Factors Influencing a Woman¿s Decision for Breast Conservation vs. Mastectomy with Contralateral Prophylactic Mastectomy in Early-Stage, Hormone-Sensitive, Breast Cancer: A Systematic Review

Abstract

Research Question: What factors influence a woman¿s decision for breast conservation vs mastectomy and contralateral prophylactic mastectomy in early-stage, hormone-sensitive, breast cancer?

Background and Significance: Breast conservation (BC) is a viable option for many patients diagnosed with early-stage breast cancer. With proper medical management and radiation, there is no difference in overall survival (OS) between BC and mastectomy in patients who lack genetic mutations. While this data is well-established, women are opting for mastectomy with contralateral prophylactic mastectomy (CPM) at increasing rates. A better understanding of factors influencing a patient¿s desire for mastectomy and CPM can honor the approach of shared decision making and autonomy, while potentially leading to less invasive surgical intervention. We completed a systematic review of both quantitative and qualitative studies exploring factors impacting patient decision making for mastectomy and contralateral prophylactic mastectomy vs breast conservation surgery in patients with early state breast cancer.

Materials and Methods: Studies were identified via database searches of Cochrane, Embase, and PubMed. Articles of interest were identified and then selected based on inclusion and exclusion criteria. Data was then extracted by one author using a standardized criterion and analyzed. Quality was assessed using standardized criteria through Covidence.

Results: 366 citations were reviewed with 68 meeting the specified inclusion criteria. Analysis showed that factors most influential for CPM included anxiety (45%), lack of knowledge regarding their cancer (43%), lack of understanding regarding future cancer risk (44%), and the desire to extend/prolong life while avoiding future treatment (35%). Surgeon preference (35%) and a desire for symmetry (31%) also were important factors when choosing CPM.

Conclusion: While patients are satisfied with their decision to undergo the more invasive treatment option of mastectomy with CPM, patients will benefit from education techniques that target the risks and benefits and address the common misconceptions surrounding both surgical options for breast cancer. This approach honors both patient autonomy and shared decision making, while staying true to the basic principle of ¿do no harm.¿ Understanding specific factors influencing the patient decision making process can help ensure patients receive an individualized approach to their cancer care.