Psychological response to mastectomy. A prospective comparison study

Abstract

This study reports data from 412 women prospectively studied over a 1‐year period from five collaborating centers: one group had modified radical mastectomy for Stages I and II breast cancer, 145; cholecystectomy for gall bladder disease, 90; biopsy for benign breast disease, 87; and healthy women, 90. All were between the ages of 30 and 70 years, without pre‐existing psychiatric illness and absence of current physical illness. All women were seen initially within 3 months of surgery. Data were analyzed from structured interviews, speech samples, and questionnaire responses which measured presence and degree of psychopathological symptoms, mood, physical complaints, self‐esteem, and quality of interpersonal relationships. Principal components analysis was used to generate seven identifiable factors which were analyzed by MANOVA (multiple analysis of variance). Women with breast cancer showed greater psychological distress related to social and interpersonal relationships. More distress was seen in women with Stage II disease, and they also had more negative attitudes toward self and the future, concern with physical symptoms, anxiety, strain, and interpersonal difficulties. They did not, however, show any greater signs of psychopathological symptoms severe enough to warrant psychiatric intervention than the other groups over the year following surgery. The findings suggest that healthy women without prior psychiatric disorder or concurrent physical illness experienced some post‐surgical distress, primarily in psychosocial functioning which was more than that in women after cholecystectomy or biopsy, but severe psychopathological symptoms over the year following surgery were conspicuously absent. These data do not support the belief that severe psychiatric sequelae follow a mastectomy in psychologically healthy women. Cancer 59:189–196, 1987.