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Surgeons’ Perspectives of Contralateral Prophylactic Mastectomy

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Contralateral prophylactic mastectomy (CPM) is commonly performed for the treatment of breast cancer, despite its limited oncologic benefit. Little is known about surgeons’ perceptions of performing CPM. We hypothesized that a proportion of surgeons would report discomfort with performing CPM, particularly when there is discordance between patients’ perceived benefit from CPM and the expected oncologic benefit.

Methods

A survey was sent to members of the American Society of Breast Surgeons seeking self-reports of surgeons’ practice patterns, perceptions, and comfort levels with CPM.

Results

Of the 2436 members surveyed, 601 responded (response rate = 24.7 %). The median age of respondents was 52 years, and 59 % of responders were women. The majority (58 %) reported that 80 % of their practice was devoted to the treatment of breast disease. Fifty-seven percent (n = 326) of respondents reported discomfort with performing CPM at some point in their practice. While most surgeons (95 %) were comfortable with CPM on a patient with a deleterious BRCA mutation, only 34 % were comfortable performing CPM on an average-risk patient. The most common reasons reported for surgeon discomfort with CPM were a concern for overtreatment, an unfavorable risk/benefit ratio, and inadequate patient understanding of the anticipated risks and benefits of CPM.

Conclusions

Despite the increasing use of CPM for the treatment of breast cancer, many surgeons report discomfort with CPM. Concerns with performing CPM predominantly focus on ambiguities surrounding the oncologic benefit and relative risk of this procedure. Further research is needed to define optimal shared decision-making practices in this area.

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Disclosures

Jeffery Peppercorn: Spouse is employed by GlaxcoSmithKline Inc. Deborah Collyar: Honoraria, travel and accommodations from Merck. Fay Hlubocky: Speaker’s Bureau for Lilly Oncology.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Maryland, Baltimore, MD, USA

    Emily Bellavance MD

  2. Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA, USA

    Jeffrey Peppercorn MD, MPH

  3. Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA

    Shari Kronsberg MS & Laurence Magder PhD, RN, MBA

  4. Department of Surgery, Duke University Medical Center, Durham, NC, USA

    Rachel Greenup MD, MPH

  5. Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA

    Jason Keune MD

  6. Veterans Health Administration, Bedford, MA, USA

    Julie Lynch PhD, RN, MBA

  7. RTI International, Research Triangle Park, NC, USA

    Julie Lynch PhD, RN, MBA

  8. Patient Advocates in Research, Danville, CA, USA

    Deborah Collyar BA

  9. Division of General Internal Medicine and Biomedical Ethics Research Unit and Knowledge & Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA

    Jon Tilburt MD, MPH

  10. Department of Medicine, The University of Chicago, Chicago, IL, USA

    Fay Hlubocky PhD, MA

  11. Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA

    Katharine Yao MD

Authors
  1. Emily Bellavance MD
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  2. Jeffrey Peppercorn MD, MPH
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  11. Katharine Yao MD
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Corresponding author

Correspondence to Emily Bellavance MD.

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Bellavance, E., Peppercorn, J., Kronsberg, S. et al. Surgeons’ Perspectives of Contralateral Prophylactic Mastectomy. Ann Surg Oncol 23, 2779–2787 (2016). https://doi.org/10.1245/s10434-016-5253-9

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  • DOI: https://doi.org/10.1245/s10434-016-5253-9

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