User login
Women with breast cancer are much less likely to opt for contralateral prophylactic mastectomies if they know it won’t prolong their lives, according to a survey of 2,402 women with unilateral stage 0-II breast cancer.
Contralateral prophylactic mastectomy (CPM) – removing the healthy breast along with the cancerous one – is on the rise for early-stage, unilateral breast cancer because of “celebrity exposure and publicity,” said investigators led by Reshma Jagsi, MD, of the University of Michigan, Ann Arbor (JAMA Surg. 2016 Dec 21. doi: 10.1001/jamasurg.2016.4749).
CPM might make sense for women at genetic risk for breast cancer, like actress Angelina Jolie – who made headlines in 2013 when she opted for double mastectomy – but the survey found that nearly one in five women with no genetic risks also opted for CPM when their surgeons made no recommendation either way.
When surgeons advised against the procedure, the number fell to about 2%. Meanwhile, many women said their surgeons stayed silent on the issue, which is a problem, according to the investigators.
Overall, about 44% of women in the survey considered CPM, but just 38% of them said they knew that CPM didn’t improve survival for all women with breast cancer.
“Some patients may pursue CPM for cosmetic symmetry or other reasons. However, it is not clear that average-risk patients who choose CPM truly understand that it will not improve their survival or alter recurrence risk,” the investigators noted.
Surgeons’ knowledge and communication practices could be targets for quality improvement interventions, the investigators wrote. “Our findings should motivate surgeons to broach these difficult conversations with their patients, to make their recommendations clear, and to promote patients’ peace of mind by emphasizing how other treatments complement surgery to reduce the risk of both tumor recurrence and subsequent cancer development,” they said.
Women in the study were identified through the Surveillance Epidemiology and End Results (SEER) registries of Los Angeles County and Georgia. They were 62 years old, on average. CPM was associated with younger age, white race, higher educational level, family history, and private insurance.
The National Institutes of Health supported the study. Dr. Jagsi reported having no disclosures. A coauthor reported research funding from Myriad Genetics, Invitae, Ambry Genetics, GeneDx, and Genomic Health.
Although CPM is not associated with improved survival, it reduces the risk of contralateral breast cancer, and the significance of this fact to some patients should not be minimized.
As we move toward an ever-more personalized, patient-centered approach to care, we must thoughtfully weigh the balance between respecting patients’ preferences and leaving them with the long-term consequences associated with an “unnecessary” operation. For many women who choose CPM, the peace of mind associated with a reduced – albeit not eliminated – likelihood of subsequent cancer justifies the additional surgery and the potential attendant complications, even if the avoided cancer might not have actually shortened their lives. Furthermore, concerns about postsurgical cosmesis and symmetry can significantly affect the self-esteem of young women with breast cancer and affect their quality of life as much as, if not more than, concerns surrounding mortality and risk reduction.
Patients should be supported to make their own value-based medical decisions, but the medical community must continue to do its part to educate patients on the negligible benefits of this procedure and help to overcome the fears and misperceptions that often drive this decision.
Oluwadamilola M. Fayanju, MD, and E. Shelley Hwang, MD, are at Duke University in Durham, N.C. Their comments are adapted from an editorial (JAMA Surg. 2016 Dec 21. doi: 10.1001/jamasurg.2016.4750). They reported having no conflicts of interest.
Although CPM is not associated with improved survival, it reduces the risk of contralateral breast cancer, and the significance of this fact to some patients should not be minimized.
As we move toward an ever-more personalized, patient-centered approach to care, we must thoughtfully weigh the balance between respecting patients’ preferences and leaving them with the long-term consequences associated with an “unnecessary” operation. For many women who choose CPM, the peace of mind associated with a reduced – albeit not eliminated – likelihood of subsequent cancer justifies the additional surgery and the potential attendant complications, even if the avoided cancer might not have actually shortened their lives. Furthermore, concerns about postsurgical cosmesis and symmetry can significantly affect the self-esteem of young women with breast cancer and affect their quality of life as much as, if not more than, concerns surrounding mortality and risk reduction.
Patients should be supported to make their own value-based medical decisions, but the medical community must continue to do its part to educate patients on the negligible benefits of this procedure and help to overcome the fears and misperceptions that often drive this decision.
Oluwadamilola M. Fayanju, MD, and E. Shelley Hwang, MD, are at Duke University in Durham, N.C. Their comments are adapted from an editorial (JAMA Surg. 2016 Dec 21. doi: 10.1001/jamasurg.2016.4750). They reported having no conflicts of interest.
Although CPM is not associated with improved survival, it reduces the risk of contralateral breast cancer, and the significance of this fact to some patients should not be minimized.
As we move toward an ever-more personalized, patient-centered approach to care, we must thoughtfully weigh the balance between respecting patients’ preferences and leaving them with the long-term consequences associated with an “unnecessary” operation. For many women who choose CPM, the peace of mind associated with a reduced – albeit not eliminated – likelihood of subsequent cancer justifies the additional surgery and the potential attendant complications, even if the avoided cancer might not have actually shortened their lives. Furthermore, concerns about postsurgical cosmesis and symmetry can significantly affect the self-esteem of young women with breast cancer and affect their quality of life as much as, if not more than, concerns surrounding mortality and risk reduction.
