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Local Therapy Decision-Making and Contralateral Prophylactic Mastectomy in Young Women with Early-Stage Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Rates of contralateral prophylactic mastectomy (CPM) have increased in the United States, with younger women with breast cancer the most likely to have CPM.

Methods

As part of an ongoing cohort study of young women diagnosed with breast cancer at age ≤40 years, we conducted multinomial logistic regression of data from 560 women with unilateral Stage I–III disease to identify factors associated with: (1) CPM versus unilateral mastectomy (UM); (2) CPM versus breast-conserving surgery (BCS).

Results

Median age at diagnosis was 37 years; 66 % of women indicated that their doctor said that BCS was an option or was recommended. Of all women, 42.9 % had CPM, 26.8 % UM, and 30.4 % BCS. Among women who said the surgical decision was patient-driven, 59.9 % had CPM, 22.8 % BCS, and 17.3 % UM. Clinical characteristics associated with CPM versus BCS included HER2 positivity, nodal involvement, larger tumor size, lower BMI, parity, and testing positive for a BRCA mutation. Emotional and decisional factors associated with CPM versus UM and BCS included anxiety, less fear of recurrence, and reporting a patient-driven decision. Women who reported a physician-driven decision were less likely to have had CPM than both of the other surgeries, whereas higher confidence with the decision was associated with having CPM versus BCS.

Conclusions

Many young women with early-stage breast cancer are choosing CPM. The association between CPM and emotional and decisional factors suggest that improved communication together with better psychosocial support may improve the decision-making process.

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References

  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;25:5203–9.

    Article  PubMed  Google Scholar 

  2. Tuttle TM, Jarosek S, Habermann EB, et al. Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ. J Clin Oncol. 2009;27:1362–7.

    Article  PubMed  Google Scholar 

  3. 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;17:2554–62.

    Article  PubMed  Google Scholar 

  4. Kummerow KL, Du L, Penson DF, Shyr Y, Hooks MA. Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surg. 2015;150:9–16.

    Article  PubMed  Google Scholar 

  5. King TA, Sakr R, Patil S, et al. Clinical management factors contribute to the decision for contralateral prophylactic mastectomy. J Clin Oncol. 2011;29:2158–64.

    Article  PubMed  Google Scholar 

  6. Jones NB, Wilson J, Kotur L, Stephens J, Farrar WB, Agnese DM. Contralateral prophylactic mastectomy for unilateral breast cancer: an increasing trend at a single institution. Ann Surg Oncol. 2009;16:2691–6.

    Article  PubMed  Google Scholar 

  7. 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;16:2697–704.

    Article  PubMed  Google Scholar 

  8. Brewster AM, Parker PA. Current knowledge on contralateral prophylactic mastectomy among women with sporadic breast cancer. Oncologist. 2011;16:935–41.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Murphy JA, Milner TD, O’Donoghue JM. Contralateral risk-reducing mastectomy in sporadic breast cancer. Lancet Oncol. 2013;14:e262–9.

    Article  PubMed  Google Scholar 

  10. Nichols HB, Berrington de Gonzalez A, Lacey JV Jr., Rosenberg PS, Anderson WF. Declining incidence of contralateral breast cancer in the United States from 1975 to 2006. J Clin Oncol. 2011;29:1564–9.

    Google Scholar 

  11. Lostumbo L, Carbine NE, Wallace J. Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database Syst Rev. 2010. doi: 10.1002/14651858.CD002748.

    PubMed  Google Scholar 

  12. Portschy PR, Kuntz KM, Tuttle TM. Survival outcomes after contralateral prophylactic mastectomy: a decision analysis. J Natl Cancer Inst. 2014. doi: 10.1093/jnci/dju160.

    PubMed  Google Scholar 

  13. Miller ME, Czechura T, Martz B, et al. Operative risks associated with contralateral prophylactic mastectomy: a single institution experience. Ann Surg Oncol. 2013;20:4113–20.

