Surgeons' Perspectives of Contralateral Prophylactic Mastectomy

Area of Science:

• Oncology
• Surgical Practice
• Patient Decision-Making

Background:

• Contralateral prophylactic mastectomy (CPM) is frequently performed for breast cancer treatment.
• The oncologic benefit of CPM is often limited.
• Surgeons' perceptions and comfort levels regarding CPM are not well understood.

Purpose of the Study:

• To investigate surgeons' perceptions and comfort levels with performing CPM.
• To identify factors influencing surgeons' discomfort with CPM.
• To explore the discrepancy between patient-perceived and actual oncologic benefits of CPM.

Main Methods:

• A survey was distributed to members of the American Society of Breast Surgeons.
• The survey collected data on practice patterns, perceptions, and comfort levels with CPM.
• Response rate was 24.7% (601 out of 2436 members).

Main Results:

• 57% of responding surgeons reported discomfort with performing CPM at some point.
• Surgeon comfort was high for BRCA-mutated patients (95%) but low for average-risk patients (34%).
• Key reasons for discomfort included concerns about overtreatment, unfavorable risk/benefit ratios, and inadequate patient understanding.

Conclusions:

• A significant proportion of surgeons experience discomfort with CPM.
• Concerns primarily relate to the ambiguous oncologic benefit and risk-benefit profile of CPM.
• Further research is needed to establish optimal shared decision-making guidelines for CPM.