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Understanding patient preferences for contralateral prophylactic mastectomy (CPM) is crucial. Women with cancer prioritized mastectomy type over complication risks, unlike surgeons who focused on surgical safety.

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Area of Science:

  • Oncology
  • Surgical Decision Making
  • Health Economics

Background:

  • Increasing rates of contralateral prophylactic mastectomy (CPM) in unilateral breast cancer patients.
  • Lack of quantitative data on stakeholder preferences for CPM, especially from healthy volunteers.
  • Conjoint analysis as a method to evaluate trade-offs in CPM decision-making.

Purpose of the Study:

  • Quantify stakeholder preferences in the contralateral prophylactic mastectomy (CPM) decision-making process.
  • Identify key factors influencing choices between single (SM) and double mastectomy (DM).
  • Compare preferences across diverse stakeholder groups: healthy volunteers (HV), women with cancer (WwCa), surgical oncologists, and plastic surgeons.

Main Methods:

  • Conjoint analysis simulation exercise administered to 1,244 participants.
  • Survey included varying recurrence rates, complication risks, surveillance needs, and symmetry conditions.
  • Hierarchical Bayesian models used to calculate partworth utilities and importance scores.

Main Results:

  • Top factors for all stakeholders: DM complication rates, surgery type (SM vs. DM), and 10-year contralateral cancer risk.
  • Healthy volunteers and surgeons prioritized minimizing DM complications.
  • Women with cancer preferred bilateral mastectomy (DM) irrespective of complication risks or future cancer probability.

Conclusions:

  • Stakeholder risk tolerance for complications and future cancer episodes varies significantly, particularly for women with cancer.
  • Findings indicate a need for improved patient-provider alignment in CPM discussions.
  • Risk perception shifts post-breast cancer diagnosis necessitate tailored communication strategies.