Exploring Surgeon Variability in Recommendations for Contralateral Prophylactic Mastectomy: What Matters Most?

Area of Science:

• Oncology
• Surgical Oncology
• Breast Surgery

Background:

• The American Society of Breast Surgeons (ASBrS) guidelines emphasize surgeon responsibility in discussing contralateral prophylactic mastectomy (CPM) risks, benefits, and recommendations.
• A survey assessed factors influencing surgeon recommendations for CPM, their confidence levels, and awareness/adoption of ASBrS guidelines.

Purpose of the Study:

• To evaluate factors affecting surgeon recommendations for contralateral prophylactic mastectomy (CPM).
• To assess surgeon confidence in CPM recommendations.
• To determine awareness and adoption rates of ASBrS guidelines among surgeons.

Main Methods:

• A survey was distributed to ASBrS members.
• Vignettes with patient variables (age, stage, receptor status, family history, patient preference) were used.
• Respondents estimated contralateral cancer risk, stated recommendation for CPM, and confidence level.

Main Results:

• Recommendation odds and confidence increased with younger age, higher disease stage, triple-negative/HER2+ status, and family history.
• 51% of surgeons were familiar with guidelines; 38% used them frequently.
• Guideline use did not decrease CPM recommendation rates.

Conclusions:

• Surgeons generally agree on factors influencing CPM recommendations, but individual recommendations and confidence vary.
• While familiar with ASBrS guidelines, most surgeons do not routinely incorporate them into practice.