A multidisciplinary team approach minimises prophylactic mastectomy rates

Area of Science:

• Oncology
• Surgical Oncology
• Decision Sciences

Background:

• Prophylactic mastectomy (PM) is increasingly common but carries risks, especially with reconstruction.
• Contralateral PM offers no survival benefit for sporadic unilateral breast cancer patients.
• Multidisciplinary team (MDT) communication can improve shared decision-making and potentially lower PM rates.

Purpose of the Study:

• To investigate the impact of regional multidisciplinary team (MDT) meetings on prophylactic mastectomy (PM) decision-making.
• To analyze factors influencing PM acceptance and refusal within an MDT setting.

Main Methods:

• Observational study with retrospective review of prospectively recorded MDT meeting records (2011-2014).
• Analysis of 151 patient requests for PM, categorizing decisions as 'accepted', 'declined', or 'pending'.
• Documentation of justifications for both accepted and declined PM requests.

Main Results:

• Approximately 53% of PM requests were accepted, while 32.5% were declined.
• Common reasons for declining PM included low contralateral breast cancer risk versus high systemic relapse risk (45.7%).
• Patient-related factors for decline included changing minds (19.6%), missed appointments (6.5%), medical unfitness for reconstruction (13%), cosmetic concerns (6.5%), and unsubstantiated family history (6.5%).

Conclusions:

• MDT meetings enable thorough cross-specialty review of PM requests.
• These meetings help minimize unnecessary prophylactic mastectomy procedures.
• MDTs ensure PM is performed only when it offers maximum patient benefit.