scholarly journals Discussions about contralateral prophylactic mastectomy among surgical oncology providers and women with sporadic breast cancer: a content analysis

2018 ◽  
Vol 10 (2) ◽  
pp. 347-354 ◽  
Author(s):  
Thomas A D’Agostino ◽  
Abenaa M Brewster ◽  
Susan K Peterson ◽  
Isabelle Bedrosian ◽  
Patricia A Parker
Keyword(s):  
Breast Cancer ◽  
Sporadic Breast Cancer ◽  
Prophylactic Mastectomy ◽  
Early Stage ◽  
Treatment Options ◽  
Treatment Decision ◽  
Contralateral Prophylactic Mastectomy ◽  
Surgical Oncology ◽  
Breast Cancer Patients ◽  
Oncology Providers

Abstract Rates of contralateral prophylactic mastectomy (CPM) have risen substantially, yet little is known about how and to what extent CPM is discussed within surgical oncology visits at the time of treatment decision-making. We examined CPM discussions in naturally occurring interactions between sporadic breast cancer patients and their surgical oncology providers. Women with early-stage unilateral disease were recruited before their first surgical visit and completed brief questionnaires to determine study eligibility and interest in treatment options. After their visits, enrolled patients and their providers completed questionnaires assessing discussion of and interest in CPM. Audio-recorded visits from 36 unique patients were randomly selected, transcribed, and analyzed. A CPM discussion was present in 28 transcripts. Approximately half of CPM discussions were initiated by the patient or the oncology provider. The topic of CPM was most frequently introduced while reviewing available treatment options. Patients were most interested in pursuing CPM to reduce the risk of future breast cancer. Providers most frequently responded by offering information (e.g., about risk of contralateral disease). A high level of agreement was found among patient, provider, and observer ratings of whether or not CPM was discussed. CPM discussions were consistently present within our sample. Results can be used to build providers' skills and bring provider–patient communication more in line with best practices and recommendations from leading professional medical societies.

What surgical oncology providers and women with sporadic breast cancer should not forget in the decision-making about contralateral prophylactic mastectomy

2019 ◽  
Vol 10 (2) ◽  
pp. 364-365
Author(s):  
Gianluca Franceschini ◽  
Alba Di Leone ◽  
Riccardo Masetti
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Sporadic Breast Cancer ◽  
Prophylactic Mastectomy ◽  
Brca Mutation ◽  
Local Treatment ◽  
Contralateral Prophylactic Mastectomy ◽  
Surgical Oncology ◽  
First Choice ◽  
Oncology Providers

Women with sporadic breast cancer should consider unilateral surgery as first choice for local treatment. Contralateral prophylactic mastectomy should be offered to patients with BRCA mutation.

Is There a Bias Against Obese Patients in the Treatment of Breast Cancer?

2020 ◽  
pp. 000313482098487
Author(s):  
Melinda Wang ◽  
Julian Huang ◽  
Anees B. Chagpar
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Prophylactic Mastectomy ◽  
Implicit Bias ◽  
Treatment Decision ◽  
Obese Patients ◽  
Breast Cancers ◽  
Breast Cancer Patients ◽  
Immediate Reconstruction

Background Patient and tumor characteristics often coincide with obesity, potentially affecting treatment decision-making in obese breast cancer patients. Independent of all of these factors, however, it is unclear whether obesity itself impacts the decision to offer patients undergoing mastectomy breast reconstruction, postmastectomy radiation therapy (PMRT), or neoadjuvant chemotherapy. We sought to determine whether implicit bias against obese breast cancer patients undergoing mastectomy plays a role in their treatment. Methods Medical records of breast cancer patients undergoing mastectomy from January 2010 to April 2018 from a single institution were retrospectively reviewed, separated into obese (BMI ≥30) and nonobese (BMI <30) categories, and compared using nonparametric statistical analyses. Results Of 972 patients, 291 (31.2%) were obese. Obese patients were more likely to have node-positive, triple-negative breast cancers ( P = .026) and were also more likely to have other comorbidities such as a history of smoking ( P = .026), hypertension ( P < .001), and diabetes ( P < .001). Receipt of immediate reconstruction and contralateral prophylactic mastectomy did not vary between obese and nonobese patients. While obese patients were more likely to undergo neoadjuvant chemotherapy (26.5% vs. 18.1%, P = .004) and PMRT (33.0% vs. 23.4%, P = .003), this did not remain significant when controlling for comorbidities and clinicopathologic confounders. Conclusion Obese patients present with more aggressive tumors and often have concomitant comorbidities. Independent of these factors, however, differences in the treatment of patients undergoing mastectomy do not seem to be affected by an implicit bias against obese patients.