    Article  PubMed  Google Scholar 

  14. Osman F, Saleh F, Jackson TD, Corrigan MA, Cil T. Increased postoperative complications in bilateral mastectomy patients compared to unilateral mastectomy: an analysis of the NSQIP database. Ann Surg Oncol. 2013;20:3212–7.

    Article  PubMed  Google Scholar 

  15. Sharpe SM, Liederbach E, Czechura T, Pesce C, Winchester DJ, Yao K. Impact of bilateral versus unilateral mastectomy on short term outcomes and adjuvant therapy, 2003-2010: a report from the National Cancer Data Base. Ann Surg Oncol. 2014;21:2920–7.

    Article  PubMed  Google Scholar 

  16. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psych Scand. 1983;67:361–70.

    Article  CAS  Google Scholar 

  17. Lasry JC, Margolese RG. Fear of recurrence, breast-conserving surgery, and the trade-off hypothesis. Cancer. 1992;69:2111–5.

    Article  CAS  PubMed  Google Scholar 

  18. Degner LF, Kristjanson LJ, Bowman D, et al. Information needs and decisional preferences in women with breast cancer. JAMA. 1997;277:1485–92.

    Article  CAS  PubMed  Google Scholar 

  19. Sepucha KR, Belkora JK, Chang Y, et al. Measuring decision quality: psychometric evaluation of a new instrument for breast cancer surgery. BMC Med Inform Decis Mak. 2012;12:51.

    Article  Google Scholar 

  20. Chung A, Huynh K, Lawrence C, Sim MS, Giuliano A. Comparison of patient characteristics and outcomes of contralateral prophylactic mastectomy and unilateral total mastectomy in breast cancer patients. Ann Surg Oncol. 2012;19:2600–6.

    Article  PubMed  Google Scholar 

  21. Stucky CC, Gray RJ, Wasif N, Dueck AC, Pockaj BA. Increase in contralateral prophylactic mastectomy: echoes of a bygone era? Surgical trends for unilateral breast cancer. Ann Surg Oncol. 2010;17(Suppl 3):330–7.

    Article  PubMed  Google Scholar 

  22. Howard-McNatt M, Schroll RW, Hurt GJ, Levine EA. Contralateral prophylactic mastectomy in breast cancer patients who test negative for BRCA mutations. Am J Surg. 2011;202:298–302.

    Article  PubMed  Google Scholar 

  23. Yi M, Hunt KK, Arun BK, et al. Factors affecting the decision of breast cancer patients to undergo contralateral prophylactic mastectomy. Cancer Prev Res (Phila). 2010;3:1026–34.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Hawley ST, Jagsi R, Morrow M, et al. Social and clinical determinants of contralateral prophylactic mastectomy. JAMA Surg. 2014;149(6):582–89.

    Article  Google Scholar 

  25. Katz SJ, Lantz PM, Janz NK, et al. Patient involvement in surgery treatment decisions for breast cancer. J Clin Oncol. 2005;23:5526–33.

    Article  PubMed  Google Scholar 

  26. Hawley ST, Griggs JJ, Hamilton AS, et al. Decision involvement and receipt of mastectomy among racially and ethnically diverse breast cancer patients. J Natl Cancer Inst. 2009;101:1337–47.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Zikmund-Fisher BJ, Fagerlin A, Ubel PA. Risky feelings: why a 6% risk of cancer does not always feel like 6%. Patient Educ Couns. 2010;81 Suppl:S87–93.

    Article  Google Scholar 

  28. Katz SJ, Morrow M. Contralateral prophylactic mastectomy for breast cancer: addressing peace of mind. JAMA. 2013;310:793–4.

