title: Redefining Risk and Benefit: Understanding the Decision to Undergo Contralateral Prophylactic Mastectomy.
abstract: Rates of contralateral prophylactic mastectomy (CPM) among unilateral breast cancer patients are rapidly increasing; however, there are little data documenting the decision-making process of patients with no known BRCA mutations, who elect this more aggressive treatment. We conducted semistructured interviews with nine newly diagnosed patients who elected CPM over other surgical options. Using grounded theory, we analyzed interview data to identify influential decision-making factors by prevalence and intensity across participants. Decision-making factors included subjective evaluations of risk and benefit, avoidance of future breast cancer surveillance and accompanying worry, and desire to maintain (or improve) breast appearance. Based solely on survival benefit, the decision to undergo CPM might be viewed as unnecessary or even misguided. However, our findings show the importance of psychosocial factors in patients' assessments of risk and benefit, and support the need for additional patient-provider communication regarding these factors.
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA rendlek@pamfri.org.
authors.forename: Katharine A S
authors.initials: KA
authors.lastname: Rendle
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA.
authors.forename: Meghan C
authors.initials: MC
authors.lastname: Halley
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA.
authors.forename: Suepattra G
authors.initials: SG
authors.lastname: May
authors.affiliation: Gordon and Betty Moore Foundation, Palo Alto, California, USA.
authors.forename: Dominick L
authors.initials: DL
authors.lastname: Frosch
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis / Q000523:psychology* / Q000601:surgery; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D010817:Physician-Patient Relations; D000072036:Prophylactic Mastectomy / Q000523:psychology*; D018570:Risk Assessment; D012495:San Francisco; D016387:Women's Health
keywords: cancer, breast; cancer, genetics; cancer, psychosocial aspects; decision making; risk