Annals of Surgical Oncology

, Volume 22, Issue 12, pp 3809–3815 | Cite as

Local Therapy Decision-Making and Contralateral Prophylactic Mastectomy in Young Women with Early-Stage Breast Cancer

  • Shoshana M. Rosenberg
  • Karen Sepucha
  • Kathryn J. Ruddy
  • Rulla M. Tamimi
  • Shari Gelber
  • Meghan E. Meyer
  • Lidia Schapira
  • Steven E. Come
  • Virginia F. Borges
  • Mehra Golshan
  • Eric P. Winer
  • Ann H. Partridge
Breast Oncology

Abstract

Background

Rates of contralateral prophylactic mastectomy (CPM) have increased in the United States, with younger women with breast cancer the most likely to have CPM.

Methods

As part of an ongoing cohort study of young women diagnosed with breast cancer at age ≤40 years, we conducted multinomial logistic regression of data from 560 women with unilateral Stage I–III disease to identify factors associated with: (1) CPM versus unilateral mastectomy (UM); (2) CPM versus breast-conserving surgery (BCS).

Results

Median age at diagnosis was 37 years; 66 % of women indicated that their doctor said that BCS was an option or was recommended. Of all women, 42.9 % had CPM, 26.8 % UM, and 30.4 % BCS. Among women who said the surgical decision was patient-driven, 59.9 % had CPM, 22.8 % BCS, and 17.3 % UM. Clinical characteristics associated with CPM versus BCS included HER2 positivity, nodal involvement, larger tumor size, lower BMI, parity, and testing positive for a BRCA mutation. Emotional and decisional factors associated with CPM versus UM and BCS included anxiety, less fear of recurrence, and reporting a patient-driven decision. Women who reported a physician-driven decision were less likely to have had CPM than both of the other surgeries, whereas higher confidence with the decision was associated with having CPM versus BCS.

Conclusions

Many young women with early-stage breast cancer are choosing CPM. The association between CPM and emotional and decisional factors suggest that improved communication together with better psychosocial support may improve the decision-making process.