The impact of breast reconstruction on the decision to undergo contralateral prophylactic mastectomy.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 96-96
Author(s):  
L. J. McGhan ◽  
B. A. Pockaj ◽  
R. J. Gray ◽  
S. P. Bagaria ◽  
S. A. McLaughlin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Multivariate Analysis ◽  
Breast Reconstruction ◽  
Prophylactic Mastectomy ◽  
Contralateral Prophylactic Mastectomy ◽  
Tumor Grade ◽  
Breast Cancer Patients ◽  
Unilateral Breast Cancer ◽  
The Impact ◽  
Implant Reconstruction

96 Background: In the last decade there has been an increase in the incidence of contralateral prophylactic mastectomy (CPM) for unilateral breast cancer. Although many factors have been proposed to explain this trend, the impact of breast reconstruction on the decision to undergo CPM has not been extensively studied. Methods: A retrospective review of breast cancer patients from Surveillance, Epidemiology and End Results (SEER) registry data (2004-2008) was conducted. Characteristics of patients undergoing CPM were evaluated. Results: 71,176 patients with a diagnosis of stage I-III infiltrating ductal or lobular breast cancer underwent mastectomy for their primary lesion. Among these, 10,558 patients (15%) underwent a CPM. A significantly higher proportion of women undergoing CPM had reconstruction performed (44%) than those patients not undergoing CPM (13%), p<0.001. On multivariate analysis (Table), significant variables predicting CPM included age <50 years (OR 10.12), breast reconstruction (OR 3.58), and lobular histology (OR 1.41), all p<0.001. Of the 12,466 patients (18%) who underwent reconstruction, 4,636 (37%) had implant reconstruction, 4,498 (36%) had tissue reconstruction, and 1,122 (9%) had combined tissue/implant reconstruction (no data for 18%). On multivariate analysis, predictors of reconstruction included age <50 years (OR 20.5; CI 18.5-22.7), year of surgery (2008 vs. 2004; OR 1.60; CI 1.49-1.71), low tumor grade (OR 1.19; CI 1.13-1.25) and ER+ status (OR 1.16; 95% CI 1.10-1.23). The use of radiation therapy was associated with a lower likelihood of pursuing reconstruction (OR 0.61; CI 0.58-0.65). Conclusions: Apart from age, the factor most strongly associated with CPM is the decision to have reconstructive surgery performed. This suggests that CPM may not be purely associated with risk-reduction but also with treatment factors such as cosmesis. [Table: see text]

Taking control of cancer: Women’s choice for mastectomy.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 11-11
Author(s):  
Andrea Marie Covelli ◽  
Nancy Baxter ◽  
Margaret Fitch ◽  
Frances Catriona Wright
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Prophylactic Mastectomy ◽  
Early Stage ◽  
Qualitative Interviews ◽  
Contralateral Prophylactic Mastectomy ◽  
Active Role ◽  
Breast Conserving Surgery ◽  
Fear Of Recurrence ◽  
Extensive Surgery

