Does a Surgeon’s Opinion on Mastectomy Influence the Frequency of Surgery?

Cancer


A new study published in JAMA Surgery looked at whether individual surgeon opinions on mastectomy had a great influence on whether the patient underwent the surgery.

In 2013, Angelina Jolie promoted prophylactic mastectomy, a breast removal surgery to reduce the risk of developing breast cancer. Prophylactic mastectomy in women who carry certain gene mutations, such as BRCA1 and BRCA2, may reduce the risk of developing breast cancer. Nevertheless, approximately one in eight women in the USA will still develop breast cancer in their lifetime. At this point, a mastectomy of the cancerous breast tissue is often recommended. However, the use of contralateral prophylactic mastectomy (CPM), the removal of the healthy breast alongside the cancerous one, is increasing rapidly as well with approximately 20% of breast cancer patients receiving CPM.

There are many pros and cons to receiving CPM. First, CPM can reduce the risk of recurring breast cancer. Secondly, breast cancer patients require annual mammograms to ensure cancer has not returned. CPM reduces the need for imaging. Lastly, many patients opt for CPM for a more symmetrical and cosmetically appealing option. However, costs associated with CPM can be high and CPM is associated with longer operative times, more complications, and longer hospital stays.

Surgeons play an important role in advising newly diagnosed breast cancer patients of their treatment options. Studies have found that almost all patients receive the treatment recommended by their surgeons, and similarly, if their surgeon recommends against CPM, few undergo the procedure. Medical consensus statements say CPM should only be considered in patients at a high risk for a second breast cancer lesion but discouraged in those with average risk. Despite this, only a third of individuals with an average risk reported their surgeon discouraging the procedure.

A new study published in JAMA Surgery assessed the influence of individual surgeons on the receipt of CPM. A total of 5000 women with stages 0 to II breast cancer and 377 surgeons were surveyed following breast cancer surgery. Approximately 28% of these women had a high risk of second primary breast cancer and 16% received CPM. The estimated rate of CPM for surgeons who favoured initial breast conservation was 4% while the rate for surgeons who were not reluctant to perform CPM was 34%.

While there is controversy about whether CPM is necessary for breast cancer patients, rates of CPM have increased over the last decade. This study showed that the attending surgeon exerts a strong influence on the likelihood of a breast cancer patient to receive CPM after a breast cancer diagnosis. These findings suggest we need better ways to communicate with patients about the advantages and disadvantages of extensive surgeries to allow them to make informed decisions free of surgeon bias.

Written by Neeti Vashi, BSc

Reference:

Katz SJ, Hawley ST, Hamilton AS, Ward KC, Morrow M, Jagsi R, Hofer TP. Surgeon Influence on Variation in Receipt of Contralateral Prophylactic Mastectomy For Women With Breast Cancer. JAMA Surg. 2017 Sep 13. doi: 10.1001/jamasurg.2017.3415. [Epub ahead of print] PubMed PMID: 28903158.

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