Abstract CS1-2: Contralateral prophylactic mastectomy: Patient preferences and risk perceptions

Abstract

Abstract Recent studies have revealed increasing rates of contralateral prophylactic mastectomy (CPM) among women with unilateral early stage breast cancer. Bilateral mastectomy at diagnosis of unilateral breast cancer is particularly common among young women, with younger age consistently identified as a predictor of CPM. This trend for more surgery rather than less has raised concerns, given the lack of evidence for a survival benefit from CPM and the relatively low risk of contralateral breast cancer for most women in this setting. Although mastectomy is a safe procedure and major complications are rare, there are potential negative consequences including cosmetic concerns and clinically significant potential long-term sequelae such as numbness of the chest skin and chronic pain and decreased function. Given most women opt for reconstructive surgery, extended recovery time, additional surgical complications, and decreased strength or function due to muscles being moved or stretched are also additional risks. Recent data have revealed that some women who undergo CPM have misperceptions about their actual risks and the values of the prophylactic surgery. In a recent cross-sectional survey of young breast cancer survivors who had undergone bilateral mastectomy for unilateral breast cancer, most women indicated that desire to decrease their risk for contralateral breast cancer (98%) and improve survival (94%) were extremely or very important factors in their decision to have CPM. However, only 18% indicated that women with breast cancer who undergo CPM live longer than those who do not. BRCA1 or BRCA2 mutation carriers more accurately perceived their risk for contralateral breast cancer, whereas women without a known mutation substantially overestimated this risk. An increasing body of literature suggests that fear of recurrence and anxiety are strong predictors of undergoing CPM. Improved education and counseling about the risks and benefits of CPM, as well as increased awareness and management of anxiety surrounding breast cancer diagnosis and treatment, are likely to help patients to understand their risks more fully and to make decisions consistent with their preferences and values. Decision aids may be particularly useful in this setting. Citation Format: Ann Partridge. Contralateral prophylactic mastectomy: Patient preferences and risk perceptions [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr CS1-2.