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ASCO 2015: Patient Misconceptions Persist About Impact of Double Mastectomy on Survival

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Key Points

  • Of the women surveyed who reported considering a double mastectomy, only 37% knew that the more aggressive procedure does not improve survival for women with breast cancer.
  • Within the same survey population, 36% believed it would improve their survival.
  • Surgeon recommendation played a large role in patients' decisions to have a double mastectomy: 4% of women who said their surgeon recommended against double mastectomy had the procedure, but 59% of women who perceived their surgeon to recommend it had double mastectomy.

A University of Michigan survey of women with breast cancer found that nearly half considered having a double mastectomy—but of those who considered it, only 37% knew that the more aggressive procedure does not improve survival for women with breast cancer. Among women who received a double mastectomy, 36% believed it would improve their survival. Studies have shown that for women at average risk of a second cancer, removing the unaffected breast does not meaningfully improve survival.

Survey Results

The study, presented at the 2015 ASCO Annual Meeting in Chicago (Abstract 1011), looked at 1,949 women who had been treated for breast cancer. About 20% of the women surveyed had undergone a contralateral prophylactic mastectomy. Even among patients without a genetic mutation or family history that might put them at risk of developing cancer in the other breast, 19% had elected to undergo a double mastectomy.

“Our finding that so many women are receiving much more extensive surgery than needed to treat their disease is striking. Women diagnosed with breast cancer are naturally eager to do everything in their power to fight the disease. It is up to us, as doctors, to make sure they understand which treatments are really going to do that, and which actions might seem heroic, but are actually not expected to improve the outcomes for a typical woman with early stage breast cancer,” said lead study author Reshma Jagsi, MD, DPhil, Associate Professor of Radiation Oncology at the University of Michigan Medical School

Surgeon recommendations—or perceptions of surgeon recommendations—played a big role. Only 4% of women who said their surgeon recommended against double mastectomy had the procedure. But 59% of women who perceived their surgeon to recommend it had double mastectomy.

“Patients are coming away with perceptions that really require adjustments. Doctors need to address the jaw-dropping gap between knowledge of contralateral prophylactic mastectomy and the perception of what their surgeons are telling them,” said study author Steven J. Katz, MD, MPH, Professor of Internal Medicine at the University of Michigan Medical School and of Health Management and Policy at the University of Michigan School of Public Health.

The study was conducted by the Cancer Surveillance and Outcome Research Team, a multi-institution research group based at the University of Michigan Comprehensive Cancer Center focused on issues related to cancer quality of care.

 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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