Attending surgeons can have a strong influence on whether a patient undergoes contralateral prophylactic mastectomy after a diagnosis of breast cancer, according to a study published in the journal JAMA Surgery.
Use of contralateral prophylactic mastectomy (CPM) for the treatment of breast cancer has increased markedly over the last decade in the wake of greater patient awareness of the procedure. Currently, about 20 percent of patients receive CPM, representing about half of those who get any mastectomy. Little is known about the influence of the attending surgeon on variations in receipt of CPM.
Steven J. Katz, M.D., M.P.H., of the University of Michigan, Ann Arbor, and colleagues surveyed 7,810 women with stages 0 to II breast cancer and 488 attending surgeons identified by the patients to quantify the influence of the attending surgeon on rates of CPM and clinician attitudes that explained it. Surveys were sent approximately two months after surgery.
A total of 5,080 women responded to the survey (70 percent response rate), and 377 surgeons responded (77 percent response rate). The researchers found that the individual attending surgeon explained a large amount (20 percent) of the overall variation in CPM use: the estimated rate of CPM was 34 percent for surgeons who least favored initial breast conservation and were least reluctant to perform CPM vs 4 percent for surgeons who most favored initial breast conservation and were most reluctant to perform CPM. One-quarter (25 percent) of the surgeon influence was explained by attending attitudes about initial recommendations for surgery and responses to patient requests for CPM.
The study notes some limitations, including that despite high survey response rates, there was inevitable decay in the sample given the requirement for completed surveys from both the surgeon and the patient.
"Our findings reinforce the need to address better ways to communicate with patients with regard to their beliefs about the benefits of more extensive surgery and their reactions to the management plan including surgeon training and deployment of decision aids," the authors write.
JAMA Surgery, online edition, September 13, 2017