Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2021

01-12-2021 | Mastectomy | Breast Oncology

Surgical Decision-Making Surrounding Contralateral Prophylactic Mastectomy: Comparison of Treatment Goals, Preferences, and Psychosocial Outcomes from a Multicenter Survey of Breast Cancer Patients

Authors: Ingrid M. Lizarraga, MBBS, Mary C. Schroeder, PhD, Ismail Jatoi, MD, PhD, Sonia L. Sugg, MD, Amy Trentham-Dietz, PhD, Laurel Hoeth, Elizabeth A. Chrischilles, PhD

Published in: Annals of Surgical Oncology | Issue 13/2021

Login to get access

Abstract

Background

Differences in patient characteristics and decision-making preferences have been described between those who elect breast-conserving surgery (BCS), unilateral mastectomy (UM), or contralateral prophylactic mastectomy (CPM) for breast cancer. However, it is not known whether preferred and actual decision-making roles differ across these surgery types, or whether surgery choice reflects a woman’s goals or achieves desired outcomes.

Methods

Women diagnosed with stage 0–III unilateral breast cancer across eight large medical centers responded to a mailed questionnaire regarding treatment decision-making goals, roles, and outcomes. These data were linked to electronic medical records. Differences were assessed using descriptive analyses and logistic regression.

Results

There were 750 study participants: 60.1% BCS, 17.9% UM, and 22.0% CPM. On multivariate analysis, reducing worry about recurrence was a more important goal for surgery in the CPM group than the others. Although women’s preferred role in the treatment decision did not differ by surgery, the CPM group was more likely to report taking a more-active-than-preferred role than the BCS group. On multivariate analysis that included receipt of additional surgery, posttreatment worry about both ipsilateral and contralateral recurrence was higher in the BCS group than the CPM group (both p < 0.001). The UM group was more worried than the CPM group about contralateral recurrence only (p < 0.001).

