'Taking Control of Cancer' Ups Rates of Unilateral, Contralateral Prophylactic Mastectomies

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(ChemotherapyAdvisor) – “Taking control of cancer” emerged as a dominant theme during in-person interviews with women with early-stage breast cancer who were suitable candidates for breast-conserving surgery, but instead underwent unilateral mastectomy or contralateral prophylactic mastectomy.

These results may explain, in part, why rates of both unilateral and contralateral prophylactic mastectomy for early-stage breast cancer have increased over the past decade, noted Andrea Marie Covelli, MD, PhD, of the University of Toronto, Ontario, Canada, during the 2013 Breast Cancer Symposium held in San Francisco, CA.

“More extensive surgery is not a benign procedure without the risk of complications,” the investigators noted.

To determine what factors were influencing the choice for more extensive surgery, Dr. Covelli and colleagues conducted a qualitative study that identified women in the Toronto area who were suitable candidates for breast-conserving surgery but had undergone unilateral mastectomy or contralateral prophylactic mastectomy. Data were collected through semi-structured interviews, and constant comparative analysis was used to identify key concepts and themes.

After 29 in-person interviews, data saturation was achieved, Dr. Covelli reported; 12 were treated at an academic cancer center, six at an academic non-cancer cancer, and 11 at community centers. Median age of the women was 55 years; 15 underwent unilateral mastectomy and 14, unilateral plus contralateral prophylactic mastectomy.

Fear of breast cancer was found to be expressed at diagnosis and remained throughout the decision-making process. “Fear translates into the overestimated risk of local recurrence and contralateral cancer,” she said.

Furthermore, despite discussions of the equivalence of breast-conserving surgery and unilateral mastectomy, “patients chose unilateral mastectomy due to fear of recurrence and misperceived survival advantage. Similarly, patients chose contralateral prophylactic mastectomy to eliminate the risk of contralateral cancer and misperceived survival advantage. Women were actively trying to control outcomes, as more surgery was seen as greater control.”

“Women seeking unilateral mastectomy and contralateral prophylactic mastectomy for treatment of their early-stage breast cancer manage their fear of cancer by undergoing more extensive surgery, which in turn drives mastectomy rates,” Dr. Covelli concluded. “It is important to understand this process so that we may improve our ability to discuss issues of importance to women and facilitate informed decision making.”

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