Disparities in contralateral prophylactic mastectomy use among women with early-stage breast cancer

Abstract

Contralateral prophylactic mastectomy use has increased over the past decades among women with early-stage breast cancer. Racial differences in contralateral prophylactic mastectomy use are well described, but with unclear causes. This study examined contralateral prophylactic mastectomy use among black and white women and the contribution of differences in perceived risk to differences in use. We surveyed women diagnosed with early-stage unilateral breast cancer between ages 41–64 in Pennsylvania and Florida between 2007–2009 to collect data on breast cancer treatment, family history, education, income, insurance, and perceived risk. Clinical factors—age,stage at diagnosis, receptor status—were obtained from cancer registries. The relationships between patient factors and contralateral prophylactic mastectomy were assessed using logistic regression. The interaction between race and contralateral prophylactic mastectomy on the perceived risk of second breast cancers was tested using linear regression. Of 2182 study participants, 18% of whites underwent contralateral prophylactic mastectomy compared with 10% of blacks (p < 0.001). The racial difference remained after adjustment for clinical factors and family history (odds ratio = 2.32, 95% confidence interval 1.76–3.06, p < 0.001). The association between contralateral prophylactic mastectomy and a reduction in the perceived risk of second breast cancers was significantly smaller for blacks than whites. Blacks were less likely than whites to undergo contralateral prophylactic mastectomy even after adjustment for clinical factors. This racial difference in use may relate to the smaller impact of contralateral prophylactic mastectomy on the perceived risk of second breast cancers among blacks than among whites. Future research is needed to understand the overall impact of perceived risk on decisions about contralateral prophylactic mastectomy and how that may explain racial differences in use.

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

“…This finding goes along with previous findings that demonstrated significantly higher CPM rate among patients of female oncology surgeons <50 years old (47%), as compared with male oncology surgeons (23%) even when controlling for male age (19). In addition to young age, white race amongst laywomen was associated with a choice for CPM, also consistent with other studies in the literature that have demonstrated higher rates of CPM in white women with early stage breast cancer (12,(19)(20).…”

“…This goes along with findings from a recent study based on SEER data of women in Los Angeles and Georgia treated for early stage breast cancer (20). With a 17% CPM rate in the study population, only 38% of women who considered CPM knew that CPM does not improve survival for all women with breast cancer (20). It accordingly makes sense that specific level of breast cancer knowledge is likely influential in decisions made for CPM and as such decision aids could play a major role in delivery and processing of this information.…”

“…On assessment of knowledge, laywomen with a high level of breast cancer knowledge had significantly lower odds of choosing CPM in comparison to women with lower levels of knowledge (OR 0.37, 95% CI 0.28-0.49). This goes along with findings from a recent study based on SEER data of women in Los Angeles and Georgia treated for early stage breast cancer (20). With a 17% CPM rate in the study population, only 38% of women who considered CPM knew that CPM does not improve survival for all women with breast cancer (20).…”

Medical oncologists’ willingness to participate in bundled payment programs

“…The physicians included were listed in the American Medical Association Masterfile or were identified by cancer patients who were surveyed as part of a larger study of disparities in genetic testing [ 10 – 12 ]. The states included were chosen for the diversity of their populations as well as the ability to recruit patients directly from the Pennsylvania and Florida state cancer registries of the State Departments of Health.…”

“…Items regarding bundled payment programs were embedded in a larger 17-item survey as part of a study of disparities in genetic testing [ 10 – 12 ]. The survey collected information on provider demographics, as well as the characteristics of providers’ patient panels, including the percentage of patients who are black, as well as the percentage who have no health insurance or are insured by Medicaid.…”