Conclusions

Women with CPM were more likely to report being able to reduce worry about recurrence as a very important goal for surgery. They were also the least worried about ipsilateral breast recurrence and contralateral breast cancer almost two years postdiagnosis.
Appendix
Available only for authorised users
Literature
1.
Kummerow KL, Du L, Penson DF, Shyr Y, Hooks MA. Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surg. 2015;150(1):9–16.PubMed
2.
Panchal H, Pilewskie ML, Sheckter CC, et al. National trends in contralateral prophylactic mastectomy in women with locally advanced breast cancer. J Surg Oncol. 2019;119(1):79–87.PubMed
3.
Jatoi I, Kemp Z. Risk-reducing mastectomy. JAMA. 2021;325(17):1781–2.PubMed
4.
Nichols HB, Berrington de Gonzalez A, Lacey JV Jr, Rosenberg PS, Anderson WF. Declining incidence of contralateral breast cancer in the United States from 1975 to 2006. J Clin Oncol. 2011;29(12):1564–9.PubMedPubMedCentral
5.
Carbine NE, Lostumbo L, Wallace J, Ko H. Risk-reducing mastectomy for the prevention of primary breast cancer. Cochrane Database Syst Rev. 2018;4:Cd002748.PubMed
6.
Katz SJ, Morrow M. Addressing overtreatment in breast cancer: The doctors’ dilemma. Cancer. 2013;119(20):3584–8.PubMed
7.
Boughey JC, Attai DJ, Chen SL, et al. Contralateral prophylactic mastectomy (CPM) consensus statement from the American Society of Breast Surgeons: data on CPM outcomes and risks. Ann Surg Oncol. 2016;23(10):3100–5.PubMedPubMedCentral
8.
Hunt KK, Euhus DM, Boughey JC, et al. Society of Surgical Oncology Breast Disease Working Group statement on prophylactic (risk-reducing) mastectomy. Ann Surg Oncol. 2017;24(2):375–97.PubMed
9.
10.
Wright FC, Look Hong NJ, Quan ML, et al. Indications for contralateral prophylactic mastectomy: a consensus statement using modified Delphi methodology. Ann Surg. 2018;267(2):271–9.PubMed
11.
Jagsi R, Hawley ST, Griffith KA, et al. Contralateral prophylactic mastectomy decisions in a population-based sample of patients with early-stage breast cancer. JAMA Surg. 2017;152(3):274–82.PubMedPubMedCentral
12.
Hwang ES, Locklear TD, Rushing CN, et al. Patient-reported outcomes after choice for contralateral prophylactic mastectomy. J Clin Oncol. 2016;34(13):1518–27.PubMed
13.
Arrington AK, Jarosek SL, Virnig BA, Habermann EB, Tuttle TM. Patient and surgeon characteristics associated with increased use of contralateral prophylactic mastectomy in patients with breast cancer. Ann Surg Oncol. 2009;16(10):2697–704.PubMed
14.
King TA, Sakr R, Patil S, et al. Clinical management factors contribute to the decision for contralateral prophylactic mastectomy. J Clin Oncol. 2011;29(16):2158–64.PubMed
15.
Hawley ST, Jagsi R, Morrow M, et al. Social and clinical determinants of contralateral prophylactic mastectomy. JAMA Surg. 2014;149(6):582–9.PubMedPubMedCentral
16.
Parker PA, Peterson SK, Shen Y, et al. Prospective study of psychosocial outcomes of having contralateral prophylactic mastectomy among women with nonhereditary breast cancer. J Clin Oncol. 2018;36(25):2630–8.PubMedPubMedCentral
17.
Abbott A, Rueth N, Pappas-Varco S, Kuntz K, Kerr E, Tuttle T. Perceptions of contralateral breast cancer: an overestimation of risk. Ann Surg Oncol. 2011;18(11):3129–36.PubMed
18.
Rosenberg SM, Tracy MS, Meyer ME, et al. Perceptions, knowledge, and satisfaction with contralateral prophylactic mastectomy among young women with breast cancer: a cross-sectional survey. Ann Intern Med. 2013;159(6):373–81.PubMedPubMedCentral
19.
Frost MH, Schaid DJ, Sellers TA, et al. Long-term satisfaction and psychological and social function following bilateral prophylactic mastectomy. JAMA. 2000;284(3):319–24.PubMed
20.
Geiger AM, West CN, Nekhlyudov L, et al. Contentment with quality of life among breast cancer survivors with and without contralateral prophylactic mastectomy. J Clin Oncol. 2006;24(9):1350–6.PubMed
21.
Collins K, Gee M, Clack A, Wyld L. The psychosocial impact of contralateral risk reducing mastectomy (CRRM) on women: a rapid review. Psychooncology. 2018;27(1):43–52.PubMed
22.
Frost MH, Slezak JM, Tran NV, et al. Satisfaction after contralateral prophylactic mastectomy: the significance of mastectomy type, reconstructive complications, and body appearance. J Clin Oncol. 2005;23(31):7849–56.PubMed
23.
Frost MH, Hoskin TL, Hartmann LC, Degnim AC, Johnson JL, Boughey JC. Contralateral prophylactic mastectomy: long-term consistency of satisfaction and adverse effects and the significance of informed decision-making, quality of life, and personality traits. Ann Surg Oncol. 2011;18(11):3110–6.PubMedPubMedCentral
24.
Montgomery LL, Tran KN, Heelan MC, et al. Issues of regret in women with contralateral prophylactic mastectomies. Ann Surg Oncol. 1999;6(6):546–52.PubMed
25.
Bellavance E, Peppercorn J, Kronsberg S, et al. Surgeons’ perspectives of contralateral prophylactic mastectomy. Ann Surg Oncol. 2016;23(9):2779–87.PubMed
26.
Rosenberg SM, Greaney ML, Patenaude AF, Sepucha KR, Meyer ME, Partridge AH. “I don’t want to take chances.”: A qualitative exploration of surgical decision making in young breast cancer survivors. Psychooncology. 2018;27(6):1524–9.PubMedPubMedCentral
27.
Rosenberg SM, Sepucha K, Ruddy KJ, et al. Local therapy decision-making and contralateral prophylactic mastectomy in young women with early-stage breast cancer. Ann Surg Oncol. 2015;22(12):3809–15.PubMedPubMedCentral
28.
Sando IC, Billig JI, Ambani SW, et al. An evaluation of the choice for contralateral prophylactic mastectomy and patient concerns about recurrence in a reconstructed cohort. Ann Plast Surg. 2018;80(4):333–8.PubMed
29.
Buchanan PJ, Abdulghani M, Waljee JF, et al. An analysis of the decisions made for contralateral prophylactic mastectomy and breast reconstruction. Plast Reconstr Surg. 2016;138(1):29–40.PubMed
30.
Hawley ST, Griffith KA, Hamilton AS, et al. The association between patient attitudes and values and the strength of consideration for contralateral prophylactic mastectomy in a population-based sample of breast cancer patients. Cancer. 2017;123(23):4547–55.PubMed
31.
Huang J, Chagpar A. Factors associated with decision to undergo contralateral prophylactic mastectomy versus unilateral mastectomy. Am J Surg. 2019;218(1):170–4.PubMed
32.
Sabel MS, Kraft CT, Griffith KA, et al. Differences between breast conservation-eligible patients and unilateral mastectomy patients in choosing contralateral prophylactic mastectomies. Breast J. 2016;22(6):607–15.PubMed
