Contralateral Prophylactic Mastectomy: A Decision Strongly Influenced by the Surgeon

April 9, 2017

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Take-Home Message:

Women who receive no recommendation about contralateral prophylactic mastectomy (CPM) are more likely to choose the procedure than women whose surgeons recommend against it.

 

Contralateral Prophylactic Mastectomy Decisions in a Population-Based Sample of Patients with Early-Stage Breast Cancer

Authors: Jagsi, R. et. al.
Source: JAMA Surg, doi:10.1001/jamasurg.2016.4749
jamanetwork.com/journals/jamasurgery/article-abstract/2593807

Women in the US are increasingly choosing CPM as part of the treatment for their unilateral (one side) breast cancer diagnoses. Efforts are being made to inform these women that CPM does not improve their cancer outcomes or their overall survival.

This group surveyed over 2,400 women with early stage breast cancer in California and Georgia. They were asked about their surgical decisions, their motivations for those decisions and their knowledge about their diagnoses and options. Over 1300 of these women considered CPM. Only 395 of them knew that CPM did not improve breast cancer survival. However, 428 of them had CPM performed.

The investigators evaluated a smaller group of about 1,560 women and found that 598 of them were advised against CPM by their surgeons. Only 12 (1.9%) of them proceeded to that surgery. Of the over 740 women who received no advice from a surgeon, 148 (19%) of them had CPM.

This study shows the influence a surgeon has over her/his patient’s decision-making. Patients are highly likely to follow their surgeons’ advice. It is known that CPM holds little to no benefit for most women who consider it. Their surgeons have the opportunity to increase their awareness and dissuade them from unnecessary surgery. The group summarizes that more effective communication between surgeon and patient is needed to reduce potential overtreatment of unilateral breast cancer.