“I don't want to take chances.”: A qualitative exploration of surgical decision making in young breast cancer survivors

Abstract

Objective: Young women with unilateral breast cancer are increasingly choosing contralateral prophylactic mastectomy (CPM), despite its limited medical benefit for most women. The purpose of this study was to better understand this choice through a qualitative exploration of surgical decision-making in young survivors, including how issues particular to younger women affected their decision and the post-surgical experience. Methods: Women age ≤40 years with stage 0-III breast cancer, 1-3 years from diagnosis who had undergone breast cancer surgery were recruited to participate. Four focus groups were conducted: two with women who had bilateral mastectomy and two with women who kept their contralateral breast. Focus groups were recorded and transcribed with identifiers removed. Emergent themes were identified by thematic content analysis using NVivo 11. Results: Of the twenty participants, median age at diagnosis was 37 years. Emergent themes were categorized into the following domains 1) emotions/feelings surrounding surgery/decision about surgery; 2) factors affecting the decision; 3) communication and interaction with the healthcare team; 4) impact on post-surgical life and recovery; 5) support needs. Young women who chose CPM often were concerned about a future breast event, despite this low risk, suggesting some gain peace of mind by choosing CPM. Young survivors also had many physical and emotional concerns after surgery for which they did not always feel prepared. Conclusions: Informational resources and decision aids may enhance patient-doctor communication and help young survivors better understand risk and manage expectations surrounding short and longer-term physical and emotional effects after surgery.

Resection or Preservation? A Tough Surgical Decision for Chinese Breast Cancer Patients Who Are in Line with Breast Conserving

“…[38] When all the patients around choose mastectomy, they will also be more inclined to choose mastectomy. The cautious character of the Chinese also prompted them to choose mastectomy to reduce the risk of recurrence of breast cancer, they said they do not want to live in the shadow of breast cancer in the future, which is consistent with the results of Rosenberg, S.M., et al [39] Limitations Our research has some limitations. Our participants were mainly from Yangzhou, a third-tier city in China.…”

Acute health-related quality of life outcomes and systemic inflammatory markers following contemporary breast cancer surgery

“…Breastconserving surgery is as efficacious as mastectomy for disease-free survival for early-stage disease [1][2][3][4][5] , with mastectomy only being advised when the patient has a medical condition that precludes radiation therapy, has a hereditary germline mutation that warrants preventive risk reduction surgery, has inflammatory cancer, multifocal/multicentric breast cancers in which breast conservation is not feasible, or a very large tumor where the cosmetic result of limited surgery would not be acceptable. Currently, other factors frequently influence the choice of more extensive surgery; these include the patient's fear of recurrence, perceived survival benefit, media influence, desire to reduce the need for surveillance imaging, and cosmetic considerations 6,7 . The rise in the use of more extensive surgery has been influenced by the availability of newer breast reconstruction techniques, as well as the more widespread use of immediate reconstruction at the time of mastectomy.…”

Current Considerations in Surgical Treatment for Adolescents and Young Women with Breast Cancer

“…Many patients chose mastectomy out of fear of potentially leaving cancer cells behind and the desire to avoid future screening imaging [ 62 ]. The increased piece of mind gained from a mastectomy was similar to the reasons for why patients chose to undergo a CPM [ 62 , 63 , 74 ]. Patients who underwent a mastectomy with reconstruction had better quality of life scores with less stress and anxiety, but endorsed more physical discomfort in the post operative setting [ 64 ].…”