Breast cancer patients' recurrence fear distorted

The majority of women who undergo contralateral prophylactic mastectomy (CPM) do so out of fear that their breast cancer will recur, rather than because they have a clinically high risk for recurrence, indicate US study results.

Indeed, the findings reveal that approximately 70% of the 1446 women in the study who received CPM had a low clinical risk for recurrence, where a likelihood of recurrence is indicated by a family history of the disease (at least two family members) and/or a positive genetic test for the disease.

"Worry about recurrence had a strong influence on receipt of CPM, although this procedure has not been associated with reducing recurrence risk," said Sarah Hawley (University of Michigan Medical School, Ann Arbor) who presented the research at the American Society of Clinical Oncology's Quality Care Symposium in San Diego, California.

"We, as physicians, may not be adequately educating our patients about their risk for recurrent disease," she added in a press statement.

Hawley and colleagues identified women from the 2005-2007 Detroit and Los Angeles Surveillance, Epidemiology, and End Results (SEER) database who had recently been diagnosed with breast cancer, analyzed their surgical treatment decisions, and repeated the survey 4 years later.

The women were categorized as being either "very" or "somewhat/not at all" concerned about recurrence when considering their treatment decision.

Of the women whose breast cancer had not recurred by the 4-year follow up, 35.0% reported having considered CPM, and 7.4% had received it. Among women who had already received a mastectomy for their primary tumor, 53.0% and 19.0% had considered and received CPM, respectively.

The researchers report that 90% of women who underwent CPM reported being "very" worried about recurrence when making their treatment decision, despite approximately 70% of them being clinically at very low risk for recurrence (ie, having no family members affected or no genetic risk).

After adjusting results for race/ethnicity, age, disease stage, and SEER site, the team found that having a family history, a positive genetic test, and being "very" worried about recurrence increased the odds for receiving CPM versus unilateral mastectomy a respective 5.1-, 10.9-, and 2.1-fold.

Hawley believes the study results indicate a need to re-examine how best to communicate and educate patients regarding the decision to undergo prophylactic mastectomy.

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