Abstract
Background/Aims Women diagnosed with unilateral breast cancer are electing to undergo contralateral prophylactic mastectomy (CPM)—or removal of the healthy breast—at rapidly increasing rates worldwide. CPM significantly reduces the risk of recurrence of contralateral breast cancer; however, it is also believed to be unnecessary for most patients due to the relatively low risk of contralateral breast cancer, and the effectiveness of less invasive treatment options. Additionally, since the risk of systemic metastases often exceeds the risk of contralateral breast cancer, most patients will not receive any survival benefit. As such, there is a growing need to understand why patients are electing to have CPM. Drawing from prospective, in-depth interviews with breast cancer patients, we explore how women are making this decision and investigate what factors beyond risk reduction may be impacting their decision.
Methods Participants were recruited from a multispecialty clinic in Northern California. Participants were interviewed at four time points during their treatment journey. Medical records for each participant were reviewed to confirm therapies received. Analysis of interview transcripts used grounded theory to identify emergent decision-making factors across participants.
Results Of the 41 patients enrolled in the study, 11 (27%) women elected to have CPM. The majority of these women underwent BCRA testing (9 or 82%), but only two women received a positive result. Influential factors identified across participants were: 1) desire to reduce or avoid breast cancer treatment; 2) having a close relationship with someone who died from breast cancer; 3) wanting to maintain (or improve) breast appearance; and 4) receiving imaging results that showed “suspicious” but ultimately benign changes in their healthy breast.
Conclusions The decision to undergo CPM is impacted by a variety of factors including, but not limited to, risk reduction. Moreover, perceptions of risk are entangled with individual experiences prior to and during treatment, which may influence the ways patients understand risk as both a concept and a decision-making factor. Further investigation of the impact of both risk comprehension and perceived benefits of CPM—most notably reconstruction—on decision-making is needed to understand why women are electing to undergo this invasive and potentially medically unnecessary procedure.
