Surgeons Have Major Influence on Breast Cancer Treatment

Excerpt:

“A woman’s choice of surgeon plays a significant role in whether she’s likely to receive an increasingly popular aggressive breast cancer surgery.

“The procedure, called contralateral prophylactic mastectomy or CPM, involves removing both breasts even when  is found only in one. It is seen to be strongly driven by ‘ preferences.

“A new study, published in JAMA Surgery, finds that surgeons had the strongest influence on the likelihood of a woman having CPM.”

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How Decision-Making Habits Influence the Breast Cancer Treatments Women Consider

Excerpt:

“A new study finds that more than half of women with early stage breast cancer considered an aggressive type of surgery to remove both breasts. The way women generally approach big decisions, combined with their values, impacts what breast cancer treatment they consider, the study also found.

“Contralateral prophylactic  – a procedure to remove both breasts when  occurs in only one breast – has become increasingly popular in recent years, with more than 20 percent of  opting for it. For most women, removing the unaffected breast does not improve survival.”

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When the Doctor Recommends Against the Surgery a Breast Cancer Patient Wants

Excerpt:

“More women with breast cancer are electing to have both breasts removed, even when cancer affects only one breast. The procedure, called contralateral prophylactic mastectomy (CPM), is a more complex surgery that has not been shown to improve survival.

“A new study from the University of Michigan Comprehensive Cancer Center examines the complex interaction between patients’ desires for the most extensive and surgeons’ responsibility to minimize harm.

“The population-based survey, published in JAMA Surgery, found that few patients sought a second opinion or went to a different hospital when their surgeon recommended against CPM. Further, patients were overwhelmingly satisfied with their treatment, even when their surgeon dismissed CPM with little discussion.”

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More Women With Breast Cancer Opt to Remove Healthy Breast

Excerpt:

“One in three breast cancer patients under 45 removed the healthy breast along with the breast affected by cancer in 2012, a sharp increase from the one in 10 younger women with breast cancer who had double mastectomies eight years earlier, a new study reports.

“The rate is especially high in some parts of the country, the study in JAMA Surgery found. Nearly half of younger women in five neighboring states — Nebraska, Missouri, Colorado, Iowa and South Dakota — had double mastectomies in 2010-12. Women often remove the healthy breast so they don’t have to worry about developing another cancer, even though there is no evidence that removing the healthy breast extends lives.”

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Lack of Patient Knowledge May Contribute to Overuse of Contralateral Prophylactic Mastectomy

Excerpt:

“Many women decide to undergo contralateral prophylactic mastectomy despite having limited knowledge about the procedure and before completing discussions and evaluations with surgeons, according to results of a population-based study.

“However, the use of contralateral prophylactic mastectomy among women without clinical indications appeared lower if a surgeon recommended against it.”

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Surgical Options After a Cancer Diagnosis in One Breast

Excerpt:

“Dear Mayo Clinic: My daughter was diagnosed with breast cancer at 54 and had surgery to remove one breast. Her surgeon told her that it wasn’t necessary to remove both breasts, because she was not at high risk for developing cancer on the other side. How can that be true? Isn’t a recurrence likely if she still has breast tissue on the other side?

“A: The fact that your daughter developed cancer in one doesn’t mean she is at high risk to develop cancer in the other breast. Her risk of developing a new cancer in the breast that remains after surgery is lower than most people think (around 0.2 to 0.6 percent per year). And the risk that the will come back in a different part of her body is not changed, whether or not her healthy breast is removed.”

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Cancer Surgeons Advise Against Removal of Healthy Breast

Excerpt:

“Only certain women with cancer in one breast should have their healthy breast removed in an attempt to prevent cancer, a leading group of breast surgeons maintains.

“The new position statement from the American Society of Breast Surgeons comes at a time when more breast cancer patients are asking doctors to remove the unaffected breast — a procedure known as contralateral prophylactic mastectomy.

” ‘Contralateral prophylactic mastectomy is a growing trend that has generated significant discussion among physicians, patients, breast cancer advocates and media,’ said position statement lead author Dr. Judy Boughey. She is professor of surgery at Mayo Clinic in Rochester, Minn.”

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American Society of Breast Surgeons Recommends Against Contralateral Prophylactic Mastectomy

Excerpt:

“The American Society of Breast Surgeons issued a position statement that recommends against contralateral prophylactic mastectomy for average-risk women with unilateral breast cancer.

“In its statement — published in Annals of Surgical Oncology — the society encouraged an evidence-based, patient value-focused approach to determine the value of contralateral prophylactic mastectomy in patients with breast cancer.”

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Early First Cancer in BRCA1/2 Ups Risk in Opposite Breast

“BRCA1/2 mutation carriers have increased risk of contralateral breast cancer (CBC), with age at first diagnosis a significant predictor of CBC risk, according to a study published online Dec. 23 in the Journal of Clinical Oncology.

“Alexandra J. van den Broek, from the Netherlands Cancer Institute in Amsterdam, and colleagues examined overall and age-specific estimates of CBC risk for young patients with breast cancer with or without BRCA1/2 mutations. Data were included for 6,294 patients with invasive breast cancer diagnosed under 50 years of age and treated between 1970 and 2003; participants were tested for the most prevalent BRCA1/2 mutations.”