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Contralateral Prophylactic Mastectomy Decisions in Patients With Early-Stage Breast Cancer

Posted: Wednesday, March 1, 2017

A survey-based study conducted between July 2013 and September 2014 reported that nearly half of patients with early-stage breast cancer (stages 0–II) considered having double mastectomy. Moreover, 1 in 6 women underwent double mastectomy—including many who were at low risk of developing a second breast cancer. The survey was sent to 3,631 patients; the final sample was based on 2,402 women who did not have bilateral disease. Many patients who chose double mastectomy apparently did not understand that this aggressive procedure is not associated with a significant protective benefit in most patients. Among patients who considered double mastectomy, only 38% knew that it does not improve survival for all women with breast cancer. Almost all patients said peace of mind motivated them to choose double mastectomy.

According to a report in The ASCO Post, lead author of the study, Reshma Jagsi, MD, DPhil, Professor and Deputy Chair of Radiation Oncology at the University of Michigan observed that although it was known that the frequency of bilateral mastectomy is increasing, “I don’t think many of us realized just how frequent this is.”

When patients perceived that their surgeons recommended strongly against contralateral prophylactic mastectomy, most heeded that advice: only 2% of these women went on to choose the procedure.

“As physicians, we want to be respectful of our patients’ preferences and values,” Dr. Jagsi said. “When a patient comes in saying she has already decided on double mastectomy, it can be challenging to strike that balance between respecting her preferences and adequately conveying why the medical community in general doesn’t think it’s necessary,” she added.

The study authors call for better communication training for physicians to help them navigate these difficult conversations more effectively.