Psychosocial factors associated with the uptake of contralateral prophylactic mastectomy among BRCA1/2 mutation noncarriers with newly diagnosed breast cancer

Abstract

Purpose Women who are newly diagnosed with breast cancer may consider contralateral prophylactic mastectomy (CPM) to reduce their future risk of cancer in their unaffected breast. Pre-surgical BRCA1/2 genetic testing can provide valuable risk information to guide this choice. However, little is understood about why BRCA1/2 mutation noncarriers, who are generally not at substantially elevated risk of contralateral disease, select CPM. Methods We examined the uptake of CPM among breast cancer patients identified as BRCA1/2 mutation noncarriers (n=92) as part of a larger prospective study of the impact of pre-surgical BRCA1/2 testing. Data obtained from self-report questionnaires and patient medical records were used to examine associations between theoretically-relevant background and psychosocial factors and BRCA1/2 mutation noncarriers’ decisions to undergo CPM. Results Among BRCA1/2 mutation noncarriers, 25% (n=23) elected to undergo CPM. Psychosocial factors including a self-reported physician recommendation for CPM, greater perceived contralateral breast cancer risk, and greater perceived benefits of CPM were all significantly associated with the uptake of CPM. Conclusions A sizeable minority of BRCA1/2 mutation noncarriers choose to undergo CPM after learning their mutation status through pre-surgical genetic testing. BRCA1/2 mutation noncarriers’ cognitive perceptions and social influences appear to be important in shaping their decisions regarding CPM. This work highlights the importance of several psychosocial factors in influencing patients’ surgical decisions. Future research is needed that examines the formation of BRCA1/2 mutation noncarriers’ beliefs regarding their disease and available treatment options, and that characterizes the physician-patient communication that occurs in this complex decision-making context.

Second primary breast cancer after unilateral mastectomy alone or with contralateral prophylactic mastectomy

“…Despite these findings, rates of CPM continue to increase 12,13,21‐25 . Although the reasons for this trend are under investigation, 2,5,7,21,22,26‐28 patient anxiety and overestimation of personal contralateral breast cancer risk (CBC) have received substantial attention as a driving force for the increasing utilization of CPM 4,15,21,24,27,29 . Using patient‐directed surveys, one previous study has shown that patients overestimate their risk for CBC, with 10‐year self‐reported risk estimates over 30% 29 .…”

Mastectomia Contralateral Profilática (CPM) - quebra de paradigma no tratamento cirúrgico do câncer mamário

“…Com as análises BRCA-1 e BRCA-2 aumentaram as indicações de mastectomia subcutânea bilateral preventiva e mastectomia contralateral profilática (CPM) 2 .…”

The development of a template for psychological assessment of women considering risk‐reducing or contralateral prophylactic mastectomy: A national Delphi consensus study

“…While they are not always necessary nor feasible, psychological consultations are frequently recommended and completed in order to best support decision-making, minimise potential patient regret, and assess suitability and readiness for surgery. [11][12][13][14] Literature suggests that some patients may especially benefit from presurgical assessment, including those with anxiety or other psychological distress, [12][13][14][15] a high perception of cancer risk, 15,16 decisionmaking difficulty, 15 a family member who has experienced BC, 13,15 or perception that others are endorsing patient's surgery uptake. 15,16 Studies suggest that some women may perceive a routine psychological consultation to be appropriate and helpful in consolidating their preferences and assisting with decision-making.…”

“…[11][12][13][14] Literature suggests that some patients may especially benefit from presurgical assessment, including those with anxiety or other psychological distress, [12][13][14][15] a high perception of cancer risk, 15,16 decisionmaking difficulty, 15 a family member who has experienced BC, 13,15 or perception that others are endorsing patient's surgery uptake. 15,16 Studies suggest that some women may perceive a routine psychological consultation to be appropriate and helpful in consolidating their preferences and assisting with decision-making. 12,13 In such consultations, the patients' understanding of the procedure, along with its associated risks and benefits, decision-making preferences, and psychological distress (anxiety and body image), appear key areas to assess, among others.…”