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

Abstract

BACKGROUND:

Rates of contralateral prophylactic mastectomy (CPM) have increased in the United States, with younger women with breast cancer the most likely to have CPM.

METHODS:

As part of an ongoing cohort study of young women diagnosed with breast cancer at age ≤40 years, we conducted multinomial logistic regression of data from 560 women with unilateral Stage I-III disease to identify factors associated with: (1) CPM versus unilateral mastectomy (UM); (2) CPM versus breast-conserving surgery (BCS).

RESULTS:

Median age at diagnosis was 37 years; 66 % of women indicated that their doctor said that BCS was an option or was recommended. Of all women, 42.9 % had CPM, 26.8 % UM, and 30.4 % BCS. Among women who said the surgical decision was patient-driven, 59.9 % had CPM, 22.8 % BCS, and 17.3 % UM. Clinical characteristics associated with CPM versus BCS included HER2 positivity, nodal involvement, larger tumor size, lower BMI, parity, and testing positive for a BRCA mutation. Emotional and decisional factors associated with CPM versus UM and BCS included anxiety, less fear of recurrence, and reporting a patient-driven decision. Women who reported a physician-driven decision were less likely to have had CPM than both of the other surgeries, whereas higher confidence with the decision was associated with having CPM versus BCS.

CONCLUSIONS:

Many young women with early-stage breast cancer are choosing CPM. The association between CPM and emotional and decisional factors suggest that improved communication together with better psychosocial support may improve the decision-making process.

• Authors: Shoshana M Rosenberg, Karen Sepucha, Kathryn J Ruddy, Rulla M Tamimi, Shari Gelber, Meghan E Meyer, Lidia Schapira, Steven E Come, Virginia F Borges, Mehra Golshan, Eric P Winer, Ann H Partridge
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 22 Issue 12 Pg. 3809-15 (Nov 2015) ISSN: 1534-4681 [Electronic] United States
• PMID: 25930247 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• ERBB2 protein, human
• Receptor, ErbB-2

Topics

• Adolescent
• Adult
• Anxiety (etiology)
• Body Mass Index
• Breast Neoplasms (genetics, pathology, prevention & control, surgery)
• Decision Making
• Directive Counseling
• Fear
• Female
• Genes, BRCA1
• Genes, BRCA2
• Genetic Testing
• Humans
• Lymphatic Metastasis
• Mastectomy, Segmental
• Mutation
• Neoplasm Staging
• Parity
• Patient Participation
• Prophylactic Surgical Procedures (psychology)
• Receptor, ErbB-2 (analysis)
• Recurrence
• Tumor Burden
• Young Adult