The impact of prophylactic mastectomy on sexual well-being: a systematic review.

INTRODUCTION: Considering the increasing women's awareness of health promotion and disease prevention programs, mutation carriers are inevitably asked to face important decisions concerning the possibility of undergoing prophylactic mastectomy. Risk-reducing mastectomy (RRM) has become increasingly more common, although it has a significant impact on women's quality of life and sexual well-being. OBJECTIVES: The systematic review aims to evaluate the impact of RRM on the sexuality of women with breast cancer. METHODS: According to Cochrane Collaboration guidelines and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, the study quantified the effects of frontline work on the mental health of healthcare workers. This review followed the PRISMA guidelines. Three databases were systematically searched from inception to December 2022. The expression ("sexuality" OR "sexual" OR "sex") AND ("prophylactic mastectomy" OR "risk-reducing mastectomy") was searched in PubMed, Ovid Medline, and Embase. Twenty-two articles published in English until 2022 were selected. RESULTS: Two studies investigated sexual experience after risk-reducing surgeries as a single outcome, while other studies analyzed the relationship between sexuality and psychosocial outcomes, risk perception, and satisfaction. In all of the included studies, significant findings in sexual dysfunction were found. The most reported problems were related to sexual satisfaction and attractiveness, body image, and loss of femininity. Last, women reported changes in the relationship with their partners. CONCLUSION: RRM has a major impact on body image that affects sexual functioning and quality of life. These implications must be considered during treatment selection.

Preliminary observations regarding the expectations, acceptability and satisfaction of whole-body MRI in self-referring asymptomatic subjects.

OBJECTIVE: To evaluate the satisfaction of asymptomatic subjects who self-referring Whole-Body Magnetic Resonance Imaging (WB-MRI) for early cancer diagnosis. METHODS: Subjects completed a pre-examination questionnaire, while waiting for their WB-MRI examination, recording demographics, expected discomfort, perceived knowledge and usefulness of the procedure and health risk perceptions, as well as a post-examination questionnaire, measuring discomfort experienced, acceptability and satisfaction with WB-MRI. We examined which factors influenced discomfort and satisfaction associated with WB-MRI. RESULTS: 65 asymptomatic subjects (median age 51; 29 females) completed the questionnaire. Before WB-MRI, 29% of subjects expected discomfort of some form with claustrophobia (27.7%) and exam duration (24.6%) being the most common concerns. Experienced discomfort due to shortness of breath was significantly lower than expected. This difference was significantly associated with the personal risk perception to get a disease (p = 0.01) and educational level (p = 0.002). More specifically, higher level of perceived personal risk of getting a disease and lower level of education were associated with higher expected than experienced discomfort. Similarly, experiencing less claustrophobia than expected was significantly associated with gender (p = 0.005) and more pronounced among females. A majority (83%) of subjects expressed high levels of satisfaction with WB-MRI for early cancer diagnosis and judged it more acceptable than other diagnostic exams. CONCLUSIONS: Asymptomatic subjects self-referring to WB-MRI for early cancer diagnosis showed high levels of satisfaction and acceptability with the examination. Nevertheless, a relevant proportion of participants reported some form of discomfort. Interestingly, participants with higher perceived personal risk to get a disease, lower education and females showed to expect higher discomfort than experienced. ADVANCES IN KNOWLEDGE: Scope exists for measures to assess expected feelings and develop personalized interventions to reduce the stress anticipated by individuals deciding to undergo WB-MRI for early cancer diagnosis.