Posts by: James Frederick, PA-C, MMSc

A new study from the University of Michigan Comprehensive Cancer Center explored the complex relationship between newly diagnosed breast cancer and recommendations against potentially unnecessary surgery. The population-based survey, “Patient Reactions to Surgeon Recommendations About Contralateral Prophylactic Mastectomy for Treatment of Breast Cancer,“ appeared in JAMA Surgery. It found that patients are generally satisfied with their treatment, even when their surgeons dismissed contralateral prophylactic mastectomy (CPM) with little discussion. More and more women with cancer affecting a single breast are opting to have both breasts removed. Yet this procedure, known as CPM, is complicated and has not been shown to improve survival. Subsequently, surgeons are increasingly likely to counsel against CPM in women who don't have an elevated risk for a second primary breast cancer. "The increased attention to and preference for CPM among patients for whom it is not a clinical imperative is a relatively recent phenomenon," University of Michigan professor Steven J. Katz, MD, MPH, said in a press release. "It's one of many considerations on the minds of patients we know are understandably anxious and who may feel they need to make treatment decisions quickly after diagnosis." To determine the effect of an initial surgical consultation with a recommendation against CPM on patient satisfaction, researchers sent out surveys to 1,140 women with unilateral breast cancer who considered CPM. Surveys included questions about surgical recommendations, level of discussion regarding CPM, satisfaction with surgical decision-making, whether a second opinion was sought, and if surgery was ultimately performed by another surgeon. The study found that about half of patients with unilateral breast cancer considered CPM. Of those patients, a quarter reported that their surgeon recommended against it, and 30 percent reported no substantial discussions regarding CPM. Dissatisfaction with surgical planning was found to be low — only 7.6 percent. Notably, dissatisfaction was higher, 15 percent, when the surgeon recommended against pursuing CPM but did not have a substantial discussion regarding why. One in five patients sought second opinions, and only one in 10 patients decided to pursue surgery with a different surgeon. These results show that most patients are satisfied with surgical recommendations when counseled against CPM. Recommendations did not substantially increase patient satisfaction, second opinions by a second surgeon, or loss of the patient to another surgeon altogether. "About 95 percent of breast cancer patients are treated by the first surgeon they see," says Katz. "It's so important in those initial consultations that the patient and the surgeon feel free to discuss all of the options and work together to determine the best path forward."