

Purpose: Currently, only limited preventive interventions are available to women who carry BRCA1 or BRCA2 mutations or who are at increased risk for breast and ovarian cancer. Prophylactic mastectomy and oophorectomy are, in addition to chemoprevention, the only primary prevention up to now. In this review studies of the attitudes, decision making, coping and long term satisfaction of high risk women and of the attitudes of health care professionals are the main outcome variables. Methods: The review is based on the analysis of German and English databases with a search of both medical and psychological databases until 2005. Results: Performance of prophylactic surgery for hereditary breast and ovarian cancer varies widely internationally. 3% to 67% of women at risk or mutation carriers elect to undergo prophylactic mastectomy and between 13% to 64% choose to undergo prophylactic oophorectomy. Studies examining attitudes towards prophylactic mastectomy and oophorectomy show similarly diverse results. Different counseling strategies may account for this finding. Heightened risk perception, cancer specific anxiety and physicians' recommendations affect, in addition to the objective disease risk, the decision for prophylactic mastectomy. In addition male physicians recommend prophylactic surgeries more often than female physicians. Studies focusing on satisfaction and coping with prophylactic surgery are mostly retrospective and only few studies include women, with a longer follow up. In addition to the objective risk reduction the studies suggest that prophylactic surgery is associated with a considerable reduction in psychological distress which counterbalances the impairment in body image and endocrine symptoms. Very few women regretted the decision to undergo prophylactic surgery. Conclusion: Informed decision making and time to consider is crucial when women consider prophylactic surgery. At the same time other less invasive methods of risk reduction such as chemoprevention should be extensively discussed. © Georg Thieme Verlag KG Stuttgart.