Unfounded fears prompt prophylactic mastectomy

Unfounded fears prompt prophylactic mastectomy
Unfounded fears prompt prophylactic mastectomy

HealthDay News -- Many women with breast cancer know that contralateral prophylactic mastectomy (CPM) does not improve survival, but opt for the surgery anyway in hopes of extending life, results of a small survey show.

Among 128 women with bilateral breast cancer, 98% of those who underwent CPM said they did so to decrease their risk of contralateral breast cancer, and 94% said they wanted to improve their chance of survival, Shoshana M. Rosenberg, ScD, MPH, of Memorial Sloan-Kettering Cancer Center in New York City, and colleagues reported in Annals of Internal Medicine.

However, only 18% said they thought CPM actually improved survival rates.

"Despite knowing that CPM does not clearly improve survival, women who have the procedure do so, in part, to extend their lives," the researchers wrote. "Many women overestimate their actual risk for cancer in the unaffected breast. Interventions aimed at improving risk communication in an effort to promote evidence-based decision making are warranted."

The one-time, 23-item survey to assess decision making, knowledge, risk perception and breast cancer worry was administered an average two years after women with bilateral breast cancer underwent CPM. Participants had an average age of 37 years at diagnosis -- 92% were white, 85% were college educated and 96% had health insurance.

Overall, 80% of participants reported they were extremely confidant in their decision and 90% said they would make the same decision again. Nearly half said they were concerned screening would miss cancer in the contralateral breast.

One quarter of survey participants were BRCA1 or BRCA2 mutation carriers, and more accurately perceived their risk for contralateral breast cancer than those who were not. Risk was substantially overestimated in women without a known mutation at 56%.

The majority of women had stage 1 or 2 breast cancer, and 60% of tumors were estrogen-receptor positive.

Overwhelmingly, women said they chose to undergo CPM for peace of mind (95%), with 83% indicating it was "extremely important" and 15% indicating it was "very important" to lower their risk for contralateral breast cancer. Few women said they based their decision on advice from family or friends (14%).

"The apparent discordance between patient perceptions and realistic expectations provides a teachable opportunity for physicians treating newly diagnosed patients with breast cancer," Pamela R. Portschy, MD, and Todd M. Tuttle, MD, MS, of the University of Minnesota in Minneapolis, wrote in an accompanying editorial.

They emphasized the importance of clinicians providing accurate and easily understandable information to help inform the decision making process.


References

  1. Rosenberg SM et al. Ann Intern Med. 2013; 159: 373-381.
  2. Portschy PR, Tuttle TM. Ann Intern Med. 2013; 159: 428-429.
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