Motivations for contralateral prophylactic mastectomy as a function of socioeconomic status

Abstract

BackgroundDespite no demonstrated survival advantage for women at average risk of breast cancer, rates of contralateral prophylactic mastectomy (CPM) continue to increase. Research reveals women with higher socioeconomic status (SES) are more likely to select CPM. This study examines how indicators of SES, age, and disease severity affect CPM motivations.MethodsPatients (N = 113) who underwent CPM at four Indiana University affiliated hospitals completed telephone interviews in 2013. Participants answered questions about 11 CPM motivations and provided demographic information. Responses to motivation items were factor analyzed, resulting in 4 motivational factors: reducing long-term risk, symmetry, avoiding future medical visits, and avoiding treatments.ResultsAcross demographic differences, reducing long-term risk was the strongest CPM motivation. Lower income predicted stronger motivation to reduce long-term risk and avoid treatment. Older participants were more motivated to avoid treatment; younger and more-educated patients were more concerned about symmetry. Greater severity of diagnosis predicted avoiding treatments.ConclusionsReducing long-term risk is the primary motivation across groups, but there are also notable differences as a function of age, education, income, and disease severity. To stop the trend of increasing CPM, physicians must tailor patient counseling to address motivations that are consistent across patient populations and those that vary between populations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12905-017-0366-2) contains supplementary material, which is available to authorized users.

Reframing the conversation about contralateral prophylactic mastectomy: Preparing women for postsurgical realities

“…Patients equated trauma from hearing they had breast cancer with PTSD and feared that just going for mammograms would trigger similar anguish. Consistent with research showing that misinformation influences women's choices, participants had limited knowledge about the harms of CPM when making their decision …”

“…Participants were women with ESBC at low genetic risk, ranging in age from 22 to 72 (median = 45). Most were Caucasian, young, partnered, well educated, with annual incomes over $100 000, reflecting the demographic of those who have been reported in the literature to most often choose CPM . All but 10 were partnered at the time of surgery.…”

Impact of age, rurality and distance in predicting contralateral prophylactic mastectomy for breast cancer in a Midwestern state: a population-based study

“…They also had higher proportion of CPM use than other women of similar ages treated at those hospitals, implying an intrinsic preference for CPM in this group. Women facing a high travel burden for the level of care they desire may perceive CPM as one way to minimize future need for healthcare utilization, particularly if they are rural or of lower socioeconomic status [16,30].…”

On the Ethical Issues of Bilateral and Contralateral Risk-Reducing Mastectomy

“…This raises the suspicion that the doctrine of informed consent is violated to different degrees, since it is difficult see why women would choose a more invasive and extensive type of surgery in possession of all available information. Even if there is reliable medical evidence that contralateral cancer recurrence is rare, many patients wish to undergo mastectomy because of the fear of recurrence [21]. It seems that even though the patients are generally more conscious and better informed, they do not necessarily favor the medically more supportable options.…”