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Surgeon Impact on the Decision to Have Contralateral Prophylactic Mastectomy

By: Bruce Cleary
Posted: Wednesday, October 18, 2017

Surgeons strongly influence whether their patients with breast cancer choose to have a contralateral prophylactic mastectomy (CPM), based on the findings of a survey of more than 5000 women and nearly 400 surgeons. Steven J. Katz, MD, MPH, of the University of Michigan, and colleagues, presented their findings in JAMA Surgery.

“Even for a procedure that is very patient-driven, we see that surgeons account for a lot of the variability in the community,” commented Dr. Katz in a University of Michigan press release, “and those surgeon attitudes really matter in terms of whether a patient does or does not get CPM.”

For surgeons who least favored initial breast conservation and were least reluctant to perform CPM, the estimated rate of CPM was 34%. As for surgeons who most favored initial breast conservation and were most reluctant to perform CPM, the estimated rate was 4%.

The mean age of the responding patients was 61.9 years, and 28% had an increased risk of second primary cancer. Of the responding surgeons, half had practices for more than 20 years, and 30% had treated more than 50 new patients with breast cancer each year. Among the reasons surgeons reported for performing double mastectomy if the patient requested it were to provide peace of mind for the patient, to avoid conflict, and to improve cosmetic outcomes.