Abstract
BackgroundDespite no demonstrated survival advantage for women at average risk of breast cancer, rates of contralateral prophylactic mastectomy (CPM) continue to increase. Research reveals women with higher socioeconomic status (SES) are more likely to select CPM. This study examines how indicators of SES, age, and disease severity affect CPM motivations.MethodsPatients (N = 113) who underwent CPM at four Indiana University affiliated hospitals completed telephone interviews in 2013. Participants answered questions about 11 CPM motivations and provided demographic information. Responses to motivation items were factor analyzed, resulting in 4 motivational factors: reducing long-term risk, symmetry, avoiding future medical visits, and avoiding treatments.ResultsAcross demographic differences, reducing long-term risk was the strongest CPM motivation. Lower income predicted stronger motivation to reduce long-term risk and avoid treatment. Older participants were more motivated to avoid treatment; younger and more-educated patients were more concerned about symmetry. Greater severity of diagnosis predicted avoiding treatments.ConclusionsReducing long-term risk is the primary motivation across groups, but there are also notable differences as a function of age, education, income, and disease severity. To stop the trend of increasing CPM, physicians must tailor patient counseling to address motivations that are consistent across patient populations and those that vary between populations.
Highlights
Despite no demonstrated survival advantage for women at average risk of breast cancer, rates of contralateral prophylactic mastectomy (CPM) continue to increase
Research conducted in the interim indicates that women choosing CPM are not being influenced by the medical evidence demonstrating no survival advantage [8, 10, 11]
To remedy limitations in the existing research and provide additional insights into CPM decision making, this study addresses the following research questions: (1) What personal motivations for seeking CPM are stronger or weaker overall, and (2) to what extent does their importance for women vary as a function of education, employment, income, insurance status, race, age, and disease severity?
Summary
Ethics This study was approved by the Indiana University Institutional Review Board (IRB-04, protocol number 1210009689; and IRB-03, protocol number 1304011094). Study measures Participants were asked to consider their experience of 11 motivations for undergoing CPM These were (1) risk reduction—belief that removing both breasts reduces likelihood of cancer coming back, (2) recurrence-opposite—concern that cancer would appear in the opposite breast, (3) survival—belief that removing both breasts increases the chance of long-term survival, (4) surgery—reduce or avoid need for later breast surgeries, (5) symmetry—desire to maintain a symmetrical appearance, (6) recurrence-distant—concern that cancer would appear elsewhere in the body, (7) radiation—desire to reduce or avoid need for radiation treatment, (8) procedures—desire to reduce or avoid procedures such as mammograms and MRIs, (9) chemotherapy—desire to reduce or avoid chemotherapy, (10) physician visits–desire to reduce or avoid future visits to the breast surgeon, oncologist, or hospital, and (11) medications– desire to reduce or avoid medications that block hormones. The third stage utilized hierarchical multiple regression analyses to determine which predictors had effects independent of the others. 87.5% For all analyses, unless otherwise specified, significance 12.5% is reported at p < .05
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