title: Surgeons' Perspectives of Contralateral Prophylactic Mastectomy.
abstract: Contralateral prophylactic mastectomy (CPM) is commonly performed for the treatment of breast cancer, despite its limited oncologic benefit. Little is known about surgeons' perceptions of performing CPM. We hypothesized that a proportion of surgeons would report discomfort with performing CPM, particularly when there is discordance between patients' perceived benefit from CPM and the expected oncologic benefit.
  
  
  
  A survey was sent to members of the American Society of Breast Surgeons seeking self-reports of surgeons' practice patterns, perceptions, and comfort levels with CPM.
  
  
  
  Of the 2436 members surveyed, 601 responded (response rate = 24.7 %). The median age of respondents was 52 years, and 59 % of responders were women. The majority (58 %) reported that 80 % of their practice was devoted to the treatment of breast disease. Fifty-seven percent (n = 326) of respondents reported discomfort with performing CPM at some point in their practice. While most surgeons (95 %) were comfortable with CPM on a patient with a deleterious BRCA mutation, only 34 % were comfortable performing CPM on an average-risk patient. The most common reasons reported for surgeon discomfort with CPM were a concern for overtreatment, an unfavorable risk/benefit ratio, and inadequate patient understanding of the anticipated risks and benefits of CPM.
  
  
  
  Despite the increasing use of CPM for the treatment of breast cancer, many surgeons report discomfort with CPM. Concerns with performing CPM predominantly focus on ambiguities surrounding the oncologic benefit and relative risk of this procedure. Further research is needed to define optimal shared decision-making practices in this area.
authors.affiliation: Department of Surgery, University of Maryland, Baltimore, MD, USA. ebellavance@smail.umaryland.edu.
authors.forename: Emily
authors.initials: E
authors.lastname: Bellavance
authors.affiliation: Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Peppercorn
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA.
authors.forename: Shari
authors.initials: S
authors.lastname: Kronsberg
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Greenup
authors.affiliation: Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Keune
authors.affiliation: Veterans Health Administration, Bedford, MA, USA.|RTI International, Research Triangle Park, NC, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Lynch
authors.affiliation: Patient Advocates in Research, Danville, CA, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Collyar
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA.
authors.forename: Laurence
authors.initials: L
authors.lastname: Magder
authors.affiliation: Division of General Internal Medicine and Biomedical Ethics Research Unit and Knowledge & Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jon
authors.initials: J
authors.lastname: Tilburt
authors.affiliation: Department of Medicine, The University of Chicago, Chicago, IL, USA.
authors.forename: Fay
authors.initials: F
authors.lastname: Hlubocky
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Katharine
authors.initials: K
authors.lastname: Yao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D032882:Comprehension; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006801:Humans; D008297:Male; D000069342:Medical Overuse; D008875:Middle Aged; D010361:Patients / Q000523:psychology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D000072036:Prophylactic Mastectomy; D018570:Risk Assessment; D012307:Risk Factors; D000071077:Surgical Oncology; D011795:Surveys and Questionnaires; D000069584:Unilateral Breast Neoplasms / Q000235:genetics / Q000601:surgery*