33.
Gutnik L, Allen CM, Presson AP, Matsen CB. Breast cancer surgery decision role perceptions and choice of surgery. Ann Surg Oncol. 2020;27(10):3623–32.PubMed
34.
35.
Ayanian JZ, Zaslavsky AM, Arora NK, et al. Patients’ experiences with care for lung cancer and colorectal cancer: findings from the Cancer Care Outcomes Research and Surveillance Consortium. J Clin Oncol. 2010;28(27):4154–61.PubMedPubMedCentral
36.
Brady MJ, Cella DF, Mo F, et al. Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument. J Clin Oncol. 1997;15(3):974–86.PubMed
37.
Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord. 2006;7:44.PubMedPubMedCentral
38.
LeBlanc M, Stineman M, DeMichele A, Stricker C, Mao JJ. Validation of QuickDASH outcome measure in breast cancer survivors for upper extremity disability. Arch Phys Med Rehabil. 2014;95(3):493–8.PubMed
39.
Chew LD, Bradley KA, Boyko EJ. Brief questions to identify patients with inadequate health literacy. Fam Med. 2004;36(8):588–94.PubMed
40.
Chew LD, Griffin JM, Partin MR, et al. Validation of screening questions for limited health literacy in a large VA outpatient population. J Gen Intern Med. 2008;23(5):561–6.PubMedPubMedCentral
41.
Degner LF, Sloan JA, Venkatesh P. The Control Preferences Scale. Can J Nurs Res. 1997;29(3):21–43.PubMed
42.
Janz NK, Hawley ST, Mujahid MS, et al. Correlates of worry about recurrence in a multiethnic population-based sample of women with breast cancer. Cancer. 2011;117(9):1827–36.PubMed
43.
Hawley ST, Griggs JJ, Hamilton AS, et al. Decision involvement and receipt of mastectomy among racially and ethnically diverse breast cancer patients. J Natl Cancer Inst. 2009;101(19):1337–47.PubMedPubMedCentral
44.
Hawley ST, Janz NK, Lillie SE, et al. Perceptions of care coordination in a population-based sample of diverse breast cancer patients. Patient Educ Couns. 2010;81(Suppl):S34-40.PubMed
45.
Berger AM, Buzalko RJ, Kupzyk KA, Gardner BJ, Djalilova DM, Otte JL. Preferences and actual chemotherapy decision-making in the greater plains collaborative breast cancer study. Acta Oncol. 2017;56(12):1690–7.PubMed
46.
Mora-Pinzon MC, Chrischilles EA, Greenlee RT, et al. Variation in coordination of care reported by breast cancer patients according to health literacy. Support Care Cancer. 2018;27:857.PubMedPubMedCentral
47.
Chrischilles EA, Gryzlak B, McDowell BD, Connolly DW, Waitman LR. Abstract P5-08-23: The share thoughts on breast cancer study: a greater plains collaborative cohort characterization project. Cancer Res. 2017;77(4 Supplement):P5-08-23.
48.
McDowell BD, Klemp J, Blaes A, et al. Abstract PD4-05: Survivorship care planning is associated with breast cancer survivors' reported quality and coordination of care. Cancer Res. 2017;77(4 Supplement):PD4-05.
49.
Katz SJ, Lantz PM, Janz NK, et al. Patient involvement in surgery treatment decisions for breast cancer. J Clin Oncol. 2005;23(24):5526–33.PubMed
50.
Mandelblatt JS, Hadley J, Kerner JF, et al. Patterns of breast carcinoma treatment in older women: patient preference and clinical and physical influences. Cancer. 2000;89(3):561–73.PubMed
51.
Chrischilles EA, Riley D, Letuchy E, et al. Upper extremity disability and quality of life after breast cancer treatment in the Greater Plains Collaborative clinical research network. Breast Cancer Res Treat. 2019;175(3):675–89.PubMedPubMedCentral
52.
Katz SJ, Hawley ST, Hamilton AS, et al. Surgeon influence on variation in receipt of contralateral prophylactic mastectomy for women with breast cancer. JAMA Surg. 2018;153(1):29–36.PubMed
53.
Yao K, Bleicher R, Moran M, et al. Differences in physician opinions about controversial issues surrounding contralateral prophylactic mastectomy (CPM): a survey of physicians from accredited breast centers in the United States. Cancer Med. 2020;9(9):3088–96.PubMedPubMedCentral
54.
Tesson S, Richards I, Porter D, et al. Women’s preferences for contralateral prophylactic mastectomy following unilateral breast cancer: What risk-reduction makes it worthwhile? Breast. 2017;31:233–40.PubMed
55.
Beesley H, Holcombe C, Brown SL, Salmon P. Risk, worry and cosmesis in decision-making for contralateral risk-reducing mastectomy: analysis of 60 consecutive cases in a specialist breast unit. Breast. 2013;22(2):179–84.PubMed
56.
Covelli AM, Baxter NN, Fitch MI, Wright FC. Increasing mastectomy rates-the effect of environmental factors on the choice for mastectomy: a comparative analysis between Canada and the United States. Ann Surg Oncol. 2014;21(10):3173–84.PubMed
57.
Parker PA, Peterson SK, Bedrosian I, et al. Prospective study of surgical decision-making processes for contralateral prophylactic mastectomy in women with breast cancer. Ann Surg. 2016;263(1):178–83.PubMed
58.
Rosenberg SM, Dominici LS, Gelber S, et al. Association of breast cancer surgery with quality of life and psychosocial well-being in young breast cancer survivors. JAMA Surg. 2020;155(11):1035–42.PubMed
59.
Yao K, Belkora J, Bedrosian I, et al. Impact of an in-visit decision aid on patient knowledge about contralateral prophylactic mastectomy: a pilot study. Ann Surg Oncol. 2017;24(1):91–9.PubMed
60.
Partridge A, Adloff K, Blood E, et al. Risk perceptions and psychosocial outcomes of women with ductal carcinoma in situ: longitudinal results from a cohort study. J Natl Cancer Inst. 2008;100(4):243–51.PubMed
61.
Keim-Malpass J, Doede A, Camacho F, Kennedy C, Showalter SL. Impact of patient health literacy on surgical treatment of breast cancer. Breast J. 2018;24(4):633–6.PubMed
62.
63.
Manne SL, Smith BL, Frederick S, Mitarotondo A, Kashy DA, Kirstein LJ. B-Sure: a randomized pilot trial of an interactive web-based decision support aid versus usual care in average-risk breast cancer patients considering contralateral prophylactic mastectomy. Transl Behav Med. 2020;10(2):355–63.PubMed
Metadata
Title
Surgical Decision-Making Surrounding Contralateral Prophylactic Mastectomy: Comparison of Treatment Goals, Preferences, and Psychosocial Outcomes from a Multicenter Survey of Breast Cancer Patients
Authors
Ingrid M. Lizarraga, MBBS
Mary C. Schroeder, PhD
Ismail Jatoi, MD, PhD
Sonia L. Sugg, MD
Amy Trentham-Dietz, PhD
Laurel Hoeth
Elizabeth A. Chrischilles, PhD
Publication date
01-12-2021
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 13/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-021-10426-y