11 Background: Rates of both unilateral (UM) and contralateral prophylactic mastectomy (CPM) for early stage breast cancer (ESBC) have been increasing since 2003. Studies suggest that the increase is due to women playing an active role in decision-making. We do not know what factors are influencing the choice for more extensive surgery. Methods: To identify these factors we completed a multi-method study; conducting a systematic review of quantitative literature and qualitative interviews. Decision-making literature was identified from 5 databases and underwent thematic analysis. Purposive sampling identified women across the Toronto Area (Ontario, Canada), who were suitable candidates for breast conserving surgery (BCS) but underwent UM or CPM. Data saturation was achieved after 29 in-person interviews. Constant comparative analysis identified key concepts and themes. Results: ‘Taking control of cancer’ was the dominant theme. Literature illustrated that patients markedly overestimate risk of local recurrence, contralateral cancer and particularly, mortality. Similarly, interviews revealed that fear of breast cancer was expressed at diagnosis and drives the decision-making process. Despite surgeons discussing survival equivalence of BCS and UM, patients chose UM due to fear of recurrence and an overestimated survival advantage. Similarly, patients chose CPM to eliminate contralateral cancer and a misperceived survival benefit. Women were actively trying to Control Outcomes, as more surgery was believed to offer greater survival and therefore greater control. Conclusions: Both the literature and our interviews have illustrated that women seek UM and CPM for treatment of their ESBC to manage their fear of cancer mortality by undergoing more extensive surgery; this in turn drives mastectomy rates. It is important to understand this process so that we may improve our ability to communicate issues of importance to women and facilitate informed decision-making.

A misperceived threat: Understanding the increasing mastectomy rates.

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.

Contralateral prophylactic mastectomy (CPM) use and utility in New Zealand (NZ) breast cancer patients.

2015 ◽  
Vol 33 (15_suppl) ◽  
pp. e17671-e17671
Author(s):  
Abbey Jebb ◽  
Ian Campbell ◽  
Rachel Shirley ◽  
Mark Barrios ◽  
David James Porter
Keyword(s):  
Breast Cancer ◽  
New Zealand ◽  
Cancer Patients ◽  
Prophylactic Mastectomy ◽  
Contralateral Prophylactic Mastectomy ◽  
Breast Cancer Patients

The predictive potential of the spatial signature of lymphocytes in breast cancer patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 530-530
Author(s):  
Nora Balint-Lahat ◽  
Chen Mayer ◽  
Noa Ben-Baruch ◽  
Ady Yosepovich ◽  
Kira Sacks ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Early Stage ◽  
Principal Component ◽  
Treatment Decision ◽  
High Ratio ◽  
Luminal Breast Cancer ◽  
Breast Cancers ◽  
Breast Cancer Patients ◽  
Validation Set

530 Background: Tumor-infiltrating lymphocytes in breast cancer have emerged as both a prognostic and a potentially predictive immunotherapy biomarker. Advancements in artificial intelligence can extract pathology-based spatial immune fingerprints for use as treatment decision support tools. Methods: We examined 908 primary breast cancer patients with whole slide images (WSI) available from TCGA database. Digital structuring of WSIs included automated detection of lymphocytes, tumor and tumor adjacent stroma, using deep learning-based semantic segmentation. Prognosis was defined as progression free interval (PFI). A Cox Survival analysis was used to detect prognostic spatial features. We used principal component analysis (PCA) to reduce and decorrelate significant features. The resulting PCA features were used to fit the final model. The model was then validated on an independent database of WSI of breast lumpectomies, from two tertiary hospitals in Israel. Results: The analysis included 908 WSI. The average age was 58.4 years old, with a majority of early stage breast cancer (76.7%, stage I and II). The detection performance for tumor area and lymphocytes reached F1 scores of 99% and 97% respectively, in comparison to human annotation. In the Kaplan Meier (KM) analysis of 414 early stage luminal breast cancers, a high number of lymphocyte clusters (LC) and a high ratio between stromal lymphocyte density and tumor lymphocyte density (LD-S/LD-T) were significantly associated with longer PFI (p = 0.005 and p = 0.038, respectively). Based on these features, two continuous PCA features were added to the multivariate model, and remained significantly associated with PFI after adjusting for age (HR = 1.19, 95% CI 1.05-1.35; HR = 1.26 95% CI 1.03-1.55). The validation set was underpowered (n = 79) and data is still being collected. In a preliminary KM analysis of 37 early stage luminal breast cancer cases from the validation set, LD-S/LD-T was significantly associated with longer PFI (p = 0.046). Conclusions: In our study, LC and LD-S/LD-T, presumably surrogate measures of peritumoral lymphocytes, were found significantly associated with longer PFI.

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