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Exploring Surgeon Variability in Recommendations for Contralateral Prophylactic Mastectomy: What Matters Most?

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

Abstract

Background

American Society of Breast Surgeons (ASBrS) guidelines state that it is the responsibility of the surgeon to discuss the risks/benefits of and give a recommendation regarding contralateral prophylactic mastectomy (CPM). We conducted a survey of ASBrS members to evaluate the factors that affect this recommendation, confidence in this recommendation, and awareness/adoption of the guidelines.

Methods

A survey was sent to the ASBrS membership. Vignettes with the following variables about breast cancer patient were randomly included: age, disease stage, receptor status, family history (FH) of breast cancer, and patient preference for CPM. Respondents were asked to estimate the patient’s chance of developing contralateral cancer, whether they would recommend CPM, and their confidence in this recommendation, and about their familiarity with and use of the guidelines.

Results

536 members (21.9%) responded. The odds of recommending CPM and confidence in recommendation were higher in a younger patient, higher-stage disease, triple-negative and human epidermal growth factor receptor (HER)2+ relative to estrogen receptor (ER)+, and in women with FH. Of surgeons, 51% were familiar or very familiar with the guidelines and 38% used the guidelines most or all of the time. Surgeons who used the guidelines were not less likely to recommend CPM.

Conclusions

While surgeons generally agree on the factors that are important in making a recommendation on CPM, there is variability in how strongly the different factors influence the recommendation and their confidence in that recommendation. In addition, while most surgeons were at least a little familiar with the ASBrS guidelines, the vast majority do not routinely use them.

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References

  1. Tuttle TM, Habermann EB, Grund EH, Morris TJ, Virnig BA. Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol. 2007;25(33):5203–9

    Article  PubMed  Google Scholar 

  2. Soran A, Kamali Polat A, Johnson R, McGuire KP. Increasing trend of contralateral prophylactic mastectomy: what are the factors behind this phenomenon? Surgeon. 2014;12(6):316–22

    Article  PubMed  Google Scholar 

  3. Burke EE, Portschy PR, Tuttle TM. Prophylactic mastectomy: who needs it, when and why. J Surg Oncol. 2015;111(1):91–5

    Article  PubMed  Google Scholar 

  4. Dragun AE, Pan J, Riley EC, et al. Increasing use of elective mastectomy and contralateral prophylactic surgery among breast conservation candidates: a 14-year report from a comprehensive cancer center. Am J Clin Oncol. 2013;36(4):375–80

    Article  PubMed  Google Scholar 

  5. 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

    Article  CAS  PubMed  Google Scholar 

  6. Angelos P, Bedrosian I, Euhus DM, Herrmann VM, Katz SJ, Pusic A. Contralateral prophylactic mastectomy: challenging considerations for the surgeon. Ann Surg Oncol. 2015;22(10):3208–12

    Article  PubMed  PubMed Central  Google Scholar 

  7. Yao K, Stewart AK, Winchester DJ, Winchester DP. Trends in contralateral prophylactic mastectomy for unilateral cancer: a report from the National Cancer Data Base, 1998–2007. Ann Surg Oncol. 2010;17(10):2554–62

    Article  PubMed  Google Scholar 

  8. Morrow M, Jagsi R, Alderman AK, et al. Surgeon recommendations and receipt of mastectomy for treatment of breast cancer. JAMA. 2009;302(14):1551–6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Baker SK, Mayer DK, Esposito N. The contralateral prophylactic mastectomy decision-making process. Plast Surg Nurs. 2013;33(1):11–21; quiz 22–13

    Article  PubMed  Google Scholar 

  10. Hawley ST, Lantz PM, Janz NK, et al. Factors associated with patient involvement in surgical treatment decision making for breast cancer. Patient Educ Couns. 2007;65(3):387–95

    Article  PubMed  Google Scholar 

  11. de Haes H. Dilemmas in patient centeredness and shared decision making: a case for vulnerability. Patient Educ Couns. 2006;62(3):291–98

    Article  PubMed  Google Scholar 

  12. Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Social Sci Med (1982). 1997;44

    Google Scholar 

  13. Rosenberg SM, Partridge AH. Contralateral prophylactic mastectomy: an opportunity for shared decision making. JAMA Surg. 2014;149(6):589–90

