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Annals of Surgical Oncology

, Volume 26, Issue 10, pp 3224–3231 | Cite as

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

  • Mark A. Taylor
  • Chelsea McCarty Allen
  • Angela P. Presson
  • Morgan M. Millar
  • Rudi Zurbuchen
  • Cindy B. MatsenEmail author
Breast Oncology
  • 42 Downloads

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.

Notes

Acknowledgment

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

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(33):5203–9CrossRefGoogle Scholar
  2. 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):316–22CrossRefGoogle Scholar
  3. 3.
    Burke EE, Portschy PR, Tuttle TM. Prophylactic mastectomy: who needs it, when and why. J Surg Oncol. 2015;111(1):91–5CrossRefGoogle Scholar
  4. 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):375–80CrossRefGoogle Scholar
  5. 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):29–40CrossRefGoogle Scholar
  6. 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):3208–12CrossRefGoogle Scholar
  7. 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):2554–62CrossRefGoogle Scholar
  8. 8.
    Morrow M, Jagsi R, Alderman AK, et al. Surgeon recommendations and receipt of mastectomy for treatment of breast cancer. JAMA. 2009;302(14):1551–6CrossRefGoogle Scholar
  9. 9.
    Baker SK, Mayer DK, Esposito N. The contralateral prophylactic mastectomy decision-making process. Plast Surg Nurs. 2013;33(1):11–21; quiz 22–13CrossRefGoogle Scholar
  10. 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):387–95CrossRefGoogle Scholar
  11. 11.
    de Haes H. Dilemmas in patient centeredness and shared decision making: a case for vulnerability. Patient Educ Couns. 2006;62(3):291–98CrossRefGoogle Scholar
  12. 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;44Google Scholar
  13. 13.
    Rosenberg SM, Partridge AH. Contralateral prophylactic mastectomy: an opportunity for shared decision making. JAMA Surg. 2014;149(6):589–90CrossRefGoogle Scholar
  14. 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;27Google Scholar
  15. 15.
    Bellavance E, Peppercorn J, Kronsberg S, et al. Surgeons’ perspectives of contralateral prophylactic mastectomy. Ann Surg Oncol. 2016;23(9):2779–87CrossRefGoogle Scholar
  16. 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):2697–704CrossRefGoogle Scholar
  17. 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):658–64CrossRefGoogle Scholar
  18. 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):3100–5CrossRefGoogle Scholar
  19. 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):3106–11CrossRefGoogle Scholar
  20. 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):153–60CrossRefGoogle Scholar
  21. 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):452CrossRefGoogle Scholar
  22. 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):849–55CrossRefGoogle Scholar
  23. 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):83CrossRefGoogle Scholar
  24. 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):3365–70CrossRefGoogle Scholar
  25. 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):79–87CrossRefGoogle Scholar
  26. 26.
    Elwyn G, Cochran N, Pignone M. Shared decision making-the importance of diagnosing preferences. JAMA Intern Med. 2017;177(9):1239–40CrossRefGoogle Scholar
  27. 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):611–3CrossRefGoogle Scholar
  28. 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):579–84CrossRefGoogle Scholar
  29. 29.
    Politi MC, Legare F. Physicians’ reactions to uncertainty in the context of shared decision making. Patient Educ Couns. 2010;80(2):155–7CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Mark A. Taylor
    • 1
  • Chelsea McCarty Allen
    • 2
  • Angela P. Presson
    • 2
  • Morgan M. Millar
    • 2
  • Rudi Zurbuchen
    • 3
  • Cindy B. Matsen
    • 1
    Email author
  1. 1.Department of Surgery, Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUSA
  2. 2.Division of EpidemiologyUniversity of Utah School of MedicineSalt Lake CityUSA
  3. 3.University of Utah School of MedicineSalt Lake CityUSA

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