Patients should be supported to make their own value-based medical decisions, but the medical community must continue to do its part to educate patients on the negligible benefits of this procedure and help to overcome the fears and misperceptions that often drive this decision.
Oluwadamilola M. Fayanju, MD, and E. Shelley Hwang, MD, are at Duke University in Durham, N.C. Their comments are adapted from an editorial (JAMA Surg. 2016 Dec 21. doi: 10.1001/jamasurg.2016.4750). They reported having no conflicts of interest.
Women with breast cancer are much less likely to opt for contralateral prophylactic mastectomies if they know it won’t prolong their lives, according to a survey of 2,402 women with unilateral stage 0-II breast cancer.
Contralateral prophylactic mastectomy (CPM) – removing the healthy breast along with the cancerous one – is on the rise for early-stage, unilateral breast cancer because of “celebrity exposure and publicity,” said investigators led by Reshma Jagsi, MD, of the University of Michigan, Ann Arbor (JAMA Surg. 2016 Dec 21. doi: 10.1001/jamasurg.2016.4749).
CPM might make sense for women at genetic risk for breast cancer, like actress Angelina Jolie – who made headlines in 2013 when she opted for double mastectomy – but the survey found that nearly one in five women with no genetic risks also opted for CPM when their surgeons made no recommendation either way.
When surgeons advised against the procedure, the number fell to about 2%. Meanwhile, many women said their surgeons stayed silent on the issue, which is a problem, according to the investigators.
Overall, about 44% of women in the survey considered CPM, but just 38% of them said they knew that CPM didn’t improve survival for all women with breast cancer.
“Some patients may pursue CPM for cosmetic symmetry or other reasons. However, it is not clear that average-risk patients who choose CPM truly understand that it will not improve their survival or alter recurrence risk,” the investigators noted.
Surgeons’ knowledge and communication practices could be targets for quality improvement interventions, the investigators wrote. “Our findings should motivate surgeons to broach these difficult conversations with their patients, to make their recommendations clear, and to promote patients’ peace of mind by emphasizing how other treatments complement surgery to reduce the risk of both tumor recurrence and subsequent cancer development,” they said.
Women in the study were identified through the Surveillance Epidemiology and End Results (SEER) registries of Los Angeles County and Georgia. They were 62 years old, on average. CPM was associated with younger age, white race, higher educational level, family history, and private insurance.
The National Institutes of Health supported the study. Dr. Jagsi reported having no disclosures. A coauthor reported research funding from Myriad Genetics, Invitae, Ambry Genetics, GeneDx, and Genomic Health.
Women with breast cancer are much less likely to opt for contralateral prophylactic mastectomies if they know it won’t prolong their lives, according to a survey of 2,402 women with unilateral stage 0-II breast cancer.
Contralateral prophylactic mastectomy (CPM) – removing the healthy breast along with the cancerous one – is on the rise for early-stage, unilateral breast cancer because of “celebrity exposure and publicity,” said investigators led by Reshma Jagsi, MD, of the University of Michigan, Ann Arbor (JAMA Surg. 2016 Dec 21. doi: 10.1001/jamasurg.2016.4749).
CPM might make sense for women at genetic risk for breast cancer, like actress Angelina Jolie – who made headlines in 2013 when she opted for double mastectomy – but the survey found that nearly one in five women with no genetic risks also opted for CPM when their surgeons made no recommendation either way.
When surgeons advised against the procedure, the number fell to about 2%. Meanwhile, many women said their surgeons stayed silent on the issue, which is a problem, according to the investigators.
Overall, about 44% of women in the survey considered CPM, but just 38% of them said they knew that CPM didn’t improve survival for all women with breast cancer.
“Some patients may pursue CPM for cosmetic symmetry or other reasons. However, it is not clear that average-risk patients who choose CPM truly understand that it will not improve their survival or alter recurrence risk,” the investigators noted.
Surgeons’ knowledge and communication practices could be targets for quality improvement interventions, the investigators wrote. “Our findings should motivate surgeons to broach these difficult conversations with their patients, to make their recommendations clear, and to promote patients’ peace of mind by emphasizing how other treatments complement surgery to reduce the risk of both tumor recurrence and subsequent cancer development,” they said.
Women in the study were identified through the Surveillance Epidemiology and End Results (SEER) registries of Los Angeles County and Georgia. They were 62 years old, on average. CPM was associated with younger age, white race, higher educational level, family history, and private insurance.
The National Institutes of Health supported the study. Dr. Jagsi reported having no disclosures. A coauthor reported research funding from Myriad Genetics, Invitae, Ambry Genetics, GeneDx, and Genomic Health.
FROM JAMA SURGERY
Key clinical point:
Major finding: Overall, about 44% of women in the survey considered CPM, but just 38% of them knew that it did not improve survival.
Data source: Survey of 2,402 women with unilateral stage 0-II breast cancer.
Disclosures: The National Institutes of Health supported the study. One investigator reported research funding from Myriad Genetics, Invitae, Ambry Genetics, GeneDx, and Genomic Health.