Contralateral prophylactic mastectomy decision-making in the population-based iCanCare study of early-stage breast cancer patients.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 177-177
Author(s):  
Reshma Jagsi ◽  
Sarah T. Hawley ◽  
Kent A. Griffith ◽  
Nancy K. Janz ◽  
Allison W. Kurian ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Family History ◽  
Prophylactic Mastectomy ◽  
Early Stage ◽  
Multivariable Analysis ◽  
Contralateral Prophylactic Mastectomy ◽  
Population Based ◽  
Early Stage Breast Cancer ◽  
Increased Risk

177 Background: Contralateral prophylactic mastectomy (CPM) use is increasing in women who are not at increased risk of contralateral cancer development and will experience no survival benefit from the more morbid procedure. Little is known about treatment decision-making or provider interactions. Methods: We surveyed a weighted random sample of newly diagnosed patients with early-stage breast cancer who were treated in 2013-14, identified through the population-based SEER registries of Los Angeles and Georgia about 3 months after surgical treatment, and merged with SEER data (N=2632, RR=70%), to determine receipt of diagnostic tests and factors related to the decision about surgery (including knowledge and perceived physician recommendation). Results: Nearly half of 2,436 respondents with unilateral non-metastatic cancer considered CPM (25% strongly). Only 37% of those who considered CPM knew that it does not improve survival for all women with breast cancer (24% believed it does, 39% didn’t know). Among women receiving CPM, 37% believed it generally improves survival. Ultimately, 1,464 (60%) received BCS and 972 (40%) mastectomy (of whom 438, or 18% overall, received CPM). On multivariable analysis, pts who received CPM were younger, more likely to be white, and more likely to have a family history, private rather than Medicaid insurance, and received MRI. Even among pts without a deleterious genetic mutation or family history in multiple relatives (2,303), 400 (17%) received CPM. CPM was uncommon among pts who reported that their surgeons recommended against it (2.0% [17/832]) but much higher among those who reported no surgeon recommendation regarding CPM (21.3% [229/1,077]), and among those who perceived their surgeons to have recommended it (55.4% [147/265]). Conclusions: Many patients consider CPM, but knowledge is low. Use of CPM is substantial among patients without clinical indications but is low when patients report their surgeon recommended against it. In the context of shared decision-making, surgeon recommendations against CPM might help reduce potential overtreatment.

scholarly journals Local Therapy Decision-Making and Contralateral Prophylactic Mastectomy in Young Women with Early-Stage Breast Cancer

2015 ◽  
Vol 22 (12) ◽  
pp. 3809-3815 ◽  
Author(s):  
Shoshana M. Rosenberg ◽  
Karen Sepucha ◽  
Kathryn J. Ruddy ◽  
Rulla M. Tamimi ◽  
Shari Gelber ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Young Women ◽  
Prophylactic Mastectomy ◽  
Early Stage ◽  
Local Therapy ◽  
Contralateral Prophylactic Mastectomy ◽  
Early Stage Breast Cancer ◽  
Therapy Decision

scholarly journals Contralateral Prophylactic Mastectomy Decisions in a Population-Based Sample of Patients With Early-Stage Breast Cancer

JAMA Surgery ◽  
2017 ◽  
Vol 152 (3) ◽  
pp. 274 ◽  
Author(s):  
Reshma Jagsi ◽  
Sarah T. Hawley ◽  
Kent A. Griffith ◽  
Nancy K. Janz ◽  
Allison W. Kurian ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prophylactic Mastectomy ◽  
Early Stage ◽  
Contralateral Prophylactic Mastectomy ◽  
Population Based ◽  
Early Stage Breast Cancer

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.

Taking control of cancer: Why women are choosing mastectomy.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 108-108
Author(s):  
Andrea Marie Covelli ◽  
Nancy N. Baxter ◽  
Margaret Fitch ◽  
Frances Catriona Wright
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Prophylactic Mastectomy ◽  
Early Stage ◽  
Survival Advantage ◽  
Early Stage Breast Cancer ◽  
Fear Of Recurrence ◽  
Cancer Center ◽  
Structured Interviews ◽  
Extensive Surgery

