Breast Cancer in Young Women: Decisions that Affect Contralateral Prophylactic Mastectomy

Shoshana M. Rosenberg, ScD, MPH Researcher, Susan F. Smith Center for Women's Cancers Dana-Farber Cancer Interview with:
Shoshana M. Rosenberg, ScD, MPH
Researcher, Susan F. Smith Center for Women’s Cancers
Dana-Farber Cancer Institute What are the main findings of the study?

Answer: Rates of contralateral prophylactic mastectomy (CPM) have been increasing among all breast cancer patients, however this trend has been most pronounced among the youngest women with breast cancer. Because of this trend, we sought to better understand why the youngest women – those diagnosed at age 40 or younger – were deciding to have this surgery.

Many women not considered “high-risk”, e.g., those without a cancer pre-disposing mutation, cited a desire to prevent the breast cancer from spreading as well as a desire to improve survival as reasons for undergoing the procedure, indicating they overestimate the benefit of having this surgery, as CPM does not affect these outcomes. While CPM does reduce the risk of developing breast cancer in the unaffected breast, in women who are not considered “high-risk”, this risk is relatively low, however many women overestimated this risk as well. 
Were any of the findings unexpected?

Answer: One of the interesting findings was that most women understood that survival does not depend on what type of surgery is chosen however many women cited improved survival as a reason to have CPM. We think that anxiety and fear of recurrence is likely leading some women to choose CPM (almost all women also cited peace of mind as a reason to have CPM) despite knowing objectively that it does not improve survival. In future work, we hope to more comprehensively investigate this discordance. What should clinicians and patients take away from your report?

Answer: In addition to more effective risk communication, there is a need to better support women during the decision-making process by addressing anxiety, fears, and concerns, as our findings suggest that under-attention to these important issues might lead women to choose more surgery than is actually needed. What recommendations do you have for future research as a result of this study?

Answer: Correcting misperceptions and misunderstandings is important however our findings suggest that this needs to be done in combination with better psychosocial support during the decision-making process. In addition, women should be informed of the potential that certain health and quality of life outcomes might be adversely impacted. In our study, one-third of women said the number of surgeries needed was worse than they had expected and 42% said their sense of sexuality was worse than expected.


Perceptions, Knowledge, and Satisfaction With Contralateral Prophylactic Mastectomy Among Young Women With Breast Cancer: A Cross-sectional Survey

Shoshana M. Rosenberg, ScD, MPH; Michaela S. Tracy, BA; Meghan E. Meyer, BS; Karen Sepucha, PhD; Shari Gelber, MS, MSW; Judi Hirshfield-Bartek, MS; Susan Troyan, MD; Monica Morrow, MD; Lidia Schapira, MD; Steven E. Come, MD; Eric P. Winer, MD; and Ann H. Partridge, MD, MPH

Ann Intern Med. 2013;159(6):373-381. doi:10.7326/0003-4819-159-6-201309170-00003