Predictors of contralateral prophylactic mastectomy in genetically high risk newly diagnosed breast cancer patients.

Tynan M1,2, Peshkin BN1,2, Isaacs C1,2, Willey S2,3, Valdimarsdottir HB4,5, Nusbaum R6, Hooker G7, O'Neill SC1,2, Jandorf L4, Kelly SP8, Heinzmann J9, Kelleher S10, Poggi E1, Schwartz MD11,12,13.

Author information

1: Georgetown Lombardi Comprehensive Cancer, Georgetown University, Washington, DC, USA.
2: Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC, USA.
3: INOVA Schar Cancer Institute, Fairfax, VA, USA.
4: Icahn School of Medicine At Mount Sinai, Department of Population Health Science and Policy, Center for Behavioral Oncology, New York, NY, USA.
5: Department of Psychology, Reykjavik University, Reykjavik, Iceland.
6: School of Medicine, University of Maryland, Baltimore, MD, USA.
7: Concert Genetics, Inc, Franklin, TN, USA.
8: American Academy of Ophthalmology, San Francisco, CA, USA.
9: Carol G. Simon Cancer Center, Atlantic Health Systems, Summit, NJ, USA.
10: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
11: Georgetown Lombardi Comprehensive Cancer, Georgetown University, Washington, DC, USA. schwartm@georgetown.edu.
12: Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC, USA. schwartm@georgetown.edu.
13: Georgetown University, Harris Building, 3300 Whitehaven St., NW, Suite 4100, Washington, DC, 20007, USA. schwartm@georgetown.edu.

Abstract

PURPOSE:

Recent trends indicate increased use of contralateral prophylactic mastectomy (CPM) among newly diagnosed breast cancer patients, particularly those who test positive for a pathogenic variant in the BRCA1/2 genes. However, the rate of CPM among patients who test negative or choose not to be tested is surprisingly high. We aimed to identify patient predictors of CPM following breast cancer diagnosis among such patients.

METHODS:

As part of a randomized controlled trial of rapid genetic counseling and testing vs. usual care, breast cancer patients completed a baseline survey within 6 weeks of diagnosis and before definitive surgery. Analyses focused on patients who opted against testing (n = 136) or who received negative BRCA1/2 test results (n = 149). We used multivariable logistic regression to assess the associations between sociodemographic, clinical- and patient-reported factors with use of CPM.

RESULTS:

Among patients who were untested or who received negative test results, having discussed CPM with one's surgeon at the time of diagnosis predicted subsequent CPM. Patients who were not candidates for breast-conserving surgery and those with higher levels of cancer-specific intrusive thoughts were also more likely to obtain a CPM.

CONCLUSION:

The strongest predictors of CPM in this population were objective clinical factors and discussion with providers. However, baseline psychosocial factors were also independently related to the receipt of CPM. Thus, although CPM decisions are largely guided by relevant clinical factors, it is important to attend to psychosocial factors when counseling newly diagnosed breast cancer patients about treatment options.