Local Therapy Decision-Making and Contralateral Prophylactic Mastectomy in Young Women with Early-Stage Breast Cancer.
BACKGROUND
Rates of contralateral prophylactic mastectomy (CPM) have increased in the United States, with younger women with breast cancer the most likely to have CPM.


METHODS
As part of an ongoing cohort study of young women diagnosed with breast cancer at age ≤40 years, we conducted multinomial logistic regression of data from 560 women with unilateral Stage I-III disease to identify factors associated with: (1) CPM versus unilateral mastectomy (UM); (2) CPM versus breast-conserving surgery (BCS).


RESULTS
Median age at diagnosis was 37 years; 66 % of women indicated that their doctor said that BCS was an option or was recommended. Of all women, 42.9 % had CPM, 26.8 % UM, and 30.4 % BCS. Among women who said the surgical decision was patient-driven, 59.9 % had CPM, 22.8 % BCS, and 17.3 % UM. Clinical characteristics associated with CPM versus BCS included HER2 positivity, nodal involvement, larger tumor size, lower BMI, parity, and testing positive for a BRCA mutation. Emotional and decisional factors associated with CPM versus UM and BCS included anxiety, less fear of recurrence, and reporting a patient-driven decision. Women who reported a physician-driven decision were less likely to have had CPM than both of the other surgeries, whereas higher confidence with the decision was associated with having CPM versus BCS.


CONCLUSIONS
Many young women with early-stage breast cancer are choosing CPM. The association between CPM and emotional and decisional factors suggest that improved communication together with better psychosocial support may improve the decision-making process.
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
Shoshana M
SM
Rosenberg
Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Karen
K
Sepucha
Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA.
Kathryn J
KJ
Ruddy
Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Rulla M
RM
Tamimi
Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA.
Shari
S
Gelber
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
Meghan E
ME
Meyer
Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Lidia
L
Schapira
Department of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Steven E
SE
Come
Division of Medical Oncology, University of Colorado, Aurora, CO, USA.
Virginia F
VF
Borges
Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Mehra
M
Golshan
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
Eric P
EP
Winer
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. ahpartridge@partners.org.
Ann H
AH
Partridge
D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000209:etiology; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000235:genetics / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery*; D003657:Decision Making; D037001:Directive Counseling; D005239:Fear; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005820:Genetic Testing; D006801:Humans; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental; D009154:Mutation; D009367:Neoplasm Staging; D010298:Parity; D010358:Patient Participation; D065286:Prophylactic Surgical Procedures / Q000523:psychology*; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis; D012008:Recurrence; D047368:Tumor Burden; D055815:Young Adult
D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human