title: Attitudes to contralateral risk reducing mastectomy among breast and plastic surgeons in England.
abstract: BACKGROUND
  Rates of contralateral risk reducing mastectomy (CRRM) are rising despite a paucity of data to support this practice. Surgeons work as part of the multidisciplinary team (MDT). They may counsel women on these requests without the benefit of established guidelines or agreed protocol. This study assessed the practices and perceptions of breast and plastic surgeons in England on CRRM.
  
  
  METHODS
  A postal questionnaire was sent to 455 breast and 364 plastic surgeons practising in England. Basic demographics, trends in CRRM, risk assessment, role of the MDT and knowledge base were assessed.
  
  
  RESULTS
  The response rate among breast surgeons was 48.3% (220/455) and 12.6% (46/364) among plastic surgeons. Nearly half (44%) of the respondents felt there had been an increase in rates of CRRM over the last three years. Seventy-one per cent of those surveyed performed 1-5 CRRMs annually while sixteen per cent did not perform this procedure at all. A third (32%) of respondents correctly quoted their patients an annual risk of 0.5-0.7%. Funding was refused in 4% of cases and 43% of the surgeons felt that in the future they would have to apply to relevant clinical commissioning groups. Over half (58%) of all respondents reported that decisions for CRRM are always discussed in the MDT meeting but 6% stated that these cases are never discussed by the MDT. BRCA mutation was perceived as the main risk factor for contralateral breast cancer by 81% of respondents. Surgeons felt that women requested CRRM mainly to alleviate anxiety. The next most common reasons were carriage of BRCA mutation and a desire to have reconstructions match.
  
  
  CONCLUSIONS
  A wide variation of surgical practices and perceptions exist in assessing women for CRRM. Guidelines to standardise practices are required.
authors.affiliation: Nightingale and Genesis Prevention Centre , Manchester , UK.|University of Manchester , UK.|Queen Elizabeth Hospital , Birmingham , UK.
authors.forename: N N
authors.initials: NN
authors.lastname: Basu
authors.affiliation: Nightingale and Genesis Prevention Centre , Manchester , UK.
authors.forename: S
authors.initials: S
authors.lastname: Littlechild
authors.affiliation: Nightingale and Genesis Prevention Centre , Manchester , UK.
authors.forename: L
authors.initials: L
authors.lastname: Barr
authors.affiliation: University of Manchester , UK.
authors.forename: G L
authors.initials: GL
authors.lastname: Ross
authors.affiliation: Nightingale and Genesis Prevention Centre , Manchester , UK.|University of Manchester , UK.
authors.forename: D G
authors.initials: DG
authors.lastname: Evans
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001940:Breast / Q000601:surgery; D001943:Breast Neoplasms / Q000517:prevention & control / Q000601:surgery; D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008408:Mastectomy / Q000706:statistics & numerical data*; D008875:Middle Aged; D018570:Risk Assessment; D040242:Risk Reduction Behavior; D066231:Surgeons / Q000706:statistics & numerical data*
keywords: Contralateral breast cancer; Multidisciplinary team; Risk reducing mastectomy