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Surgeons' Perspectives of Contralateral Prophylactic Mastectomy.

Abstract：

BACKGROUND:Contralateral prophylactic mastectomy (CPM) is commonly performed for the treatment of breast cancer, despite its limited oncologic benefit. Little is known about surgeons' perceptions of performing CPM. We hypothesized that a proportion of surgeons would report discomfort with performing CPM, particularly when there is discordance between patients' perceived benefit from CPM and the expected oncologic benefit. METHODS:A survey was sent to members of the American Society of Breast Surgeons seeking self-reports of surgeons' practice patterns, perceptions, and comfort levels with CPM. RESULTS:Of the 2436 members surveyed, 601 responded (response rate = 24.7 %). The median age of respondents was 52 years, and 59 % of responders were women. The majority (58 %) reported that 80 % of their practice was devoted to the treatment of breast disease. Fifty-seven percent (n = 326) of respondents reported discomfort with performing CPM at some point in their practice. While most surgeons (95 %) were comfortable with CPM on a patient with a deleterious BRCA mutation, only 34 % were comfortable performing CPM on an average-risk patient. The most common reasons reported for surgeon discomfort with CPM were a concern for overtreatment, an unfavorable risk/benefit ratio, and inadequate patient understanding of the anticipated risks and benefits of CPM. CONCLUSIONS:Despite the increasing use of CPM for the treatment of breast cancer, many surgeons report discomfort with CPM. Concerns with performing CPM predominantly focus on ambiguities surrounding the oncologic benefit and relative risk of this procedure. Further research is needed to define optimal shared decision-making practices in this area.

journal_name

Ann Surg Oncol

journal_title

Annals of surgical oncology

authors

Bellavance E,Peppercorn J,Kronsberg S,Greenup R,Keune J,Lynch J,Collyar D,Magder L,Tilburt J,Hlubocky F,Yao K

doi

10.1245/s10434-016-5253-9

subject

Has Abstract

pub_date

2016-09-01 00:00:00

pages

2779-87

issue

9

eissn

1068-9265

issn

1534-4681

pii

10.1245/s10434-016-5253-9

journal_volume

23

pub_type

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