Oncology Rounds

The startling way you could be letting down almost 50% of your breast cancer patients

by Deirdre Saulet and Kate Wister

Contralateral prophylactic mastectomies (CPM), which remove the healthy breast as a preventive measure, are commonly recommended for women with a high risk of breast cancer recurrence, but there is no compelling evidence that the extensive surgery improves overall survival or minimizes the risk of recurrence for women with a low to average risk of breast cancer.

Yet despite this lack of evidence, over the last decade the number of women electing to have CPM has actually increased.

A recent study attempted to understand how women make the decision to have or not to have CPM. Researchers had women who were diagnosed with early-stage breast cancer between July 2013 and September 2014 take a survey that accounted for socio-economic factors as well as their perceived understanding of CPM and their decision process. The study found that 14.2% of women defined as "low-risk" (without a high genetic risk or known deleterious mutation from germline genetic testing) elected to have the procedure.

Many patients don't receive a treatment recommendation from their physician

What we found most alarming about the study findings is that nearly half—a staggering 46.8%—of patients in this low-risk population reported that they did not receive a recommendation for or against CPM from their physician. It is important to note that this was a self-reported survey, but even the fact that almost half of patients said that they didn't receive a recommendation is concerning, and indicative of the disconnect between what patients absorb and what physicians think they absorb.

Of the patients who received a recommendation against CPM, only 1.9% chose to undergo the procedure. However, of those low-risk patients who did not receive a recommendation for or against the procedure from their physician, 19% chose to have CPM. These data suggest that physicians' recommendations have a significant impact on women's decisions to undergo CPM.

Percent of Low-Risk Breast Cancer Patients Who Chose CPM

Percent of Low-Risk Breast Cancer Patients Who Chose CPM

Physicians need to engage patients to help them think through their treatment goals, provide a recommendation, and ensure that patients have sufficient understanding to make an informed treatment decision. While this can be time consuming, it is instrumental to patient engagement, and in this case, can reduce non-value-added care that contributes to unnecessary health care costs.

This study is just one of many highlighting the need to provide patients with adequate information when they're faced with choices regarding their care. A recent study from researchers at The Ohio State University, found that 57% of breast cancer patients lacked the necessary medical knowledge to make an informed decision about reconstructive surgery, leading to overtreatment.

 

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