Abstract P2-12-06: Sources of information and influence on decisions regarding contralateral prophylactic mastectomy: A prospective study
Authors: Kulkarni Swati A , Van Haitsma Martha , Wroblewski Kristen , Rabbit Sarah , Yao Kathy 
Published: May 2015

Background: The number of women with a newly diagnosed ipsilateral breast cancer requesting contralateral prophylactic mastectomy (CPM) has increased significantly in recent years. Little is known about the sources of information women utilize as part of their decision making process regarding the choice of CPM.

Methods: A 55-item survey validated with breast cancer survivors was administered to 136 women with newly diagnosed breast cancer before they underwent surgical therapy at two institutions. Women were asked about the influence of medical personnel, individuals outside of medicine, websites and social media on their decision to keep or remove their healthy breast.

Results: The median age was 58 years (range 30-85); 69.2% were White, 26.7% were African American and 4.2% were Asian; Thirty-eight (28.6%) of patients had a first-degree relative with breast cancer. Seventy-five (58.6%) had a lumpectomy, 41 (32%) had a unilateral mastectomy and 12 (9.4%) had a CPM. About 80% of women felt the information they were given about breast cancer treatment was consistent. Fifty-five patients (41.7%) sought out extra information beyond what the doctor gave them. Sources of information that had strong or some influence were websites and books recommended by their doctor (44%), websites, followed books not recommended by their doctor (30.4%), and magazines (15.4%). Only 6.7% said that social media had some or strong influence on their decision making; 61.7% stated that they completely or mostly relied on their doctor’s advice to make treatment decisions and ranked their doctor’s spoken advice (74.3%) as the most important source of information in making their decision to keep or remove their healthy breast. However, Eighty-two women (62.6%) stated that information provided by staff did not include any information about removing the healthy breast. Forty-one (36%) stated that no one discussed contralateral breast cancer risk and 67 women (59%) stated that no one talked with them about the possibility that cancer could turn up somewhere else even if both breasts were removed. Of medical personnel, women stated that their surgeon (81%) had the most influence on their decision, followed by their oncologist (59.1%) and reconstructive surgeon (29.8%). When asked who influenced their decision outside of medicine, 58.7% of women stated that other breast cancer survivors influenced them. Reconstructive surgeons and the spouse/partner had more influence on those &lt;50 years old compared to &gt;50 years old (p=0.03). Oncologists (p=0.004), nurses and trained counselors (p=0.06-0.08), had more of an influence for African Americans compared to Whites.

Conclusions: Many women with newly diagnosed breast cancer do not receive information about CPM, contralateral breast cancer risk or how CPM affects recurrence from their physician. However, women still highly value their doctor’s advice and information provided by their doctor but one third of women state that websites identified on their own strongly influence their decision making for CPM. These findings highlight an opportunity for physicians to educate women about the utility of CPM as part of their surgical treatment.

Citation Format: Swati A Kulkarni, Martha Van Haitsma, Kristen Wroblewski, Sarah Rabbit, Kathy Yao. Sources of information and influence on decisions regarding contralateral prophylactic mastectomy: A prospective study [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-12-06.