    Article  PubMed  PubMed Central  Google Scholar 

  14. Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27

  15. Bellavance E, Peppercorn J, Kronsberg S, et al. Surgeons’ perspectives of contralateral prophylactic mastectomy. Ann Surg Oncol. 2016;23(9):2779–87

    Article  PubMed  Google Scholar 

  16. 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

    Article  PubMed  Google Scholar 

  17. Katz SJ, Janz NK, Abrahamse P, et al. Patient reactions to surgeon recommendations about contralateral prophylactic mastectomy for treatment of breast cancer. JAMA Surg. 2017;152(7):658–64

    Article  PubMed  PubMed Central  Google Scholar 

  18. 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

    Article  PubMed  PubMed Central  Google Scholar 

  19. Boughey JC, Attai DJ, Chen SL, et al. Contralateral prophylactic mastectomy consensus statement from the American Society of Breast Surgeons: additional considerations and a framework for shared decision making. Ann Surg Oncol. 2016;23(10):3106–11

    Article  PubMed  PubMed Central  Google Scholar 

  20. Chowdhury M, Euhus D, Onega T, Biswas S, Choudhary PK. A model for individualized risk prediction of contralateral breast cancer. Breast Cancer Res Treat. 2017;161(1):153–60

    Article  CAS  PubMed  Google Scholar 

  21. Rusner C, Wolf K, Bandemer-Greulich U, et al. Risk of contralateral second primary breast cancer according to hormone receptor status in Germany. Breast Cancer Res. 2014;16(5):452

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Saltzman BS, Malone KE, McDougall JA, Daling JR, Li CI. Estrogen receptor, progesterone receptor, and HER2-neu expression in first primary breast cancers and risk of second primary contralateral breast cancer. Breast Cancer Res Treat. 2012;135(3):849–55

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Reiner AS, Lynch CF, Sisti JS, et al. Hormone receptor status of a first primary breast cancer predicts contralateral breast cancer risk in the WECARE study population. Breast Cancer Res. 2017;19(1):83

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Murphy BL, Hoskin TL, Boughey JC, Degnim AC, Glazebrook KN, Hieken TJ. Contralateral prophylactic mastectomy for women with T4 locally advanced breast cancer. Ann Surg Oncol. 2016;23(10):3365–70

    Article  PubMed  Google Scholar 

  25. 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

    Article  PubMed  Google Scholar 

  26. Elwyn G, Cochran N, Pignone M. Shared decision making-the importance of diagnosing preferences. JAMA Intern Med. 2017;177(9):1239–40

    Article  PubMed  Google Scholar 

  27. Nass SJ, Nekhlyudov L. Commentary on the consensus statement of the American Society of Breast Surgeons on contralateral prophylactic mastectomy. Ann Surg Oncol. 2017;24(3):611–3

    Article  PubMed  Google Scholar 

  28. Politi MC, Street RL, Jr. The importance of communication in collaborative decision making: facilitating shared mind and the management of uncertainty. J Eval Clin Pract. 2011;17(4):579–84

    Article  PubMed  Google Scholar 

  29. Politi MC, Legare F. Physicians’ reactions to uncertainty in the context of shared decision making. Patient Educ Couns. 2010;80(2):155–7

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

A 2017 American Society of Breast Surgeons Foundation Grant funded this work.

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Authors and Affiliations

  1. Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA

    Mark A. Taylor MD & Cindy B. Matsen MD, MSCI, FACS

  2. Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA

    Chelsea McCarty Allen PhD, Angela P. Presson PhD & Morgan M. Millar PhD

  3. University of Utah School of Medicine, Salt Lake City, UT, USA

    Rudi Zurbuchen BS

Authors
  1. Mark A. Taylor MD
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  2. Chelsea McCarty Allen PhD
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  3. Angela P. Presson PhD
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  4. Morgan M. Millar PhD
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  5. Rudi Zurbuchen BS
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  6. Cindy B. Matsen MD, MSCI, FACS
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Correspondence to Cindy B. Matsen MD, MSCI, FACS.

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Taylor, M.A., Allen, C.M., Presson, A.P. et al. Exploring Surgeon Variability in Recommendations for Contralateral Prophylactic Mastectomy: What Matters Most?. Ann Surg Oncol 26, 3224–3231 (2019). https://doi.org/10.1245/s10434-019-07561-y

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  • DOI: https://doi.org/10.1245/s10434-019-07561-y

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