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Quantitative counseling improved breast cancer risk knowledge but did not affect decisions for contralateral prophylactic mastectomy (CPM). This study highlights the need for better tools to translate risk understanding into surgical choices for breast cancer patients.

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Area of Science:

  • Oncology
  • Genetics
  • Decision Science

Background:

  • Increasing rates of germline genetic testing may influence decisions regarding contralateral prophylactic mastectomy (CPM) in newly diagnosed breast cancer patients.
  • Accurate risk assessment is crucial for informed decision-making in breast cancer management.

Purpose of the Study:

  • To quantify the impact of a personalized contralateral breast cancer (CBC) risk counseling tool incorporating genetic testing results.
  • To evaluate how genetic testing information affects patient understanding of CBC risk and subsequent surgical decisions.

Main Methods:

  • A randomized clinical trial involving patients with unilateral breast cancer undergoing genetic counseling and surgery.
  • Participants were randomized to receive either quantitative counseling using a visual decision support tool with personalized CBC risk estimates or standard counseling.
  • Co-primary end points included CBC risk knowledge and propensity to undergo CPM, assessed before and after counseling. The secondary end point was the CPM rate.

Main Results:

  • Patients receiving quantitative counseling demonstrated more accurate reporting of their CBC risk estimates compared to those receiving standard counseling.
  • Despite improved risk knowledge, the type of counseling did not significantly impact the perception of risk, self-reported propensity for CPM, or actual CPM rates.
  • The study included 346 patients, with demographic data indicating representation across various racial groups and a notable percentage with a first-degree relative with breast cancer.

Conclusions:

  • Quantitative counseling enhances patients' understanding of their calculated CBC risk.
  • Improved risk knowledge alone did not translate into changes in decisions regarding CPM.
  • The developed CBC risk assessment tool is publicly available for use in preoperative discussions to aid shared decision-making.