Who's Deciding? A Study of Patient-Surgeon Discussions About Contralateral Prophylactic Mastectomy

Area of Science:

• Oncology
• Surgical Oncology
• Health Communication

Background:

• Contralateral prophylactic mastectomy (CPM) rates are rising, yet surgeon-patient communication regarding this procedure remains understudied.
• Limited research exists on how CPM discussions influence treatment choices, especially across multiple institutions.

Purpose of the Study:

• To analyze surgeon-patient communication during consultations for early-stage unilateral breast cancer.
• To determine the frequency of Contralateral Prophylactic Mastectomy (CPM) discussions, initiation of the topic, and decision-making processes.

Main Methods:

• Audio recordings of initial surgical consultations for eligible breast cancer patients at three academic centers.
• Qualitative analysis of transcripts to identify themes and patterns in CPM discussions.

Main Results:

• CPM was not mentioned in 14 of 27 consultations.
• Surgeons initiated CPM discussions in 10 of 13 cases where it was mentioned.
• Strong patient preference for CPM led to its selection, while undecided patients followed surgeon recommendations.

Conclusions:

• Surgeon initiation and strong patient preference are critical factors in Contralateral Prophylactic Mastectomy (CPM) decisions.
• Surgeon guidance significantly influences undecided patients, often recommending further testing before a final decision.
• Future research should investigate patient preference formation and optimal communication strategies for CPM discussions.