Prospective study of surgical decision-making processes for contralateral prophylactic mastectomy in women with breast cancer

Objective: We prospectively examined the psychosocial predictors and the decision-making process regarding contralateral prophylactic mastectomy (CPM) among women with sporadic breast cancer. Background: Increasing numbers of women with breast cancer are seeking CPM. Data are limited about the surgical decision-making process and the psychosocial factors that influence interest in CPM. Methods: Women with early-stage unilateral breast cancer (n=117) were recruited before their first surgical visit at MD Anderson and completed questionnaires assessing knowledge of and interest in CPM and associated psychosocial factors. After the appointment, women and their surgeons completed questions about the extent that various surgical options (including CPM) were discussed; also, the women rated their perceived likelihood of having CPM and the surgeons rated the appropriateness of CPM. Results: Before their first visit, 50% of women were moderately to extremely interested in CPMand 12 (10%) of women had CPMat the time of their primary breast cancer surgery. Less knowledge about breast cancer (P=0.02) and greater cancer worry (P=0.03) predicted interest in CPM. Greater cancer worry predicted who had CPM (P=0.02). Interest in CPM before surgical visit and the likelihood of having CPM after the visit differed (P ≤ 0.001). Surgeons' rating of the appropriateness of CPM and the patient's reported likelihood of having CPM were not significantly different (P=0.49). Conclusions: Interest in CPM is common among women with sporadic breast cancer. The informational and emotional aspects of CPMmay affect the decision to have CPM and should be addressed when discussing surgical options.