Practitioner Opinion on Contralateral Prophylactic Mastectomy: How Do We Steer a Patient-Driven Discussion?

Area of Science:

• Oncology
• Surgical Oncology
• Patient Decision-Making

Background:

• Contralateral prophylactic mastectomy (CPM) is increasingly performed in women with unilateral breast cancer (BC).
• The American Society of Breast Surgeons advises against CPM for average-risk women.
• Understanding healthcare practitioners' perspectives on CPM is crucial.

Purpose of the Study:

• To assess the needs of breast cancer (BC) health practitioners regarding contralateral prophylactic mastectomy (CPM).
• To gather insights into practitioners' opinions, attitudes, and experiences with CPM discussions.

Main Methods:

• Utilized the Ottawa Decision Support Framework for interview guide development.
• Conducted semistructured interviews with 16 BC practitioners in Ontario, Canada.
• Included oncologic surgeons, reconstructive surgeons, medical oncologists, and nurse navigators.

Main Results:

• Practitioners identified CPM discussions as primarily patient-initiated.
• Most practitioners (13/16) supported patients in decision-making, educating them on the lack of survival benefit.
• Decisional conflict and misaligned expectations were common patient barriers (11/16).
• Practitioners (15/16) highlighted a need for educational materials on CPM risks and benefits.

Conclusions:

• Contralateral prophylactic mastectomy (CPM) in average-risk, unilateral breast cancer (BC) patients is a rising, patient-driven trend.
• Practitioners emphasize the need for improved patient education regarding CPM's risks and lack of survival advantage.
• A dynamic decision aid is needed to facilitate shared decision-making between practitioners and patients regarding CPM.