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 “There is so much information about breast cancer that it’s easy for
patients to get overwhelmed. Interventions that address patient
anxiety and lack of knowledge are needed to facilitate more informed
decision making for patients,” Dr. Katharine Yao, director of the
breast surgical program at NorthShore University HealthSystem in
Evanston, Illinois, said during a press briefing September 2.
She will present the results September 4 in San Francisco at the
2014 Breast Cancer Symposium.
Previous research has shown that for women with early stage breast
cancer who don't have high-risk genes or a family history of the
disease, removing the healthy breast doesn't afford much of a
survival benefit and may increase complications. (See Reuters Health
stories of May 21, 2014, here: http://reut.rs/1uneGaS; and Aug. 15,
2014, here: http://reut.rs/1AlZUUu.)
Still, among women with cancer in one breast, preventive removal of
the breast on the other side - known as contralateral prophylactic
mastectomy (CPM) - has become more common over the past decade. So
Yao and her colleagues studied factors that might influence a woman
to consider CPM.
They surveyed 150 women newly diagnosed with breast cancer at two
tertiary care hospitals before they had surgery, but after they had
decided whether to have lumpectomy, unilateral mastectomy, or CPM.
The women completed a 55-item questionnaire that gauged their
knowledge about breast cancer survival and recurrence, general
anxiety and depression, and their surgery preferences.
Only eight of the women (5.6 percent) knew nothing about CPM.
Thirty-five women (24.6 percent) said they did not want CPM, while
16 (11.3 percent) did not think CPM was an option. None of the women
in the latter two groups chose CPM.
A majority of the women (58 percent) said they wanted or considered
CPM as soon as they were diagnosed. Of these, almost two-thirds had
a family history of breast cancer, as did half of the women who did
not want CPM.
Women who considered CPM were less knowledgeable about breast
cancer. For example, 68 percent of them incorrectly thought having
both breasts removed would reduce the risk of recurrence, compared
with 47 percent of women who did not want CPM.
Women who considered CPM, versus those who didn't, also believed
their risk of breast cancer was higher than average (24 percent
versus 14 percent), were more likely to be extremely worried about
getting cancer elsewhere in their body (43 percent versus 11
percent), and reported being very/extremely worried about how a
spouse or partner would feel about their changed body (19 percent vs
0 percent).
Interestingly, Yao said, 39 percent of women had thought about their
surgery choice even before being diagnosed with breast cancer.
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In a conference statement, Dr. Julie Margenthaler, of the Washington
University School of Medicine in St. Louis and member of The
American Society of Breast Surgeons, said: “We continue to see
increasing numbers of women newly diagnosed with breast cancer who
choose bilateral mastectomy despite the fact that survival rates are
equivalent between those who undergo lumpectomy with radiation and
mastectomy.
"These data demonstrate that this complex decision is often the
result of higher anxiety levels and worry about recurrence. These
are certainly valid concerns, but as oncologists we need to make
certain that we are educating each patient about her individual risk
for the future.”
Briefing moderator Dr. Harold Burstein, an oncologist at Dana-Farber
Cancer Institute in Boston, said one “striking finding in this study
is that almost all women think about (CPM) in some way or another
once they are diagnosed. The immediate thought for so many women
must be, 'why don't I just have both breasts removed and that will
solve the problem.'"
That's understandable "after a diagnosis like this," he said. “But
what the findings also point to is that those patients who were
tilting toward contralateral mastectomy are more generally anxious
about cancer in general and their own cancer coming back and more
concerned that removing the other breast might somehow be important
for the outcomes from their one already known breast cancer. Those
are knowledge gaps that the medical team . . . can help patients
understand (to) make the best decision for themselves.”
Yao and her colleagues plan to survey the women again down the road
to assess their physical and emotional recovery, anxiety levels and
satisfaction with their surgery decision.
They are also developing interactive decision aids and teaching
materials designed to empower women to talk to their doctors about
their concerns and preferences regarding breast cancer surgery.
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