Expert Talks Concerns With Prophylactic Mastectomy

In an interview with CURE, Katz, professor of Medicine and Health Management and policy at the University of Michigan, discussed his study of patient reaction to surgeon recommendations about CPM.
In recent years, more women with breast cancer have been desiring a contralateral prophylactic mastectomy (CPM), though surgical guidelines discourage the procedure for patients without an elevated risk for a second primary breast cancer.
A population-based survey was conducted to examine the association between patient report of surgical recommendation against CPM and to what extent it was discussed with the surgeon. Three outcomes were considered: patient satisfaction with surgery decisions, receipt of a second opinion, and receipt of surgery by a second surgeon.

“Surgeons have been concerned about the rise in the use of this procedure, which is quite morbid—the removal of both breasts. They are not enthusiastic about performing this procedure in the tens of thousands of women who will receive it this year, and they are concerned about how to have this discussion with patients,” said lead author Steven J. Katz, M.D.

Katz says that surgical recommendation against CPM did not seem to push patients to seek a second opinion or to switch surgeons. Although, findings did show that patients were less satisfied with surgical decision if the surgeon who recommended against CPM did not have a substantive discussion about it.

In an interview with CURE, Katz, professor of medicine and health management and policy at the University of Michigan, discussed his study of patient reaction to surgeon recommendations about CPM.

Could you provide some background on the rationale behind the study?

CPM for women with early-stage breast cancer is a major issue that has evolved over the past five to seven years and the number of the women undergoing this most extensive surgical treatment has increased rather dramatically. This is probably related to more attention given to the procedure from famous people who got it, and with more women getting CPM in the community—newly diagnosed patients know of a daughter or mother or friend who have had it and are very happy with the fact that they feel that they are completely free of any future possibility of having the caner. The problem with this mindset is that many women getting CPM are at average risk for a second primary cancer. The risk of developing a secondary breast cancer is so low, given all of the other reasons, that CPM in average-risk women does not confer any benefit with regard to survival or even distant recurrence. Additionally, reconstructive surgery means more days lost at work and long-term quality-of-life issues related to not having the natural breast.

The study that we did was a large survey of patients, shortly after diagnosis, in Georgia and Los Angeles county, and we asked what their surgeons recommended and what their reaction was along three lines: did they get a second opinion, did they go to a different surgeon to get the operation if their first surgeon recommended against it, or did the suggestion affect their satisfaction with overall surgical decision making.

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