Abstract PS9-13: Decision making process and contralateral prophylactic mastectomy
Authors: Alameddine Hala Farouk , Singareeka Akshara , Andersen Clark , Selber Jesse , Brewster Abena , Barcenas Carlos H. , Caudle Abigail , Arun Baru , Ibrahim Nuhad 
Published: February 2021

BACKGROUND The relatively high rate of contralateral prophylactic mastectomy (CPM) among women with early stage unilateral breast cancer has raised concerns particularly with the lack of evidence for a survival benefit related to the CPM and with the low risk of developing contralateral breast cancer among women with early stage breast cancer. Women might be choosing this procedure to ease their fear of recurrence, and by believing that CPM may improve their quality of life; others might be influenced by their partner, physician or media. The purpose of this study was to assess the influence of the partner, physician, or media on the decision making process of women with unilateral breast cancer who decided to undergo CPM. METHODS This is a retrospective study, conducted under MD Anderson Institutional Review Board. Women were identified from an existing cohort of breast cancer patients, age 20-60 years old, who were diagnosed with unilateral breast cancer stage 0 to III, who had no clinical or radiographic evidence of contralateral breast cancer, and who underwent CPM between January of 2010 and December of 2017 at MD Anderson Cancer Center; participants received a link to the quantitative cross-sectional survey using the Red Cap platform, 1341 patients were eligible to participate in the study, of which 397 completed the survey. The survey consisted of 16 questions that were adopted and modified from the Prophylactic Mastectomy Outcomes Study Survey. The survey design provided a numeric description of the factors that are affecting the women decision to undergo CPM; as well as the influence of the partner, physician, or media on the woman’s decision-making process. Exclusion included women who had bilateral breast cancer before undergoing CPM, women who had received any treatment for breast cancer before their initial visit to MD Anderson, women who had bilateral breast cancer before undergoing CPM and patients with incomplete documentation of diagnosis of breast cancer, hormone receptor status or metastatic disease. Incidence of doctor, partner, and media influence were each modeled by logistic regression with adjustment for family history of breast cancer and pathology stage. RESULTS 203/343 (59%) patients reported some doctor influence on the CPM decision. The logistic regression model of the incidence of doctor-influence demonstrated significantly higher overall influence on the CPM decision due to doctors compared to self-determination alone (p=.0006), suggesting that 59% of patients’ decisions were influenced by doctors. 53/189 (28%) patients with partners reported some partner influence on the CPM decision. The logistic regression model of the incidence of partner-influence demonstrated significantly lower overall influence on the CPM decision due to partners compared with self-determination alone (p&lt;.0001,), suggesting that 28% of patients’ decisions were influenced by partners. 36/213 (16%) patients reported some level of media influence on the CPM decision. The logistic regression model of the incidence of media-influence demonstrated significantly lower overall influence on the CPM decision due to media compared with self-determination alone (p&lt;.0001), suggesting that 16% of patients’ decisions were influenced by media.

CONCLUSION Partners, physicians, and media all had significant influence (p &lt; 0.05) on the decision-making process of women with unilateral breast cancer to undergo CPM. It is important for women with unilateral breast cancer to fully understand the benefits versus the adverse effect of CPM and make an informed decision regarding the irreversible surgical procedure. The findings of this study may inform policy by highlighting the need for educational aids, programs, or tools that help women with unilateral breast cancer make informed decisions that are evidence-based regarding the efficacy of CPM.

Citation Format: Hala Farouk Alameddine, Akshara Singareeka, Clark Andersen, Jesse Selber, Abena Brewster, Carlos H. Barcenas, Abigail Caudle, Baru Arun, Nuhad Ibrahim. Decision making process and contralateral prophylactic mastectomy [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-13.