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16 September 2013
Fear driving double mastectomy trend

A new survey shows that many young women with breast cancer opt for a double mastectomy (known as a contralateral prophylactic mastectomy, or CPM) despite knowing it will be unlikely to improve their chance of survival.

The study, published in the Annals of Internal Medicine, shows a certain logical disconnect between what many patients know on an abstract, intellectual level - that CPM has little impact on survival rates for most women - and the choices they make after receiving the anxiety-inducing diagnosis of breast cancer.

"An increasing percentage of women treated for early-stage breast cancer are choosing to have CPM," says the study's lead author, Shoshana Rosenberg, of the Dana-Farber Cancer Institute. "The trend is particularly notable among younger women."

The survey results, explains Rosenberg, suggest that many patients are going into this decision with an unrealistic sense of the benefits of CPM, and of the risks. "Improving the communication of those risks and benefits - together with better management of anxiety surrounding diagnosis - and providing patients with the support they need to make decisions based on solid evidence - are worthwhile steps," says Rosenberg.

In the survey, almost all the women said they opted for CPM out of a desire to improve their chances of survival and prevent the cancer from spreading to other parts of the body. At the same time, however, most understood that removing both breasts does not extend survival for women who are free of an inherited genetic predisposition to breast cancer.

"Most women acknowledge that CPM does not improve survival, but anxiety and fear of recurrence probably influence them during the decision-making process," Rosenberg speculates.

Even as they overestimated the benefits of CPM, many of the participants underestimated the severity of some of its side effects. Many respondents said the effect of CPM on their appearance was worse than they had expected. A substantial proportion of the respondents - 42 percent - reported that their sense of sexuality after CPM was worse than expected.

"Our findings underscore how important it is that doctors effectively communicate the risks and benefits of CPM to women," Rosenberg concluded. "We need to be sure that women are making informed decisions, supported decisions, based on an accurate understanding of the pros and cons of the procedure."

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Source: Dana-Farber Cancer Institute

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