Study Examines Factors in Contralateral Prophylactic Mastectomy Decisions

Many women with unilateral breast cancer consider CPM despite lack of evidence for improved survival
Many women with unilateral breast cancer consider CPM despite lack of evidence for improved survival

HealthDay News — Many patients with newly diagnosed unilateral breast cancer consider contralateral prophylactic mastectomy (CPM), according to a study published online December 21 in JAMA Surgery.

Reshma Jagsi, MD, DPhil., from the University of Michigan in Ann Arbor, and colleagues examined patient motivations, knowledge, and decisions, and the impact of surgeon recommendations on use of CPM. A total of 2,402 women with newly diagnosed, unilateral, stage 0, I, or II breast cancer were surveyed. 

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The researchers found that 43.9% of women considered CMP (24.8% considered it strongly or very strongly); more than one-third (38.1%) of them knew that CPM does not improve survival for all women with breast cancer. Ultimately, 61.6, 21.2, and 17.3% received breast-conserving surgery, unilateral mastectomy, and CPM, respectively. On multivariable analysis, factors associated with CPM included younger age, white race, higher educational level, family history, and private insurance. For the 1,569 patients without high genetic risk or an identified mutation, 39.3% reported a surgeon recommendation against CPM; only 1.9% of these women underwent CPM. Among the women who received no recommendation from a surgeon, 19.0% underwent CPM.

"Many patients consider CPM, but knowledge about the procedure is low and discussions with surgeons appear to be incomplete," the authors write. "More effective physician-patient communication about CPM is needed to reduce potential overtreatment."

One author disclosed financial ties to the biotechnology industry.

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