Surgeons' Perspectives of Contralateral Prophylactic Mastectomy.


Journal Article

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Full Text

Duke Authors

Cited Authors

  • Bellavance, E; Peppercorn, J; Kronsberg, S; Greenup, R; Keune, J; Lynch, J; Collyar, D; Magder, L; Tilburt, J; Hlubocky, F; Yao, K

Published Date

  • September 2016

Published In

Volume / Issue

  • 23 / 9

Start / End Page

  • 2779 - 2787

PubMed ID

  • 27169770

Pubmed Central ID

  • 27169770

Electronic International Standard Serial Number (EISSN)

  • 1534-4681

Digital Object Identifier (DOI)

  • 10.1245/s10434-016-5253-9


  • eng

Conference Location

  • United States