Patient Decisions About Bilateral Mastectomy Influenced by Anxiety, Worry About Recurrence

Katharine Yao, MD

One of the first studies to prospectively examine women’s breast surgery preferences has revealed that newly diagnosed women with breast cancer who decide to undergo contralateral prophylactic mastectomy (CPM), may be making this decision as result of high anxiety and fear of recurrence, rather than relying on evidence-based information. This discovery highlights the need for interdisciplinary patient education and communication.

“There is so much information about breast cancer that it’s easy for patients to get overwhelmed. As doctors, we have to be aware of each patient’s knowledge level and the concerns and worries he or she have,” said lead study author Katharine Yao, MD, director of the breast surgical program at NorthShore University HealthSystem, Evanston, Illinois, and a clinical associate professor of surgery at the Pritzker School of Medicine, University of Chicago in a press release. “And we need to do a better job of educating patients that the risk of developing contralateral breast cancer is actually low and that breast cancer can come back in other parts of their body no matter what type of surgery they have.”

Results of the study were presented during an American Society of Clinical Oncology presscast on September 2 in advance of the 2014 Breast Cancer Symposium that will take place September 4-6 at the San Francisco Marriott Marquis.

Researchers administered a 55-item survey to newly diagnosed breast cancer patients at two institutions prior to surgery. The survey asked these patients about their surgery choices. Researchers then compared patient knowledge, perception, and anxiety factors amongst those who considered a CPM versus those who did not.

Eighty-three patients (58%) wanted or considered a CPM upon initial diagnosis, whereas 35 patients (24.6%) knew that they did not want a CPM upon initial diagnosis. Sixteen patients (11.3%) said that they knew about CPM but did not think it was an option for them, and 8 patients (5.6%) did not have any knowledge of CPM.

Patients were asked a knowledge-based question: Does removing a healthy breast reduce the chance that the cancer will come back? Thirty-two percent of the patients who considered CPM and 53% of patients who did not consider CPM said that this statement was correct.

Patients were also asked a perception-based question: Before you were diagnosed with breast cancer, did you believe your risk for breast cancer was higher than average? Twenty-four percent of the considered-CPM group and 14% of patients who did not consider CPM answered this question affirmatively.

A third question measured anxiety levels and asked patients: How much do you worry about getting cancer elsewhere in your body? Forty-three percent and 11% chose very much/extremely as an answer.

“These data demonstrate that this complex decision is often the result of higher anxiety levels and worry about recurrence,” Yao said. “These are certainly valid concerns, but as oncologists we need to make certain that we are educating each patient about her individual risk for the future.”

Contralateral prophylactic mastectomy (CPM) has increased in prevalence in the past decade despite the higher risk involved and the fact that survival rates are equivalent between those who undergo lumpectomy with radiation and mastectomy.

“We continue to see increasing numbers of women newly diagnosed with breast cancer who choose bilateral mastectomy despite the fact that survival rates are equivalent between those who undergo lumpectomy with radiation and mastectomy,” said Julie Margenthaler, MD, Breast Cancer Symposium News Planning Team member in a press release.

Yao K, Wroblewski K, Van Haitsma M, et al. Surgical decision making for breast cancer: Treatment preferences prior to surgery. Presented at ASCO Breast Cancer Symposium presscast, September 2, 2014. Abstract 71.

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