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Surgeons’ knowledge of contralateral prophylactic mastectomy, breast cancer risk varies
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Nearly 40% of breast surgeons possessed a low level of knowledge about contralateral prophylactic mastectomy, according to a research letter published in JAMA Surgery.
Further, surgeons’ knowledge regarding contralateral breast cancer risk in specific patient subgroups — such as BRCA carriers and those with lobular carcinoma — also varied, according to the researchers.
Katharine Yao
The practice of contralateral prophylactic mastectomy has increased in the last decade; however, little is known about surgeons’ knowledge of contralateral prophylactic mastectomy and breast cancer and how this knowledge informs medical decision making, according to study background.
Katharine Yao, MD, director of the breast surgical program at NorthShore University HealthSystem in Evanston, Ill., and colleagues surmised that surgeon knowledge of contralateral prophylactic mastectomy varied and represented an opportunity for improving education on the topic. Thus, they emailed a survey to 2,436 active members of the American Society of Breast Surgeons between December 2013 and February 2014.
Yao and colleagues received responses from 592 surgeons (24.3%). Of the respondents, 37.5% (n = 224) completed fellowship training, 59.1% (n = 350) worked in private practice and 57.9% (n = 343) dedicated at least 80% of their practice to breast disease.
The survey included five questions:
- What is the 10-year risk for developing breast cancer in a 40-year-old BRCA carrier newly diagnosed with breast cancer?;
- Does contralateral prophylactic mastectomy provide a breast cancer-specific survival benefit for patients with early-stage breast cancer?;
- What is the contralateral breast cancer risk at 10 years for a 40-year-old woman with no additional risk factors?;
- What is the 5-year risk for developing a contralateral breast cancer for an invasive ductal carcinoma patient with no additional risk factors?; and
- In a patient with invasive lobular carcinoma, what risk do you quote of developing a contralateral breast cancer over a 5-year period?
The researchers dichotomized responses into “low” (0-3 correct answers) and “high” (4-5 correct answers) knowledge categories.
Over 60% of respondents (n = 360) were classified as possessing a high level of knowledge regarding contralateral prophylactic mastectomy, whereas 39.2% (n = 232) had a low level of knowledge, as classified by the researchers.
Surgeons surveyed scored 85% or better on questions regarding the survival benefit of contralateral prophylactic mastectomy and the 5- to 10-year risk for contralateral breast cancer in patients without additional risk factors.
However, surgeons averaged lower scores for questions regarding the risk for contralateral breast cancer in women with BRCA mutations (39.9%) or lobular carcinoma (70.6%).
In a univariate analysis, employment at a university or teaching hospital (OR = 1.7; 95% CI, 1.15-2.23), a greater proportion of practice devoted to breast disease (˃ 80% of practice; OR = 2.04; 95% CI, 1.01-4.24), and completion of fellowship training (OR = 1.74; 95% CI, 1.19-2.54) significantly correlated with a high level of knowledge.
Duration of practice and fellowship training remained significant in multivariate analyses.
The researchers acknowledged the study’s low response rate (< 25%) and the narrow focus of the questions asked as study limitations.
“Decision aids or teaching materials that address contralateral prophylactic mastectomy and its utility for a patient with newly diagnosed breast cancer are needed,” Yao and colleagues wrote. “Part of this intervention will have to involve not only educating patients on contralateral prophylactic mastectomy’s risks and benefits, but also teaching surgeons how to effectively counsel patients on contralateral prophylactic mastectomy to ensure informed decision making.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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