Differences in physician opinions about controversial issues surrounding contralateral prophylactic mastectomy (CPM): A survey of physicians from accredited breast centers in the United States

Purpose Some women with unilateral ductal carcinoma in situ (DCIS) undergo contralateral prophylactic mastectomy (CPM) to prevent cancer in the opposite breast. The use and trends of CPM for DCIS in the United States have not previously been reported. Methods We used the Surveillance, Epidemiology, and End Results database to analyze the initial treatment (within 6 months) of patients with unilateral DCIS diagnosed from 1998 through 2005. We determined the CPM rate as a proportion of all surgically treated patients and as a proportion of all patients who underwent mastectomy. We compared demographic and tumor variables in women with unilateral DCIS who underwent surgical treatment. Results We identified 51,030 patients with DCIS; 2,072 patients chose CPM. The CPM rate was 4.1% for all surgically treated patients and 13.5% for patients undergoing mastectomy. Among all surgically treated patients (including breast-conserving surgery), the CPM rate increased by 148% from 1998 (2.1%) to 2005 (5.2%). Among patients who underwent mastectomy to treat DCIS (excluding patients undergoing breast-conserving surgery), the CPM rate increased by 188% from 1998 (6.4%) to 2005 (18.4%). Young patient age, white race, recent year of diagnosis, and the presence of lobular carcinoma in situ were significantly associated with higher CPM rates among all surgically treated patients and all patients undergoing mastectomy. Large tumor size and higher grade were significantly associated with increased CPM rates among all surgically treated patients but lower CPM rates among patients undergoing mastectomy. Conclusion The use of CPM for DCIS in the United States markedly increased from 1998 through 2005.

Download Full-text

Increasing Use of Contralateral Prophylactic Mastectomy for Breast Cancer Patients: A Trend Toward More Aggressive Surgical Treatment

Journal of Clinical Oncology ◽

10.1200/jco.2007.12.3141 ◽

2007 ◽

Vol 25 (33) ◽

pp. 5203-5209 ◽

Cited By ~ 449

Author(s):

Todd M. Tuttle ◽

Elizabeth B. Habermann ◽

Erin H. Grund ◽

Todd J. Morris ◽

Beth A. Virnig

Keyword(s):

Breast Cancer ◽

United States ◽

Prophylactic Mastectomy ◽

Contralateral Prophylactic Mastectomy ◽

The United States ◽

Breast Cancer Surgery ◽

Breast Cancer Patients ◽

Unilateral Breast Cancer ◽

Large Tumor ◽

Decision Making Processes

Purpose Many patients with unilateral breast cancer choose contralateral prophylactic mastectomy to prevent cancer in the opposite breast. The purpose of our study was to determine the use and trends of contralateral prophylactic mastectomy in the United States. Patients and Methods We used the Surveillance, Epidemiology and End Results database to review the treatment of patients with unilateral breast cancer diagnosed from 1998 through 2003. We determined the rate of contralateral prophylactic mastectomy as a proportion of all surgically treated patients and as a proportion of all mastectomies. Results We identified 152,755 patients with stage I, II, or III breast cancer; 4,969 patients chose contralateral prophylactic mastectomy. The rate was 3.3% for all surgically treated patients; 7.7%, for patients undergoing mastectomy. The overall rate significantly increased from 1.8% in 1998 to 4.5% in 2003. Likewise, the contralateral prophylactic mastectomy rate for patients undergoing mastectomy significantly increased from 4.2% in 1998 to 11.0% in 2003. These increased rates applied to all cancer stages and continued to the end of our study period. Young patient age, non-Hispanic white race, lobular histology, and previous cancer diagnosis were associated with significantly higher rates. Large tumor size was associated with a higher overall rate, but with a lower rate for patients undergoing mastectomy. Conclusion The use of contralateral prophylactic mastectomy in the United States more than doubled within the recent 6-year period of our study. Prospective studies are needed to understand the decision-making processes that have led to more aggressive breast cancer surgery.

Download Full-text

State Variation in the Receipt of a Contralateral Prophylactic Mastectomy Among Women Who Received a Diagnosis of Invasive Unilateral Early-Stage Breast Cancer in the United States, 2004-2012

JAMA Surgery ◽

10.1001/jamasurg.2017.0115 ◽

2017 ◽

Vol 152 (7) ◽

pp. 648 ◽

Cited By ~ 36

Author(s):

Rebecca Nash ◽

Michael Goodman ◽

Chun Chieh Lin ◽

Rachel A. Freedman ◽

Laura S. Dominici ◽

...

Keyword(s):

Breast Cancer ◽

United States ◽

Prophylactic Mastectomy ◽

Early Stage ◽

Contralateral Prophylactic Mastectomy ◽

The United States ◽

Early Stage Breast Cancer ◽

State Variation

Download Full-text

CONTROVERSIAL ISSUES REGARDING THE EXTENSION OF THE “NEW START” TREATY: CAN THE USA AND RUSSIA PRESERVE EXISTING STRATEGIC ARMS CONTROL?

