Intentions for bilateral mastectomy among newly diagnosed breast cancer patients

Abstract

Background Recent trends suggest that bilateral mastectomy (BM) is on the rise among women diagnosed with unilateral breast cancer. Few studies have investigated the factors associated with the decision to have more aggressive surgery among young, high risk patients. Methods As part of a larger study, 284 women aged 50 and under completed an initial survey within six weeks of a breast cancer diagnosis. We assessed sociodemographics, medical and family history variables, treatment recommendations, preferences and concerns, distress, perceived risk, knowledge and neuroticism. We used multiple regression with backward entry to assess the relationship between these variables and our outcomes of decisional conflict and intentions for BM. Results Higher decisional conflict was associated with being less educated, unmarried, more anxious and less likely to have received a surgical recommendation. Preference for BM was associated with higher neuroticism, perceived risk for contralateral breast cancer, pre-testing risk of carrying a BRCA1/2 mutation, having received either a surgical recommendation (vs. no recommendation), and lower preference for lumpectomy. Conclusions For younger women, a surgical recommendation is associated with lower decisional conflict and stronger intention for BM. Results highlight the importance of effective risk communication and decision support between a woman and her surgeon.

Measuring decisional certainty among women seeking abortion

“…Levels of decisional uncertainty in this study as measured by the DCS (mean score (µ) = 15.5) were comparable to or lower than those found in other studies of women making healthcare decisions, such as mastectomy after a breast cancer diagnosis (DCS µ = 17.4) [30], prenatal testing after infertility (DCS µ =22.1) [31], or antidepressant use during pregnancy (DCS µ = 26.2) [32]. They are also lower than levels observed in studies of men and women making decisions about reconstructive knee surgery (DCS µ = 37.4-42.7) [33] or men deciding on prostate cancer treatment options (DCS µ=35.7) [34].…”

Exploring patient experiences of neo-adjuvant chemotherapy for breast cancer

“…It has been reported that more women are choosing bilateral mastectomy for unilateral breast cancer (Yao, Stewart, Winchester, Winchester 2010). Preference for bilateral mastectomy in younger women has been associated with higher neuroticism, perceived risk for contralateral breast cancer and lower preference for lumpectomy with neuroticism viewed as an indicator of trait anxiety (King, O'Neill, Spellman, Peshkin, Valdimarsdottir, Willey et al 2013). Hence, it would seem vital to ensure effective communication about risk of recurrence and long term impact of surgical decisions in younger women undergoing neo-adjuvant chemotherapy as surgery approaches.…”

Contralateral prophylactic mastectomy (CPM): A systematic review of patient reported factors and psychological predictors influencing choice and satisfaction

“…Psychological factors predicting choice of CPM included perception of risk [28,30], distress/anxiety [28,30], neuroticism [30], breast cancer knowledge [30], causal beliefs about cancer [31] and worry about BC recurrence [29]. However, only perception of risk was considered repeatedly across studies; the remaining factors were explored within single studies, thus the consistency of findings is unknown.…”

“…Psychological factors considered included perception of risk [28,30], distress/anxiety [28,30], neuroticism [30], breast cancer knowledge [30], causal beliefs about cancer [31] and worry about BC recurrence [29]. Three studies were cross-sectional [28,30,31]: one study [30] surveyed women within 6 weeks of a BC diagnosis whilst two of the studies [28,31] surveyed women after surgery. Only one study [29] employed a longitudinal approach.…”