Reframing the conversation about contralateral prophylactic mastectomy: Preparing women for postsurgical realities

• Published in: Psycho-oncology (Chichester, England) Vol. 28; no. 2; pp. 394 - 400
• Main Authors: Bloom, Diane L., Chapman, Brittany M., Wheeler, Stephanie B., McGuire, Kandace P., Lee, Clara N., Weinfurt, Kevin, Rosenstein, Donald L., Plichta, Jennifer K., Jacobson Vann, Julie C., Hwang, E. Shelley
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-02-2019
• Subjects: Adult; Aged; Breast cancer; breast cancer surgery; Breast Neoplasms - surgery; cancer; Clinical decision making; contralateral prophylactic mastectomy; CPM; Decision Making; Female; Femininity; Frame analysis; Genetic susceptibility; Health Knowledge, Attitudes, Practice; Humans; Intimacy; Mastectomy; Middle Aged; oncology; Patient education; Personal relationships; Physicians; Postoperative period; Prophylactic mastectomy; Prophylactic Surgical Procedures; psychosocial; Qualitative Research; Quality of Life; Risk factors; Risk reduction; Self image; surgery; Women; Womens health; CPM; contralateral prophylactic mastectomy; decision-making; breast cancer; psychosocial; cancer; quality of life; breast cancer surgery; oncology; surgery
• ISSN: 1057-9249; 1099-1611
• DOI: 10.1002/pon.4955

Objective
Women with unilateral, early‐stage breast cancer and low genetic risk are increasingly opting for contralateral prophylactic mastectomy (CPM), a concerning trend because CPM offers few clinical benefits while increasing risks of surgical complications. Few qualitative studies have analyzed factors motivating this irreversible decision. Using qualitative methods, this study sought to understand women's decision making and the impact of CPM on self‐confidence, sense of femininity, sexual intimacy, and peace of mind.
Methods
Women who had CPM within the last 10 years were recruited to participate in the study. We conducted a thematic analysis of the data.
Results
Forty‐five women were interviewed. When making the decision for CPM, most had incomplete knowledge of potential negative outcomes. However, all believed CPM had more benefits than harms and would confer the most peace of mind and the fewest regrets should cancer return. They knew their contralateral breast cancer risk was low but were not persuaded by statistics. They wanted to do everything possible to reduce their risk of another breast cancer, even by a minimal amount, but most reported paying an unexpectedly high price for this small reduction in risk. Nevertheless, 41 of 45 reported that they would make the same decision again.
Conclusions
These findings highlight an opportunity for physicians to reframe the conversation to focus on the patient experience of the tradeoffs of CPM rather than statistical odds of future cancers. Our findings suggest that more data may not dissuade women from CPM but may better prepare them for its outcomes.