Demographic factors associated with decision to undergo CPM

  • HemOnc Today, October 25, 2012

SAN FRANCISCO — Prior research has shown risk factors such as younger age and family history of breast cancer contributed to patients’ decisions to undergo contralateral prophylactic mastectomy, and new study results show demographic factors such as race and marital status also may play a role.

The number of women who undergo contralateral prophylactic mastectomy (CPM) has increased significantly in the past decade, according to background information provided by researchers.

Laura L. Kruper, MD, an assistant professor and surgeon in the division of general oncologic surgery at City of Hope in Duarte, Calif., and colleagues examined the factors associated with patients who underwent CPM at their institution.

Kruper and colleagues mailed a validated 30-question survey to all patients who underwent mastectomy from 1972 to 2011 and were undergoing treatment or surveillance at City of Hope. The researchers evaluated the responses to determine predictive factors for selecting CPM.

The investigators used multivariate logistic regression methods to calculate ORs and 95% CI for possible associations with factors such as age at surgery, marital status, education, race, family history of breast cancer and BRCA mutation status.

Results showed a statistically significant association between younger age and increased likelihood of choosing CPM (P-trend<.001).

“In this study, women who were younger, Caucasian, had a family history of breast cancer, married and with higher education were more probable to choose CPM, likely due to socioeconomic factors and available support systems,” Kruper told HemOnc Today. “It makes sense that younger women and women with a family history are more likely to choose CPM since there is a higher risk of recurrence in these two groups. Also, in a logit analysis, variables positively associated with a BRCA genetic mutation – many of whom underwent bilateral prophylactic mastectomy – were positive family history, younger age and higher education. Therefore, it stands to reason that these women are motivated to undergo BRCA testing due to risk aversion.”

White patients were four times as likely to undergo mastectomy vs. non-whites (OR=3.95; 95% CI, 1.89-8.23), whereas patients with a family history of breast cancer were three times as likely to undergo mastectomy compared with those who had no family history (OR=3.38; 95% CI, 1.4-8.16). In addition, married patients were three times more likely to undergo a mastectomy procedure than unmarried patients (OR=3; 95% CI, 1.39-6.52).

Reports of a BRCA mutation were significantly associated with younger age, family history of breast cancer, higher level of education and marital status, the researchers said.

“Most women choose CPM to avoid the risk of recurrence and the satisfaction rates with this decision are extremely high. Women who chose unilateral mastectomies had higher rates of regrets regarding their decisions,” Kruper said. “Although for many women the risk of a contralateral breast cancer is low, the patient’s perceived risk is much higher. I think further study is needed to tease out societal influences on women’s choices and how we, as physicians, can best counsel women about the true level of risk of future cancers; however, we must also keep in mind that women are highly satisfied with the choice of CPM.”

For more information:
Kruper L. Abstract #39. Presented at: 2012 Breast Cancer Symposium; Sept. 13-15, 2012; San Francisco.


Disclosure: The researchers report no relevant financial disclosures.

Perspective
  • This is an important study to better understand the rising national rate of contralateral prophylactic mastectomies that may not be necessary in most patients. In this study, researchers found that younger patients, Caucasian patients and those with a positive family history of breast cancer were more likely to elect to undergo contralateral prophylactic mastectomies. In order to better identify patients who are more likely to elect this procedure, we need to better understand what is motivating patients to choose this procedure. We, as physicians, also need to have more open discussions with our patients about how they understand their risk of future breast cancer in order for them to make the best possible decision about their surgical options. Additional studies are needed so we can communicate more effectively with breast cancer patients as they make these initial decisions about whether they should or should not undergo prophylactic mastectomy.

    • Maryam B. Lustberg, MD, MPH
    • Breast medical oncologist
      The Ohio State University
      Comprehensive Cancer Center
      James Cancer Hospital and Solove Research Institute
  • Disclosures: Lustberg reports no relevant financial disclosures.