Surgical decision making for breast cancer: Treatment preferences prior to surgery.

Abstract

71 Background: Contralateral prophylactic mastectomy (CPM) rates are increasing but it is unclear how many patients consider CPM prior to their surgery. Methods: We developed a 55 item survey validated with 20 breast cancer survivors which was administered to newly diagnosed breast cancer patients (n=136) at two institutions prior to surgery to determine factors associated with CPM treatment preference. Results: The median age was 58 years (range 30-85). Eighty-three (69.2%) were White. Thirty-eight (28.6%) of patients had a 1st degree relative with breast cancer. Fifty-three patients (39.8%) thought about their surgery choice prior to getting breast cancer. Seventy-four (57.8%) of patients considered undergoing a CPM during decision making process, 31 (24.2%) did not want/consider CPM and 23 (18.0%) did not think CPM was an option. Of the 74 women who considered CPM, 12 (16%) chose CPM. Nearly 70% of women who considered CPM felt that CPM reduced the chance that cancer would come back vs 43.3% of women who did not want/consider CPM (p=0.02) and 86% of women who considered CPM stated that lumpectomy and mastectomy patients have equivalent survival compared to 100% of patients who did not want/consider CPM (p=0.03). Women who considered CPM were more likely to rate the diagnostic process as very/extremely emotionally difficult (47.3% vs 22.6%, p=0.03) and to state that being diagnosed with breast cancer “sent them into a daze” than those not wanting/considering a CPM (37.5% vs 13.3%, p=0.02). Likewise, women considering CPM had higher rates of anxiety (49.3% vs 12.9%, p<0.001) and depression (19.7% vs 3.2%, p=0.03); were more likely to be very/extremely worried about getting cancer elsewhere in their body (43.8% vs 6.5%, p<0.001) and very/extremely worried about how a spouse/partner would feel about their changed body than those women who did not want/consider CPM (18.5% vs 0%, p=0.03). Women who did not think CPM was an option were older (p=0.02), less educated (p=0.05), more often single (p=0.05). Conclusions: Over 50% of newly diagnosed breast cancer patients consider CPM prior to their surgery. Women considering a CPM had greater worry about recurrence, higher anxiety levels and less knowledge than patients not wanting/considering CPM.