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Do Women With Breast Cancer Overestimate Their Risk for Cancer in the Unaffected Breast? FREE

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The full report is titled “Perceptions, Knowledge, and Satisfaction With Contralateral Prophylactic Mastectomy Among Young Women With Breast Cancer. A Cross-sectional Survey.” It is in the 17 September 2013 issue of Annals of Internal Medicine (volume 159, pages 373-381). The authors are S.M. Rosenberg, M.S. Tracy, M.E. Meyer, K. Sepucha, S. Gelber, J. Hirshfield-Bartek, S. Troyan, M. Morrow, L. Schapira, S.E. Come, E.P. Winer, and A.H. Partridge.

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Ann Intern Med. 2013;159(6):I-30. doi:10.7326/0003-4819-159-6-201309170-00001
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What is the problem and what is known about it so far?

An increasing number of women who have been diagnosed with early-stage cancer in 1 breast decide to have both that breast and the other, healthy one removed. Removal of the healthy breast is called contralateral prophylactic mastectomy (CPM). The procedure reduces the chance of developing cancer in the unaffected breast, but most women have a low risk for contralateral breast cancer—for example, the risk in women without a cancer-predisposing genetic mutation is 0.5% to 0.75% per year. Also, CPM does not necessarily improve survival or decrease the risk for cancer spread, and it can affect quality of life. Few studies have examined women's decisions about CPM, including how well-informed they were about the procedure when they decided to have it.

Why did the researchers do this particular study?

To better understand how women decide to have CPM.

Who was studied?

The study involved 123 young women from 8 academic and community hospitals in eastern Massachusetts. The women were diagnosed with early-stage cancer in 1 breast only and had both breasts removed (bilateral mastectomy) between September 2006 and November 2010. They were aged 40 years or younger at the time of the breast cancer diagnosis. Twenty-six percent had a first-degree relative and 62% had a second- or third-degree relative who had been diagnosed with breast or ovarian cancer. Approximately one quarter had a BRCA1 or BRCA2 gene mutation.

How was the study done?

The authors sent the women a 23-item survey that included questions related to decision making, knowledge, risk perception, and breast cancer worry.

What did the researchers find?

Most women responded that they had CPM because they wanted to decrease the chance of developing contralateral breast cancer (98%), improve survival (94%), and have peace of mind (95%). The women who had a BRCA1 or BRCA2 mutation more accurately perceived their risk for contralateral breast cancer, whereas those without a known mutation substantially overestimated this risk. Most women (71% to 73%) recognized that CPM probably would not extend survival.

Only one third cited a desire to follow a physician's recommendation as an extremely or very important factor in their decision. Few reported advice from family or friends or abnormal screening test results as important reasons for choosing CPM. Almost all felt that they had enough support and advice to make the choice and felt sure that CPM was the right choice for them. Most (90%) indicated that they would definitely choose CPM if deciding again. However, many felt that outcomes associated with the surgery were worse than they expected, including the number of surgeries or other procedures needed (33%), numbness or tingling in the chest (28%), an altered sense of sexuality (42%), and self-consciousness about appearance (31%).

What were the limitations of the study?

Because the women completed the survey about 2 years after surgery, some may not have accurately recalled the details about how or why they made the decision. They may also have misinterpreted some questions. The findings might not apply to women in other areas of the country or to older women.

What are the implications of the study?

Women choosing CPM may overestimate their actual risk for cancer in the unaffected breast. Some women choose CPM, in part, to live longer even though they know that the procedure will probably not extend survival.





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