Other articles of this Issue 13/2021

Annals of Surgical Oncology 13/2021 Go to the issue

ASO Author Reflections

ASO Author Reflections: Objective Response Rate after Short Duration (< 9 Weeks) Is Not Inferior to Moderate (9–27 Weeks) or Long Duration (> 27 Weeks) of Neoadjuvant Endocrine Therapy (NET)—An NCDB Analysis

ASO Author Reflections

ASO Author Reflections: Laparoscopic Arantius’ Approach as Shortcut Access for Major Hepatic Veins

ASO Author Reflections

ASO Author Reflections: Response to Neoadjuvant Chemotherapy Strengthens the Prognostic Impact of Pathological Stage for Esophageal Squamous Cell Carcinoma

Hepatobiliary Tumors

Geographic Disparities in Referral Rates and Oncologic Outcomes of Intrahepatic Cholangiocarcinoma: A Population-Based Study

ASO Author Reflections

ASO Author Reflections: The Evolution of Treatment for Advanced Esophageal Cancer Invading the Aorta: The Impact of thoracic Endovascular Aortic Repair (TEVAR) on Clinical Outcome

Colorectal Cancer

Complete Mesocolic Excision and D3 Lymphadenectomy versus Conventional Colectomy for Colon Cancer: A Systematic Review and Meta-Analysis