Laila Samiian, MD reviewing Jagsi R et al. JAMA Surg 2017 Mar 1.
The surgeon's recommendation for or against CPM can significantly influence a woman's decision about the surgery.

Rates of contralateral prophylactic mastectomy (CPM) are on the rise despite lack of benefit regarding survival or prevention of metastatic recurrence; moreover, 10-year risk for developing a new contralateral breast cancer is very low in the absence of genetic predisposition. To shed light on patients' decision making about CPM, investigators queried a Surveillance, Epidemiology, and End Results (SEER) database of 2402 women (mean age, 62) in Los Angeles County and Georgia who received diagnoses of unilateral early stage breast cancer in 2013 to 2014 and completed surveys about motivation, demographic variables, knowledge of breast cancer, and surgeons' recommendations for or against CPM.

Among respondents, 44% initially considered CPM; of these, only 38% knew that the procedure would not improve survival. Younger, more-educated white women with private insurance and family histories of breast cancer were more likely to undergo CPM; and patients in Georgia were twice as likely as those in Los Angeles County to opt for this surgery. Of 1569 women without known genetic risks, only 39% received recommendations against CPM from their surgeons; 2% still proceeded with CPM. When surgeons made no recommendation for CPM, 19% of low-risk women had the additional surgery.

CITATION(S):

Jagsi R et al. Contralateral prophylactic mastectomy decisions in a population-based sample of patients with early-stage breast cancer. JAMA Surg 2017 Mar 1; 152:274. 

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