Contralateral Prophylactic Mastectomy: Anxiety, Knowledge and Shared Decision Making

Excerpt

With the steady increase of contralateral prophylactic mastectomy (CPM) now well documented, attention increasingly has been directed at understanding the potential reasons driving utilization of this treatment approach. A key area is examining the perspective of patients who are making this choice and how this perspective may differ from those choosing more limited surgery. In this issue of the Annals of Surgical Oncology, Rosenberg et al. detail the decision-making process of young women who have opted for bilateral mastectomy. Using a large registry of young women, they explore psychological, emotional, and decision-making aspects of the choice for surgical management of breast cancer. In this cohort of patients younger than age 40 years, most of whom are not known to be BRCA 1/2 mutation carriers, they report that nearly half of the study population underwent CPM. They confirm prior associations between anxiety and fear and use of CPM and provide new insights about how surgical decisions vary depending on who is driving the decision: the physician or the patient. Significantly, nearly two-thirds of women who stated that the choice of surgical therapy was self-driven chose CPM. In stark contrast, women who reported that the decision was made by their doctor had very low rates (6 %) of CPM. In multivariate analysis, patient-driven decision was associated with threefold greater likelihood of CPM compared with those who reported shared decision making. While physician influences on use of CPM has previously been suggested, Rosenberg et al. provide more direct evidence that physician interaction and engagement on this topic may represent one opportunity to reverse the increasing utilization of CPM.1,2 …