    Article  CAS  PubMed  Google Scholar 

  29. Rosenberg SM, Tracy MS, Meyer ME, et al. Perceptions, knowledge, and satisfaction with contralateral prophylactic mastectomy among young women with breast cancer: a cross-sectional survey. Ann Intern Med. 2013;159:373–81.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Apicella C, Peacock SJ, Andrews L, Tucker K, Daly MB, Hopper JL. Measuring, and identifying predictors of women’s perceptions of three types of breast cancer risk: population risk, absolute risk and comparative risk. Br J Cancer. 2009;100:583–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  31. Partridge A, Adloff K, Blood E, et al. Risk perceptions and psychosocial outcomes of women with ductal carcinoma in situ: longitudinal results from a cohort study. J Natl Cancer Inst. 2008;100:243–51.

    Article  PubMed  Google Scholar 

  32. Liu Y, Perez M, Schootman M, et al. A longitudinal study of factors associated with perceived risk of recurrence in women with ductal carcinoma in situ and early-stage invasive breast cancer. Breast Cancer Res Treat. 2010;124:835–44.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  33. Beesley H, Holcombe C, Brown SL, Salmon P. Risk, worry and cosmesis in decision-making for contralateral risk-reducing mastectomy: analysis of 60 consecutive cases in a specialist breast unit. Breast. 2013;22:179–84.

    Article  CAS  PubMed  Google Scholar 

  34. Alderman AK, Wilkins EG, Kim HM, Lowery JC. Complications in postmastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg. 2002;109:2265–74.

    Article  PubMed  Google Scholar 

  35. Fischer JP, Nelson JA, Au A, Ct T 3rd, Serletti JM, Wu LC. Complications and morbidity following breast reconstruction: a review of 16,063 cases from the 2005-2010 NSQIP datasets. J Plast Surg Hand Surg. 2013. doi: 10.3109/2000656X.2013.819003.

    Google Scholar 

  36. Sorbero ME, Dick AW, Beckjord EB, Ahrendt G. Diagnostic breast magnetic resonance imaging and contralateral prophylactic mastectomy. Ann Surg Oncol. 2009;16:1597–605.

    Article  PubMed  Google Scholar 

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Acknowledgment

Susan G. Komen (A. Partridge); NIH 5 R25 CA057711 (S. Rosenberg). K. Sepucha receives salary and research support from the Foundation for Informed Medical Decision Making (Foundation), a not-for-profit (501 (c) 3) private foundation (http://www.informedmedicaldecisions.org). The Foundation develops content for patient education programs and has recently merged with Healthwise, another not-for-profit (501 (c) 3).

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Shoshana M. Rosenberg ScD, MPH, Meghan E. Meyer BS, Eric P. Winer MD & Ann H. Partridge MD, MPH

  2. Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Karen Sepucha PhD & Lidia Schapira MD

  3. Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA

    Kathryn J. Ruddy MD, MPH

  4. Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Rulla M. Tamimi ScD

  5. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA

    Shari Gelber MS, MSW

  6. Department of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Steven E. Come MD

  7. Division of Medical Oncology, University of Colorado, Aurora, CO, USA

    Virginia F. Borges MD

  8. Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Mehra Golshan MD

Authors
  1. Shoshana M. Rosenberg ScD, MPH
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  2. Karen Sepucha PhD
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  3. Kathryn J. Ruddy MD, MPH
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  4. Rulla M. Tamimi ScD
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  5. Shari Gelber MS, MSW
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  6. Meghan E. Meyer BS
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  7. Lidia Schapira MD
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  8. Steven E. Come MD
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  11. Eric P. Winer MD
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  12. Ann H. Partridge MD, MPH
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Corresponding author

Correspondence to Ann H. Partridge MD, MPH.

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Rosenberg, S.M., Sepucha, K., Ruddy, K.J. et al. Local Therapy Decision-Making and Contralateral Prophylactic Mastectomy in Young Women with Early-Stage Breast Cancer. Ann Surg Oncol 22, 3809–3815 (2015). https://doi.org/10.1245/s10434-015-4572-6

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  • DOI: https://doi.org/10.1245/s10434-015-4572-6

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