New studies released today reveal important advances in cancer care quality measurement, physician adherence to quality standards, and end-of-life care, while highlighting the overuse of contralateral prophylactic mastectomy (CPM), the — surgical removalof the pposite, healthy, breast,an option that mayreduce the risk of a new cancer developing. The studies were released in a presscast today in advance of American Society of Clinical Oncology’s(ASCO) inaugural 2012 Quality Care Symposium. The Symposium will take place November 30 ? December 1, 2012, at the Manchester Grand Hyatt in San Diego.

A new patient survey and analysis of the SEER cancer registry dataindicated that more than two thirds of women with early stage breast cancer who received contralateral prophylactic mastectomy (CPM),thesurgical removal of the breast not affected by cancer to prevent development of a new primary breast cancer,were clinically at very low risk for developing cancer in the unaffected breast.

In most cases,contralateral prophylactic mastectomy or CPM was strongly associated with established clinical indications for the procedure (includinga strong family history and/or positive genetic test result) but also with a greater degree of worry about recurrence, providing new insight into the factors influencing CPM overuse.

Psychological wellbeing

In the general population of women diagnosed with breast cancer, the risk of developing a new cancer in the unaffected breast is less than 1%, whereas the risk of cancer recurring locally (in the same breast or nearby lymph nodes) is 8%. But there may be a good reason for contralateral prophylactic mastectomy.?If worries about cancer recurrence are affecting a woman?s psychological wellbeing, perhaps contralateral prophylactic mastectomy would be the right choice, but our results clearly show that too many women are undergoing unnecessary surgery,? explained Sarah T. Hawley, PhD, MPH, lead author of astudy and associate professor of general medicine at University of Michigan. ?Our findings also suggest that some women made the decision based on their misconception about the ability of CPM to reduce the risk of local recurrence of cancer. In everyday practice, this means that physicians need to understand the strong impact of worry about cancer recurrence in patient decision making, and may need to do a better job of educating and reassuring women about their true risks of both cancer recurrence and of developing a new cancer,? she added.

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Survey

The researchers surveyed 2,245 women with newly diagnosed breast cancer that were reported to two SEER registries and re-surveyed 1,525 of those women approximately 4 years later. The women received lumpectomy, unilateral mastectomy, or CPM. Of the 1,446 women who did not have recurrence by the time of the second survey, 35% had considered CPM and 7.4% received it. Strikingly, about 70% of women who received CPM had a very low risk of contralateral breast cancer. More women reported being ?very worried about recurrence? among those who received CPM compared to those who received mastectomy only for the affected breast (90% vs. 80%).

Worry about recurrence

Clinically significant risk of contralateral disease was defined as family history (at least two first-degree relatives with breast or ovarian cancer) and/or having a positive genetic test for alterations in BRCA1and BRCA2 genes. Having those risk factors was associated with an increased likelihood of receiving CPM versus single breast surgery. However, greater worry about recurrence was a contributing factor in decision to receive CPM among women who did not have those clinical indications.

Hawley?s research team is launching a large study that will explore, from the perspectives of physicians as well as patients, how decisions about breast cancer treatments, including CPM, are made for patients who do not have an increased risk of cancer in the unaffected breast. The study is part of a large research program project that delves into the challenges of individualizing breast cancer treatment and reducing overtreatment. As part of this larger study, the team is also developing and testing decision tools that will help patients understand the risks and benefits of CPM and other treatment options.

For more information:

General Poster Session A:Sarah T. Hawley, PhD, MPH (University of Michigan, Ann Arbor VA Healthcare SystemAnn Arbor, Michigan)
Date: Friday, November 30, 2012, 12:00 – 1:30 PM PST
Location: Douglas Pavilion C
Abstract:#26
Title:Is contralateral prophylactic mastectomy (CPM) overused? Results from a population-based study.
Authors: Hawley ST,Jagsi R,Katz SJ.

References:

Non medical publications:

Fear of Breast Cancer May Lead to Unnecessary Mastectomies(ABC News; November 28, 2012)

Photo: Sarah T. Hawley, PhD, MPH, lead author of a study and associate professor of general medicine at University of Michigan. Photo credit: University of Michigan.

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