The association between patient attitudes and values and the strength of consideration for contralateral prophylactic mastectomy in a population‐based sample of breast cancer patients

Abstract

Background Little is known about how the individual decision styles and values of breast cancer patients at the time of treatment decision making are associated with consideration of different treatment options, specifically with consideration of contralateral prophylactic mastectomy (CPM). Methods We identified newly diagnosed patients with early-stage breast cancer treated in 2013–14, identified through SEER registries of Los Angeles & Georgia, and surveyed them about 7 months after surgery (N=2578, RR=71%). The primary outcome was consideration of CPM (strong vs. less strong). We assessed the association between patients’ values and decision styles and strong consideration using multivariable logistic regression. Results About one quarter (25%) of women reported strong/very strong consideration of CPM, and another 29% considered it moderately/weakly. Decision styles, including “rational-intuitive” approach to decision making, varied. The factors most valued by women at the time of treatment decision making were: avoiding worry about recurrence (82%), and reducing the need for more surgery (73%). In multivariable analysis, patients who preferred to make their own decisions, those who valued avoiding worry about recurrence, and who valued avoiding radiation significantly (P<0.05) more often strongly considered CPM, while those reported being more “logical” and who valued keeping their breast less often did so. Conclusions Many patients considered CPM, and consideration was associated with both decision style and values. The variability in decision style and values observed in this study suggests that formally evaluating these characteristics at or prior to the initial treatment encounter could provide an opportunity for improving patient clinician discussions.

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

“…The socio‐demographic, clinical, and psychological contributors to CPM have been well established, and prior research has also highlighted the relationship between patient‐driven decision making and CPM . As breast cancer treatment can profoundly impact quality of life, understanding how and why young women make certain decisions about surgery, including undergoing CPM, can have important implications.…”

“…5While CPM reduces the risk of developing a contralateral breast cancer, for most women (eg, those without a BRCA1 or BRCA2 mutation), this risk is relatively low, with the 5-year risk estimated to be <5%.Furthermore, there is no evidence that CPM improves survival 2,3 ; thus, this procedure is of limited medical benefit for most women.The socio-demographic, clinical, and psychological contributors to CPM have been well established, 6-8 and prior research has also highlighted the relationship between patient-driven decision making and CPM. 5,9,10 As breast cancer treatment can profoundly impact quality of life, understanding how and why young women make certain decisions about surgery, including undergoing CPM, can have important implications. Young breast cancer survivors often contend with unique issues due to their life stage, including fertility, breastfeeding, and caring for young children, when making these choices.…”

Second primary breast cancer after unilateral mastectomy alone or with contralateral prophylactic mastectomy

“…Despite these findings, rates of CPM continue to increase 12,13,21‐25 . Although the reasons for this trend are under investigation, 2,5,7,21,22,26‐28 patient anxiety and overestimation of personal contralateral breast cancer risk (CBC) have received substantial attention as a driving force for the increasing utilization of CPM 4,15,21,24,27,29 . Using patient‐directed surveys, one previous study has shown that patients overestimate their risk for CBC, with 10‐year self‐reported risk estimates over 30% 29 .…”

Parental Status in Treatment Decision Making among Women with Nonmetastatic Breast Cancer

“…[13][14][15][16][17] In addition, many women see surgery choices as their own, especially women with dependent children, 18 and considering prophylactic mastectomy is associated with preferences to make one's own treatment decisions. 19 Women's increasing sense of ownership in surgical decision making and a desire to regain a sense of control could be factors in recent trends toward more frequent prophylactic mastectomies. [20][21][22] A limitation of our study is the use of a proxy parental status measure, although our sensitivity analysis suggested that our measure had good sensitivity and specificity.…”