Young women with breast cancer often overestimate the odds that cancer will occur in their other, healthy breast, and decide to have the healthy breast surgically removed, a survey conducted by Dana-Farber Cancer Institute investigators indicates. The survey also shows that many patients opt for the procedure -- known as a contralateral prophylactic mastectomy, or CPM -- despite knowing it will be unlikely to improve their chance of survival.
The study, published in the Sept. 17 issue of the Annals of Internal Medicine, shows a certain disconnect between what many patients know on an abstract, intellectual level -- that CPM has little impact on survival rates for most women -- and the choices they make after receiving the anxiety-inducing diagnosis of breast cancer, the authors say.
"An increasing percentage of women treated for early-stage breast cancer are choosing to have CPM," says the study's lead author, Shoshana Rosenberg, ScD, MPH, of the Susan F. Smith Center for Women's Cancers at Dana-Farber. "The trend is particularly notable among younger women."
The survey results, explains Rosenberg, suggest that many patients are going into this decision with an unrealistic sense of the benefits of CPM, and of the risks. "Improving the communication of those risks and benefits -- together with better management of anxiety surrounding diagnosis -- and providing patients with the support they need to make decisions based on solid evidence -- are worthwhile steps," says Rosenberg.
In the survey, researchers canvassed 123 women age 40 or younger who had undergone a bilateral mastectomy -- the removal of both breasts -- despite having cancer in only one breast. Respondents answered questions about their reasons for having the procedure, their knowledge of its risks and benefits, and their satisfaction with the outcome.
Almost all the women said they opted for CPM out of a desire to improve their chances of survival and prevent the cancer from spreading to other parts of the body. At the same time, however, most understood that removing both breasts does not extend survival for women who are free of an inherited genetic predisposition to breast cancer.
To explain this apparent contradiction, the authors write, "Most women acknowledge that CPM does not improve survival, but anxiety and fear of recurrence probably influence them during the decision-making process."