References

  1. 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;25:5203–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Tuttle TM, Jarosek S, Habermann EB, et al. Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ. J Clin Oncol. 2009;27:1362–7.CrossRefPubMedGoogle Scholar
  3. 3.
    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;17:2554–62.CrossRefPubMedGoogle Scholar
  4. 4.
    Kummerow KL, Du L, Penson DF, Shyr Y, Hooks MA. Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surg. 2015;150:9–16.CrossRefPubMedGoogle Scholar
  5. 5.
    King TA, Sakr R, Patil S, et al. Clinical management factors contribute to the decision for contralateral prophylactic mastectomy. J Clin Oncol. 2011;29:2158–64.CrossRefPubMedGoogle Scholar
  6. 6.
    Jones NB, Wilson J, Kotur L, Stephens J, Farrar WB, Agnese DM. Contralateral prophylactic mastectomy for unilateral breast cancer: an increasing trend at a single institution. Ann Surg Oncol. 2009;16:2691–6.CrossRefPubMedGoogle Scholar
  7. 7.
    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;16:2697–704.CrossRefPubMedGoogle Scholar
  8. 8.
    Brewster AM, Parker PA. Current knowledge on contralateral prophylactic mastectomy among women with sporadic breast cancer. Oncologist. 2011;16:935–41.PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Murphy JA, Milner TD, O’Donoghue JM. Contralateral risk-reducing mastectomy in sporadic breast cancer. Lancet Oncol. 2013;14:e262–9.CrossRefPubMedGoogle Scholar
  10. 10.
    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;29:1564–9.Google Scholar
  11. 11.
    Lostumbo L, Carbine NE, Wallace J. Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database Syst Rev. 2010. doi: 10.1002/14651858.CD002748.PubMedGoogle Scholar
  12. 12.
    Portschy PR, Kuntz KM, Tuttle TM. Survival outcomes after contralateral prophylactic mastectomy: a decision analysis. J Natl Cancer Inst. 2014. doi: 10.1093/jnci/dju160.PubMedGoogle Scholar
  13. 13.
    Miller ME, Czechura T, Martz B, et al. Operative risks associated with contralateral prophylactic mastectomy: a single institution experience. Ann Surg Oncol. 2013;20:4113–20.CrossRefPubMedGoogle Scholar
  14. 14.
    Osman F, Saleh F, Jackson TD, Corrigan MA, Cil T. Increased postoperative complications in bilateral mastectomy patients compared to unilateral mastectomy: an analysis of the NSQIP database. Ann Surg Oncol. 2013;20:3212–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Sharpe SM, Liederbach E, Czechura T, Pesce C, Winchester DJ, Yao K. Impact of bilateral versus unilateral mastectomy on short term outcomes and adjuvant therapy, 2003-2010: a report from the National Cancer Data Base. Ann Surg Oncol. 2014;21:2920–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psych Scand. 1983;67:361–70.CrossRefGoogle Scholar
  17. 17.
    Lasry JC, Margolese RG. Fear of recurrence, breast-conserving surgery, and the trade-off hypothesis. Cancer. 1992;69:2111–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Degner LF, Kristjanson LJ, Bowman D, et al. Information needs and decisional preferences in women with breast cancer. JAMA. 1997;277:1485–92.CrossRefPubMedGoogle Scholar
  19. 19.
    Sepucha KR, Belkora JK, Chang Y, et al. Measuring decision quality: psychometric evaluation of a new instrument for breast cancer surgery. BMC Med Inform Decis Mak. 2012;12:51.CrossRefGoogle Scholar
  20. 20.
    Chung A, Huynh K, Lawrence C, Sim MS, Giuliano A. Comparison of patient characteristics and outcomes of contralateral prophylactic mastectomy and unilateral total mastectomy in breast cancer patients. Ann Surg Oncol. 2012;19:2600–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Stucky CC, Gray RJ, Wasif N, Dueck AC, Pockaj BA. Increase in contralateral prophylactic mastectomy: echoes of a bygone era? Surgical trends for unilateral breast cancer. Ann Surg Oncol. 2010;17(Suppl 3):330–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Howard-McNatt M, Schroll RW, Hurt GJ, Levine EA. Contralateral prophylactic mastectomy in breast cancer patients who test negative for BRCA mutations. Am J Surg. 2011;202:298–302.CrossRefPubMedGoogle Scholar
  23. 23.
    Yi M, Hunt KK, Arun BK, et al. Factors affecting the decision of breast cancer patients to undergo contralateral prophylactic mastectomy. Cancer Prev Res (Phila). 2010;3:1026–34.PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Hawley ST, Jagsi R, Morrow M, et al. Social and clinical determinants of contralateral prophylactic mastectomy. JAMA Surg. 2014;149(6):582–89.CrossRefGoogle Scholar
  25. 25.
    Katz SJ, Lantz PM, Janz NK, et al. Patient involvement in surgery treatment decisions for breast cancer. J Clin Oncol. 2005;23:5526–33.CrossRefPubMedGoogle Scholar
  26. 26.
    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;101:1337–47.PubMedCentralCrossRefPubMedGoogle Scholar
  27. 27.
    Zikmund-Fisher BJ, Fagerlin A, Ubel PA. Risky feelings: why a 6% risk of cancer does not always feel like 6%. Patient Educ Couns. 2010;81 Suppl:S87–93.CrossRefGoogle Scholar
  28. 28.
    Katz SJ, Morrow M. Contralateral prophylactic mastectomy for breast cancer: addressing peace of mind. JAMA. 2013;310:793–4.CrossRefPubMedGoogle Scholar
  29. 29.
    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;159:373–81.PubMedCentralCrossRefPubMedGoogle Scholar
  30. 30.
    Apicella C, Peacock SJ, Andrews L, Tucker K, Daly MB, Hopper JL. Measuring, and identifying predictors of women’s perceptions of three types of breast cancer risk: population risk, absolute risk and comparative risk. Br J Cancer. 2009;100:583–9.PubMedCentralCrossRefPubMedGoogle Scholar
  31. 31.
    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;100:243–51.CrossRefPubMedGoogle Scholar
  32. 32.
    Liu Y, Perez M, Schootman M, et al. A longitudinal study of factors associated with perceived risk of recurrence in women with ductal carcinoma in situ and early-stage invasive breast cancer. Breast Cancer Res Treat. 2010;124:835–44.PubMedCentralCrossRefPubMedGoogle Scholar
  33. 33.
    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;22:179–84.CrossRefPubMedGoogle Scholar
  34. 34.
    Alderman AK, Wilkins EG, Kim HM, Lowery JC. Complications in postmastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg. 2002;109:2265–74.CrossRefPubMedGoogle Scholar
  35. 35.
    Fischer JP, Nelson JA, Au A, Ct T 3rd, Serletti JM, Wu LC. Complications and morbidity following breast reconstruction: a review of 16,063 cases from the 2005-2010 NSQIP datasets. J Plast Surg Hand Surg. 2013. doi: 10.3109/2000656X.2013.819003.Google Scholar
  36. 36.
    Sorbero ME, Dick AW, Beckjord EB, Ahrendt G. Diagnostic breast magnetic resonance imaging and contralateral prophylactic mastectomy. Ann Surg Oncol. 2009;16:1597–605.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Shoshana M. Rosenberg
    • 1
  • Karen Sepucha
    • 2
  • Kathryn J. Ruddy
    • 3
  • Rulla M. Tamimi
    • 4
  • Shari Gelber
    • 5
  • Meghan E. Meyer
    • 1
  • Lidia Schapira
    • 2
  • Steven E. Come
    • 6
  • Virginia F. Borges
    • 7
  • Mehra Golshan
    • 8
  • Eric P. Winer
    • 1
  • Ann H. Partridge
    • 1
  1. 1.Department of Medical OncologyDana-Farber Cancer InstituteBostonUSA
  2. 2.Department of MedicineMassachusetts General HospitalBostonUSA
  3. 3.Department of Medical OncologyMayo ClinicRochesterUSA
  4. 4.Channing Division of Network MedicineBrigham and Women’s HospitalBostonUSA
  5. 5.Department of Biostatistics and Computational BiologyDana-Farber Cancer InstituteBostonUSA
  6. 6.Department of Medical OncologyBeth Israel Deaconess Medical CenterBostonUSA
  7. 7.Division of Medical OncologyUniversity of ColoradoAuroraUSA
  8. 8.Department of SurgeryBrigham and Women’s HospitalBostonUSA

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