Meeting News CoveragePerspective

Worry, lack of knowledge influenced decision to undergo contralateral prophylactic mastectomy

Women with newly diagnosed breast cancer who considered contralateral prophylactic mastectomy were more likely to worry about cancer recurrence and were less knowledgeable about breast cancer compared with women who did not consider the procedure, according to study results presented at the Breast Cancer Symposium.

“The rate of contralateral prophylactic mastectomy among women with breast cancer in one breast has increased over the past decade,” Katharine Yao, MD, director of the breast surgical program at NorthShore University HeathSystem in Evanston, Ill., and clinical associate professor of surgery at Pritzker School of Medicine at University of Chicago, said during a press conference. “Most survey studies on this topic have surveyed patients in a retrospective fashion, sometimes years after they have undergone the procedure. Few studies have examined how many women think about surgery choices prior to even being diagnosed or prior to undergoing surgery, and what factors influence women to consider undergoing contralateral prophylactic mastectomy.”

Katharine Yao

Yao and colleagues evaluated survey data from 150 women with newly diagnosed breast cancer before they underwent lumpectomy, unilateral mastectomy or contralateral prophylactic mastectomy.

Thirty-eight percent of women indicated they had considered their surgery options before they were diagnosed with breast cancer.

During the decision-making process after diagnosis, 83 women (58%) considered contralateral prophylactic mastectomy, whereas 35 women (24.6%) did not want or consider the procedure. Another 11.3% of women knew about the procedure but did not think it was an option for them, and 5.6% were not familiar with the procedure.

Age, race, stage of disease and family history were comparable between patients who did and did not consider undergoing contralateral prophylactic mastectomy.

Women who considered contralateral prophylactic mastectomy were more likely than those who did not want or did not consider it to incorrectly believe the procedure would reduce the risk for cancer recurrence (68% vs. 47%).

A greater proportion of women considering contralateral prophylactic mastectomy thought they had a higher-than-average breast cancer risk (24% vs. 14%), and they also were more likely to report worrying very much or extremely about getting cancer elsewhere in their bodies (43% vs. 11%).

After the decision-making process, most women (59%) opted to undergo lumpectomy and 32% chose unilateral mastectomy. Nine percent of women overall — and 16% of those who considered the procedure — chose contralateral prophylactic mastectomy.

“There is so much information about breast cancer that it’s easy for patients to get overwhelmed,” Yao said in a press release. “As doctors, we have to be aware of each patient’s knowledge level and the concerns and worries he or she have. And we need to do a better job of educating patients that the risk of developing contralateral breast cancer is actually low and that breast cancer can come back in other parts of their body no matter what type of surgery they have.”

For more information:

Yao K. Abstract #71. Scheduled for presentation at: Breast Cancer Symposium; Sept. 4-6, 2014; San Francisco.

Disclosure: The researchers report no relevant financial disclosures. The study was supported by the Breast and Ovarian Research Pilot Award, funded by the Auxiliary of Evanston and Glenbrook Hospitals at NorthShore.

Women with newly diagnosed breast cancer who considered contralateral prophylactic mastectomy were more likely to worry about cancer recurrence and were less knowledgeable about breast cancer compared with women who did not consider the procedure, according to study results presented at the Breast Cancer Symposium.

“The rate of contralateral prophylactic mastectomy among women with breast cancer in one breast has increased over the past decade,” Katharine Yao, MD, director of the breast surgical program at NorthShore University HeathSystem in Evanston, Ill., and clinical associate professor of surgery at Pritzker School of Medicine at University of Chicago, said during a press conference. “Most survey studies on this topic have surveyed patients in a retrospective fashion, sometimes years after they have undergone the procedure. Few studies have examined how many women think about surgery choices prior to even being diagnosed or prior to undergoing surgery, and what factors influence women to consider undergoing contralateral prophylactic mastectomy.”

Katharine Yao

Yao and colleagues evaluated survey data from 150 women with newly diagnosed breast cancer before they underwent lumpectomy, unilateral mastectomy or contralateral prophylactic mastectomy.

Thirty-eight percent of women indicated they had considered their surgery options before they were diagnosed with breast cancer.

During the decision-making process after diagnosis, 83 women (58%) considered contralateral prophylactic mastectomy, whereas 35 women (24.6%) did not want or consider the procedure. Another 11.3% of women knew about the procedure but did not think it was an option for them, and 5.6% were not familiar with the procedure.

Age, race, stage of disease and family history were comparable between patients who did and did not consider undergoing contralateral prophylactic mastectomy.

Women who considered contralateral prophylactic mastectomy were more likely than those who did not want or did not consider it to incorrectly believe the procedure would reduce the risk for cancer recurrence (68% vs. 47%).

A greater proportion of women considering contralateral prophylactic mastectomy thought they had a higher-than-average breast cancer risk (24% vs. 14%), and they also were more likely to report worrying very much or extremely about getting cancer elsewhere in their bodies (43% vs. 11%).

After the decision-making process, most women (59%) opted to undergo lumpectomy and 32% chose unilateral mastectomy. Nine percent of women overall — and 16% of those who considered the procedure — chose contralateral prophylactic mastectomy.

“There is so much information about breast cancer that it’s easy for patients to get overwhelmed,” Yao said in a press release. “As doctors, we have to be aware of each patient’s knowledge level and the concerns and worries he or she have. And we need to do a better job of educating patients that the risk of developing contralateral breast cancer is actually low and that breast cancer can come back in other parts of their body no matter what type of surgery they have.”

For more information:

Yao K. Abstract #71. Scheduled for presentation at: Breast Cancer Symposium; Sept. 4-6, 2014; San Francisco.

Disclosure: The researchers report no relevant financial disclosures. The study was supported by the Breast and Ovarian Research Pilot Award, funded by the Auxiliary of Evanston and Glenbrook Hospitals at NorthShore.

    Perspective
    Harold J. Burstein

    Harold J. Burstein

    One of the things that is so striking about these findings is that almost all women really think about contralateral prophylactic mastectomy in some way or another once they are diagnosed.

    The immediate thought for so many women must be that having both breasts removed will solve the problem. That’s understandable. It is a part of human nature, and it probably is something almost anybody would immediately imagine after a diagnosis like this. But these findings also suggest those patients tilting toward contralateral mastectomy are more anxious about cancer in general and about their own cancer coming back, and are more concerned that removing the other breast might somehow be important for the outcomes for their one already known breast cancer. Those are knowledge gaps that the collective medical team of oncologists, plastic surgeons and everyone else involved in caring for these women can help them understand. We don’t know that filling in those gaps would lead people to make different decisions, and there is no doubt that personal preference is still highly important for women. They need to feel comfortable with the surgical choices they have made. At the same time, understanding that these patients come in with perhaps a slightly different knowledge base or more concern, addressing [these concerns] as part of a multidisciplinary effort will be very important to help patients make the best decisions for themselves. That is what we hope to achieve, and what these data speak to.

    • Harold J. Burstein, MD, PhD
    • Medical oncologist Dana-Farber Cancer Institute Associate professor of medicine Harvard Medical School

    Disclosures: Burstein reports no relevant financial disclosures.

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