Image: Research shows that surgeons’ opinion sways patient acceptance of contralateral breast removal (Photo courtesy of Fotolia).
Attending surgeons exert influence on the likelihood of receipt of contralateral prophylactic mastectomy (CPM) after a breast cancer diagnosis.
Researchers at University of Michigan (U-M; Ann Arbor, USA), Memorial Sloan-Kettering Cancer Center (MSKCC; New York, NY, USA), and other institutions conducted a population-based survey to identify 7,810 women with stages 0 to II breast cancer treated in 2013 to 2015. The women were identified via the Surveillance, Epidemiology, and End Results (SEER) registries of the state of Georgia and Los Angeles County (CA, USA). Surveys were sent to all women approximately two months after surgery, as well as to the 488 attending surgeons identified by the patients.
In all, 5,080 women and 377 surgeons responded to the survey. The mean age of responding women was 61.9 years; 28% had an increased risk of second primary cancer, and 16% received CPM. Half of surgeons practiced for more than 20 years, and 30% treated more than 50 new patients with breast cancer annually. The results showed that the odds of a patient receiving CPM increased almost threefold if she saw a surgeon with a practice approach above that of a surgeon with the mean CPM rate.
Survey results revealed that 25% of the surgeon influence was explained by attending attitudes about initial recommendations for surgery and responses to patient requests for CPM. The estimated rate of CPM was 34% for surgeons who least favored initial breast conservation and were least reluctant to perform CPM, compared to 4% for surgeons who most favored initial breast conservation and were most reluctant to perform CPM. The study was published on September 13, 2017, in JAMA Surgery.
“Surgeons have huge influence on treatment, and with that comes ultimate responsibility to get it right with patients,” said senior author Professor Steven Katz, MD, MPH, of U-M. “Even for a procedure that is very patient-driven, we see that surgeons account for a lot of the variability in the community and those surgeon attitudes really matter in terms of whether a patient does or does not get CPM.”
CPM is defined as the removal of a healthy breast in a patient undergoing mastectomy for ipsilateral cancer. The rate of CPM is steadily increasing, with a number of possible reasons cited; these include increased patient awareness of the genetic and familial risks, use of magnetic resonance imaging (MRI), improved reconstructive techniques, and patient choice. The procedure conveys peace of mind to patients and is generally met with high patient satisfaction.
University of Michigan
Memorial Sloan-Kettering Cancer Center