A survey of 150 women newly diagnosed with breast cancer provides new insight into factors that influence women’s decisions to undergo contralateral prophylactic mastectomy (CPM) – surgical removal of both breasts including the breast not affected by cancer.

This is one of the first studies to look at women’s breast surgery preferences prospectively, before they undergo the procedure.

“We continue to see increasing numbers of women newly diagnosed with breast cancer who choose bilateral mastectomy despite the fact that survival rates are equivalent between those who undergo lumpectomy with radiation and mastectomy,” said Julie Margenthaler, MD, Breast Cancer Symposium News Planning Team member.

“These data demonstrate that this complex decision is often the result of higher anxiety levels and worry about recurrence. These are certainly valid concerns, but as oncologists we need to make certain that we are educating each patient about her individual risk for the future.”

The findings indicate that women with higher anxiety levels and less knowledge about breast cancer recurrence and survival are more likely to choose CPM.

“There is so much information about breast cancer that it’s easy for patients to get overwhelmed. As doctors, we have to be aware of each patient’s knowledge level and the concerns and worries he or she have,” said lead study author Katharine Yao, MD, Director of the breast surgical program at NorthShore University HealthSystem, Evanston, Illinois, and a clinical associate professor of surgery at the Pritzker School of Medicine, University of Chicago.

“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.”

Researchers surveyed 150 women newly diagnosed with breast cancer at two tertiary care hospitals prior to undergoing surgery but after they had made their decision on the type of surgery they would have – lumpectomy, one-sided mastectomy, or double mastectomy (CPM).

The questionnaire consisted of 55 items that assessed women’s knowledge about breast cancer survival and recurrence, general anxiety and depression, and their surgery preferences.

Overall, 59% of the patients chose lumpectomy, 32% one-sided mastectomy, and 9% CPM.

During the decision-making process, 24% of the women stated they did not want/consider CPM, 11% did not think CPM was an option and none of the women in these two groups chose CPM.

Eighty-three (58%) considered undergoing CPM, and 12 (21%) of those women chose CPM.

Overall, women who considered CPM were less knowledgeable about breast cancer ─ 68% of them incorrectly thought that the procedure would reduce the risk of recurrence, compared to only 47% of patients who did not want or consider CPM.

Furthermore, women who considered CPM believed their risk of breast cancer was higher than average (24% vs. 14%); were more likely to be extremely worried about getting cancer elsewhere in their body (43% vs. 11%); and reported being very/extremely worried about how a spouse or partner would feel about their changed body (19% vs. 0%).

Another interesting finding was that, according to the survey results, 58 (39%) patients had thought about their surgery choice even before being diagnosed with breast cancer.

A follow-up survey is planned to assess women’s physical and emotional recovery, anxiety levels, and satisfaction with their surgery decision six months after the procedure.

Researchers are also developing interactive decision aids and teaching materials designed to empower women to talk to their doctors about their concerns and preferences regarding breast cancer surgery.

Source: ASCO