Contralateral Prophylactic Mastectomy Consensus Statement from the American Society of Breast Surgeons: Additional Considerations and a Framework for Shared Decision Making

Boughey, Judy C.; Attai, Deanna J.; Chen, Steven L.; Cody, Hiram S.; Dietz, Jill R.; Feldman, Sheldon; Greenberg, Caprice C.; Kass, Rena; Landercasper, Jeffrey; Lemaine, Valérie; MacNeill, Fiona; Margenthaler, Julie A.; Song, David H.; Staley, Alicia C; Wilke, Lee G.; Willey, Shawna C.; Yao, Katharine

doi:10.1245/s10434-016-5408-8

Cited by 90 publications

(78 citation statements)

References 40 publications

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“…In contrast, women who were not concerned about cancer recurrence reported that being involved in decision‐making about their care was more important. Overall, women were more likely to choose options in which they were involved in decisions about their care, supporting the calls made by Boughey et al (), Boughey et al () for shared decision‐making in this setting (Boughey et al, ). All respondents indicated that health effects affected their choices, highlighting the importance of providing women with adequate information about the potential health effects associated with the available options for managing the risk of breast cancer recurrence.…”

Section: Discussionsupporting

confidence: 69%

My mind is made up: Cancer concern and women’s preferences for contralateral prophylactic mastectomy

et al. 2019

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The fear of cancer recurrence is cited as a motivator of women's preferences between routine monitoring and contralateral prophylactic mastectomy (CPM) as methods of managing ongoing breast cancer risk. We conducted a discrete choice experiment among a general community sample of women who completed 12 hypothetical choices between routine monitoring and CPM described by aspects of treatment efficacy, safety, cost and involvement in decision‐making. Respondents also completed a modified cancer worry question to assess cancer concern. Approximately 57.5% of 464 women always chose one option, typically routine monitoring. The majority (71.5%) reported being concerned about cancer recurrence when completing choice tasks. Latent class analysis identified three groups: preferred routine monitoring; preferred CPM; and “traders” (willing to swap between options). Among traders, women were less likely to choose an option associated with higher risk of recurrence. Women were more likely to choose options associated with less‐intrusive monitoring methods and where they were involved in decision‐making. Women concerned about cancer recurrence were more likely to choose CPM over monitoring. This study shows that women's preferences about how to manage breast cancer recurrence risk reflect the importance of the associated health effects, experience of care and attitudes to cancer recurrence.

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Section: Discussionsupporting

confidence: 69%

My mind is made up: Cancer concern and women’s preferences for contralateral prophylactic mastectomy

et al. 2019

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“…For many women, the decision to pursue CPM is driven by psychosocial concerns, such as cancer worry, fear of cancer recurrence, and negative body image . Therefore in addition to providing information about the impact of CPM on CBC risk and survival, the oncologist should encourage the patient in our vignette to share her reasons for wanting CPM and should elicit her personal treatment preferences and values . One challenge that oncologists face is that there are minimal prospectively collected data about what women can expect after surgery if they do and do not undergo CPM.…”

Section: Clinical Vignettementioning

confidence: 99%

“…14,15 Therefore in addition to providing information about the impact of CPM on CBC risk and survival, the oncologist should encourage the patient in our vignette to share her reasons for wanting CPM and should elicit her personal treatment preferences and values. 16 One challenge that oncologists face is that there are minimal prospectively collected data about what women can expect after surgery if they do and do not undergo CPM. These data are emerging, and a recent study demonstrated that, although women who had CPM had more presurgical cancer worry, their worry after surgery was similar to the worry of patients who did not undergo CPM.…”

mentioning

confidence: 99%

Who should get a contralateral prophylactic mastectomy for breast cancer?

Bedrosian

Parker

Brewster

2019

Cancer

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“…1 We are concerned, however, that the discussion guide for shared decision making does not achieve the authors' stated goal of considering ''the patient's preferences and values and an informed discussion of the risks and benefits of CPM.'' 2 None of the talking points guide the provider in eliciting a patient's preferences and values. Also, only one talking point includes a potential benefit of CPM (that women who undergo CPM will not need mammograms or routine breast imaging for cancer screening after surgery), whereas the remaining talking points focus on the harms and limitations.…”

mentioning

confidence: 99%

“…This estimate is derived from patients treated decades ago. 2 Some studies found lower rates of regret, 2 and studies of more contemporary patients using the BREAST-Q PRO instrument 14 found that CPM with reconstruction was associated with equal or better breast satisfaction and psychosocial, physical, and sexual wellbeing. [10][11][12] …”

mentioning

confidence: 99%

Commentary on the Consensus Statement of the American Society of Breast Surgeons on Contralateral Prophylactic Mastectomy

Nass

Nekhlyudov

2017

Ann Surg Oncol

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The increasing rate of contralateral prophylactic mastectomy (CPM) led the American Society of Breast Surgeons (ASBrS) to issue an evidence-based consensus statement on CPM, as well as a discussion guide that health care providers can use to facilitate shared decision making with patients considering CPM for unilateral breast cancer. This article suggests several ways to improve the discussion guide by eliciting patient values and preferences and by providing more current, detailed, and balanced information about the potential risks and benefits of CPM.We commend the American Society of Breast Surgeons (ASBrS) for addressing the complex issue of contralateral prophylactic mastectomy (CPM) with a thorough review of the data and a well-balanced consensus statement. 1 We are concerned, however, that the discussion guide for shared decision making does not achieve the authors' stated goal of considering ''the patient's preferences and values and an informed discussion of the risks and benefits of CPM.'' 2 None of the talking points guide the provider in eliciting a patient's preferences and values. Also, only one talking point includes a potential benefit of CPM (that women who undergo CPM will not need mammograms or routine breast imaging for cancer screening after surgery), whereas the remaining talking points focus on the harms and limitations. Overall, the selection and framing of many of the discussion points are intended to discourage CPM (a stated goal) rather than provide a neutral overview of the individualized potential risks and benefits of CPM.Shared decision making has been defined as a collaborative process that allows patients and their health care providers to make well-informed decisions together with the goal of achieving outcomes that matter most to the patient.3 Well-designed patient decision aids have been shown to enhance patient knowledge and improve the quality of these decisions, including decisions about breast cancer surgery.4,5 A systematic Cochrane Review found that compared with standard care, patient decision aids can enhance patient understanding, including substantial improvement of perceived personal risk, and lead to a better match between values and choices, with no or minimal effect on anxiety, depression, regret, consultation length, or health-related quality of life. 6The International Patient Decision Aids Standards (IPDAS) Collaboration has established a framework for improving the content, development, implementation, and evaluation of patient decision aids, including checklists, tools for evaluation, and minimal standards. 7,8 Their framework calls for a systematic development process using up-to-date evidence, balancing presentation of information and options, clarifying values and preferences, and measuring effectiveness.We encourage the ASBrS to facilitate shared decision making by engaging a multidisciplinary group of experts and applying the IPDAS framework to strengthen and evaluate their discussion guide. We also suggest specific ways to improve several poin...

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Contralateral Prophylactic Mastectomy Consensus Statement from the American Society of Breast Surgeons: Additional Considerations and a Framework for Shared Decision Making

Cited by 90 publications

References 40 publications

My mind is made up: Cancer concern and women’s preferences for contralateral prophylactic mastectomy

My mind is made up: Cancer concern and women’s preferences for contralateral prophylactic mastectomy

Who should get a contralateral prophylactic mastectomy for breast cancer?

Commentary on the Consensus Statement of the American Society of Breast Surgeons on Contralateral Prophylactic Mastectomy

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