Breast Cancer Knowledge and Decisions Made for Contralateral Prophylactic Mastectomy: A Survey of Surgeons and Women in the General Population

Abstract

Background: Decisions made to undergo contralateral prophylactic mastectomy (CPM), in women at low risk for bilateral disease, are often attributed to a lack of knowledge. This study examines the role knowledge plays in determining surgical treatment for unilateral breast cancer made by laywomen and surgeons for themselves or loved ones. Methods: Our study cohort had three groups 1) laywomen in the general population 2) breast surgeons and 3) plastic surgeons. Laywomen were recruited using Amazon Mechanical Turk® Crowd Sourcing. Breast and plastic surgeons from 9 states were sent electronic surveys. Demographic and CPM specific information on decisions and knowledge were collected and analyzed. Results: Surveys from 1,333 laywomen, 198 plastic surgeons, and 142 breast surgeons were analyzed. A significantly greater proportion of laywomen in the general population favored CPM (67%) relative to plastic (50%) and breast surgeons (26%), p<0.0001. Breast surgeons who chose CPM were younger (p=0.044) and female (0.012). On assessment of knowledge, 78% of laywomen had a low-level breast cancer knowledge. Laywomen with higher levels of breast cancer knowledge had lower odds of choosing CPM (OR 0.37, 95% CI 0.28-0.49). Conclusion: Fewer women are likely to make decisions in favor of CPM with better breast cancer specific education. A knowledge gap likely explains the lower rates with which surgeons choose CPM for themselves or loved ones, however, some surgeons who were predominantly young and female, favor CPM. Improving patient education on surgical options for breast cancer treatment is critical, with well informed decisions as the goal.

Consumer Awareness and Comfort with Resident-run Cosmetic Clinics: A Crowdsourcing Study

“… Categories were defined using the American Society of Plastic Surgeons’ web page on cosmetic procedures, which was available to respondents during the survey. 20 The categories were as follows: Breast (augmentation, reduction, implants, lifts); Body (tummy tuck, arm lift, thigh lift, body lift, buttock enhancement, body contouring, mommy makeover); Face and Neck (nose surgery, eyelid surgery, chin surgery, ear surgery, brow lift, face lift, neck lift, cheek reduction or enhancement); Fat reduction (liposuction, nonsurgical fat reduction); Noninvasive (Botox, laser hair removal, dermabrasion or microdermabrasion, chemical peel, dermal fillers, skin rejuvenation, spider vein treatment); and Other (not specified above). …”

Contralateral prophylactic mastectomy and implications for breast reconstruction

“…The emotional toll of a breast cancer diagnosis and therapeutic journey each patient is faced with continues to be a key driver toward increasing rates of CPM and is a crucial factor for which clinicians need to be acutely aware when discussing therapeutic options with patients and their families. Evidence strongly suggests that utilization of CPM is largely driven by patient anxiety about the potential for experiencing a subsequent breast cancer diagnosis and a desire for peace of mind (Figure 1) (13)(14)(15)27). In a recent multi-institutional study of young women who underwent CPM, the most highly ranked motivating factor driving the decision to undergo CPM was a desire to minimize risk of a second breast cancer, and nearly all patients surveyed stated that this was a very important factor in their decision to ultimately undergo CPM (28).…”

“…Knowledge about breast cancer also impacts decisions made to pursue CPM or unilateral mastectomy. Women who are less knowledgeable about breast cancer are more likely to be interested in and choose CPM (27,29) perhaps because they are unaware of the increased risk in complications and/or the relatively low risk of developing a contralateral breast cancer and the lack of clear benefit in survival. Additionally, when surgeons educate and recommend against CPM in patients without clinical indications, utilization of CPM is low (15).…”

“…Understanding that patient education regarding overall breast cancer management and specifically CPM is relatively low, and that patient decisions about CPM are largely affected by knowledge of the issue (27), substantial opportunities for patient education exist. These opportunities are prime for clinicians and researchers not only to educate individual patients, but also the public, regarding breast cancer pathology, reconstructive options, and expected outcomes of CPM and breast reconstruction with the goal of optimizing the care we deliver to all patients faced with this complex decision.…”

The changing surgical treatment of breast cancer in the United States: The tipping point

“…It is important to examine the surgeon's perspective of CPM because it can influence a woman's decision regarding surgery . Several studies have shown differences between breast surgeons and plastic surgeons in their attitudes toward CPM . The majority of breast surgeons reported discomfort with a patient's choice of CPM.…”