Why Are More Breast Cancer Patients Choosing Contralateral Prophylactic Mastectomy?

Dr. Sarah Hawley PhD MPH Associate Professor in the Division of General Medicine University of Michigan Research Investigator, Ann Arbor VA Center of Excellence in Health Services Research & DevelopmentMedicalResearch.com Interview with:
Dr. Sarah Hawley PhD MPH
Associate Professor in the Division of General Medicine
University of Michigan
Research Investigator, Ann Arbor VA Center of Excellence in Health Services Research & Development

 

MedicalResearch: What are the main findings of the study?

Dr. Hawley: There are a couple of main findings.

  • First, we found that nearly 20% of women in our population based sample of breast cancer patients reported strongly considering having contralateral prophylactic mastectomy (CPM, which means they had their unaffected breast removed at the same time as the breast with cancer), and about 8% received it. Of those who did receive contralateral prophylactic mastectomy, most (about 70%) did not have a clinical indication for it, which included a positive genetic mutation of BRCA1 or BRCA2 or a strong family history of breast or ovarian cancer.
  • However, most women (90%) who received it reported having a strong amount of worry about the cancer coming back (also called worry about recurrence).
  • We also found that when women had an MRI as part of their diagnostic work-up for breast cancer, they more often received contralateral prophylactic mastectomy than when they did not have an MRI.


MedicalResearch: Were any of the findings unexpected?

Dr. Hawley: We expected to find that many women getting contralateral prophylactic mastectomy would not have clinical indications, because the procedure has been increasing in the US, so this was not really a surprise. We also expected that worry about recurrence would be a factor in these decisions, even though having the unaffected breast removed at the same time as the breast with cancer will not result in improved survival in patients without clinical indications (positive genetic mutation or strong family history.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Hawley: Our study confirms that even among newly diagnosed breast cancer patients without specific risk factors for contralateral cancer, rates of contralateral prophylactic mastectomy continue to be significant. The fact that many women who get contralateral prophylactic mastectomy report having high levels of worry about recurrence, suggests an opportunity for clinicians to help educate patents about the benefit of CPM and the fact that the procedure will not translate to improvements in survival or reduced recurrence risk in MOST women with breast cancer (who do not have a a genetic mutation or a strong family history). Patients should make sure they clearly understand the risks and benefits of the procedure as well. The impact of imaging on treatment outcomes needs to be better understood.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Hawley: Further work is needed to understand factors driving the increasing rate of contralateral prophylactic mastectomy in patients without clinical indications. This trend appears to be largely driven by patients, and more work to understand if there is better education or information that can be given to patients to assist in this decision, and possibly reduce or slow the growth in contralateral prophylactic mastectomy in those without clinical indications, is needed.

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