Srpska politička misao ◽

10.22182/spm.7042020.7 ◽

2021 ◽

Vol 70 (4/2020) ◽

pp. 123-149

Author(s):

Marina Kostic

Keyword(s):

United States ◽

Arms Control ◽

World Order ◽

The United States ◽

Controversial Issues ◽

Strategic Stability ◽

The Usa ◽

Key Issues ◽

Security Challenge ◽

The Cold War

Treaty between the United States of America and the Russian Federation on measures for further reduction and limitation of strategic offensive arms (“New START”) is the last pillar of the arms control regime on which the end of the Cold War and the new world order rested. Its expiration on 5 February 2021 is a top security challenge and indicates a possible new strategic arms race. However, can the United States and Russia still preserve the existing strategic arms control by extending the Treaty for another five years? What are the prospects, the opportunities and obstacles for this extension? What are the most pressing issues USA and Russia face with in order to preserve strategic arms control and are they willing to do so? In order to answer to these research questions author analyses several key issues that are of paramount importance for extension of the New START: nuclear modernization processes, invention of new weapons and emergence of new warfare domains; transparency and verification and broader confidence building measures; missile defence and prompt global strike; tactical nuclear weapons in Europe and Asia; general US-Russia relations which include question of democratic capacity; and broader influence of this Treaty on nuclear non-proliferation regime. By using content and discourse analysis author concludes that, although it is obvious that the extension of the New START would be primarily in favour of Russia and that the USA has not much to gain, the character of strategic stability in the Third Nuclear Age gives reasons to believe that the New START will be extended for another five years.

Download Full-text

Teaching Controversial Issues

10.4018/978-1-7998-8730-0.ch013 ◽

2022 ◽

pp. 252-272

Author(s):

William Paul Bintz

Keyword(s):

United States ◽

Instructional Strategies ◽

Picture Books ◽

The United States ◽

Controversial Issues ◽

High Quality ◽

Related Factors ◽

Award Winning ◽

Research Findings ◽

The Way

This chapter describes recent research findings on homelessness in the United States and its relationship to poverty and other related factors. It also provides an introduction to text clusters, a curricular resource that includes high-quality and award-winning picture books and is anchored in the Way-In and Stay-In books. It continues by presenting a text cluster on the topic of homelessness, along with a variety of research-based instructional strategies that K-8 teachers can use with this text cluster, as well as with other text clusters on controversial issues. It ends with some final thoughts.

Download Full-text

Setting standards and improving the quality of care in breast centers in the United States

Journal of Surgical Oncology ◽

10.1002/jso.20681 ◽

2007 ◽

Vol 96 (5) ◽

pp. 359-360

Author(s):

David P. Winchester

Keyword(s):

United States ◽

Quality Of Care ◽

The United States ◽

Breast Centers

Download Full-text

A misperceived threat: Understanding the increasing mastectomy rates.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.28_suppl.75 ◽

2015 ◽

Vol 33 (28_suppl) ◽

pp. 75-75

Author(s):

Andrea Marie Covelli ◽

Nancy N. Baxter ◽

Margaret Fitch ◽

Frances Catriona Wright

Keyword(s):

Decision Making ◽

Prophylactic Mastectomy ◽

Early Stage ◽

Treatment Options ◽

Contralateral Prophylactic Mastectomy ◽

The United States ◽

Breast Conserving Therapy ◽

Average Risk ◽

Sources Of Information ◽

Structured Interviews

75 Background: Rates of unilateral (UM) and contralateral prophylactic mastectomy (CPM) for early-stage breast cancer (ESBC) have been increasing. Both surgeons’ preference and patients’ choice have been suggested to play a role. Methods: A qualitative study was conducted examining surgeon’s practices and patient’s decision-making during treatment for ESBC. The Health-Belief Model was applied identifying factors influential in the choice for UM+/-CPM. Purposive sampling identified non-high-risk women across Toronto, Canada who were candidates for breast conserving therapy (BCT) but underwent UM+/-CPM. Academic and community breast surgeons from across Ontario, Canada and the United States were also recruited. Data were collected through semi-structured interviews. Constant comparative analysis identified key ideas. Results: 29 patients and 45 surgeons were interviewed. The dominant theme was the ‘misperceived threat of ESBC: an overestimated risk’. Surgeons described the high survivability of ESBC, yet patients greatly overestimated the threat of death from their cancer and strived to eliminate this threat by choosing UM+/-CPM. Surgeons described BCT and UM as equivalent treatment options for ESBC, and recommended BCT. In this average-risk population CPM was discouraged by the surgeons describing no survival advantage; despite this, women requested UM+CPM. Personal cancer experiences with family and friends were extremely influential in women’s request for UM+/-CPM. Previous negative experiences translated into an overestimated risk of recurrence, contralateral cancer, metastasisand subsequent death. Patients’ misperceived the severity of ESBC, and believed that by choosing UM+/-CPM they would live longer. Most women did not perceive any risks of undergoing mastectomy, yet many had ongoing issues with skin sensation, cosmesis and body image. Conclusions: Despite surgeons counseling otherwise, women greatly overestimated the risk of ESBC and misperceived the benefits of mastectomy. As undergoing UM+/-CPM is not without risks, improved discussion of patient sources of information and fears around survival may benefit surgical consultations, facilitating informed decision-making.

Download Full-text