A physician’s recommendation against contralateral prophylactic mastectomy (CPM), did not increase the possibility that a patient would seek a second opinion or pursue surgery with a different physician, according to a recent study published in JAMA Surgery investigating the intersection of patients’ desires for effective treatment and physicians’ responsibility to minimize harm.
More women are choosing to have both breasts removed, a complex procedure known as contralateral prophylactic mastectomy, even when breast cancer affects only one breast. “The increased attention to and preference for contralateral prophylactic mastectomy among patients for whom it is not a clinical imperative is a relative recent phenomenon,” explained Stephen J. Katz, MD, MPH, professor of medicine and of health management and policy at the University of Michigan and lead investigator.
A total of 1140 patients who considered undergoing CPM were surveyed about the their initial discussions with their physician regarding the procedure, their satisfaction with their physician’s surgery recommendation, and if they sought a second opinion or another surgeon.
Approximately half of the participants considered CPM, a quarter of whom reported their physicians recommending against the procedure. Another 30% had no discussion about CPM with their physician. Only 4% of patients who discussed CPM, but whose physicians did not recommend the procedure reported dissatisfaction. Dissatisfaction was higher (15%) among those who were recommended against CPM without their physician discussing the procedure. Overall only 7% of participants were dissatisfied with their surgery recommendations. One in 5 women sought a second opinion and only 1 in 10 underwent surgery with another surgeon.
“We hypothesized that patients whose first surgeons recommended against CPM might report less satisfaction and might be more likely to seek second opinions and pursue surgery by a second surgeon,” said Katz. “But in this study, an initial recommendation against CPM had little impact on overall satisfaction with treatment or on decisions to pursue or act on a second opinion.”
1. Katz SJ, Janz NK, Abrahamse P, et al. Patient reactions to surgeon recommendations about contralateral prophylactic mastectomy for treatment of breast cancer [published ahead of print April 5, 2017]. JAMA Surg. doi:10.1001/jamasurg.2017.0458