108 Background: Rates of both unilateral (UM) and contralateral prophylactic mastectomy (CPM) for early stage breast cancer (ESBC) have been increasing since 2003. More extensive surgery is not a benign procedure without the risk of complications. Studies suggest that the increase is due to women choosing UM and CPM; we do not know what factors are influencing the choice for more extensive surgery. Methods: We conducted a qualitative study using grounded theory to identify factors for the choice of mastectomy. Purposive sampling was used to identify women across the Toronto Area (Ontario, Canada), who were suitable candidates for breast conserving surgery (BCS) but underwent UM or CPM. Data were collected through semi-structured interviews. Constant comparative analysis identified key concepts and themes. Results: Data saturation was achieved after 29 in-person interviews. 12 interviewees were treated at academic cancer centers, 6 at an academic non-cancer center and 11 at community centers. 15 women underwent UM; 14 underwent UM+CPM. Median age was 55. ‘Taking control of cancer’ was the dominant theme. Fear of breast cancerwas expressed at diagnosisand remains throughout decision making. Fear translates into the overestimated risk of local recurrenceand contralateral cancer. Despite discussion of the equivalence of BCS and UM, patients chose UM due to fear of recurrence and misperceived survival advantage. Similarly, patients chose CPM to eliminate the risk of contralateral cancer and misperceived survival advantage. Women were actively trying to Control Outcomes, as more surgery was seen as greater control. Conclusions: Women seeking UM and CPM for treatment of their early stage breast cancer manage their fear of cancer by undergoing more extensive surgery which in turn drives mastectomy rates. It is important to understand this process so that we may improve our ability to discuss issues of importance to women and facilitate informed decision-making.

Decision analysis of contralateral prophylactic mastectomy for women with sporadic, unilateral, early-stage breast cancer.

2015 ◽  
Vol 33 (15_suppl) ◽  
pp. e12572-e12572
Author(s):  
Kalatu R Davies ◽  
Abenaa M. Brewster ◽  
Patricia A. Parker ◽  
Isabelle Bedrosian ◽  
Melissa Crosby ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Analysis ◽  
Prophylactic Mastectomy ◽  
Early Stage ◽  
Contralateral Prophylactic Mastectomy ◽  
Early Stage Breast Cancer

Prevalence and predictors of second opinions from medical oncologists for early-stage breast cancer: Results from the iCanCare study.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 185-185
Author(s):  
Allison W. Kurian ◽  
Christopher Ryan Friese ◽  
Irina Bondarenko ◽  
Reshma Jagsi ◽  
Steven J. Katz
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Early Stage ◽  
Multivariable Analysis ◽  
Recurrence Score ◽  
Early Stage Breast Cancer ◽  
Clinical Indication ◽  
P Value ◽  
Medical Oncologists ◽  
Younger Age

185 Background: A second medical oncology opinion (SMO) may facilitate chemotherapy decision-making. However, little is known about the interplay between SMOs, treatment decision-making and chemotherapy use. Methods: We surveyed women newly diagnosed with early-stage invasive breast cancer and treated in 2013-2014 (response rate 70%), accrued approximately 3 months after surgery through 2 population-based SEER registries (Georgia and Los Angeles), about their experiences with medical oncologists, decision-making, and chemotherapy use. We evaluated demographic, clinical and decisional factors associated with SMO using logistic regression, and evaluated the association between SMO and chemotherapy, adjusting for clinical indication for chemotherapy, results of the 21-gene recurrence score assay, and estimated propensity for SMO given patient and tumor-specific characteristics. Results: Among 1182 insured patients who consulted any medical oncologist, 8.7% had SMO and 2.4% received chemotherapy from the SMO provider. On multivariable analysis, predictors of SMO use were younger age (odds ratio, OR 0.97 per year, 95% confidence interval, CI 0.94-0.99), education (college vs. high school graduate, OR 1.88, CI 1.06-3.33), an intermediate 21-gene recurrence score (OR 2.21, CI 1.18-4.16) and a variant of uncertain significance on BRCA1/2 gene testing (OR 5.61, CI 1.22-25.72). Satisfaction with chemotherapy decision-making was high and did not differ between patients who did vs. did not receive SMO (85.3% quite or totally satisfied vs. 86%, p-value 0.85). On multivariable analysis, chemotherapy use did not differ between SMO recipients vs. non-recipients (p-value 0.25). Conclusions: SMO use was low among early-stage breast cancer patients, and was not followed by more or less receipt of chemotherapy. High decision satisfaction regardless of SMO use suggests little unmet demand. Along with younger age and more education, the factor that predicted SMO use was uncertain results of genomic testing. Studies of precision medicine should track patients’ demand for SMO, which may rise with the dissemination of increasingly complex genomic tests. Funding: P01-CA-163233

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