New Study Demonstrates Overtreatment Due to Misperceptions About Double Mastectomy

Aliza KazmiBy Aliza Kazmi, Health Policy Intern

When a woman is faced with a breast cancer diagnosis, there is a lot to learn about the disease and her treatment options. She must navigate what often feels like a series of terrible treatment and surgical choices, each of which comes with risks and long-term effects. Some women are presented with the option of removing the healthy, non-affected breast as part of their surgical decisions which may feel logical and safe. Ultimately, for most women, increasing their odds of surviving breast cancer is a priority.

In recent years, many researchers and health writers have noted that more and more women are choosing to have their healthy breast removed at the time of a breast cancer diagnosis, despite clear evidence that doing so does not increase the chance of survival for most women at average risk of the disease. We have written about this issue, often called contralateral prophylactic mastectomy (CPM), elsewhere.

A new study from the University of Michigan shows that many women may not be receiving unbiased, evidence-based information about the risks and benefits of choosing a double mastectomy. Despite clear medical evidence that CPM will not protect them from breast cancer-related death, 36% of women perceive that a double mastectomy will improve their chance of survival. Interestingly, nearly equal numbers (37%) believe the opposite.

How do these perceptions manifest themselves in women’s choices? One-fifth, or 20%, of the entire sample of nearly 2,000 women chose CPM. Of an individual subsample of women with no genetic mutation nor family history to demonstrate a risk of cancer developing in the healthy breast, 19% opted for the surgery.

Many factors may play a role in why women choose a particular treatment option, and it’s no surprise that patient perceptions of what their medical team views as most beneficial plays a significant role. This new study highlights how a patient’s perception of their healthcare provider’s opinion impacts their decision to choose a double mastectomy. Just 4% of women perceived that their doctor did not recommend the procedure and thus opted out. On the other hand, 59% of those who perceived their doctor as favoring it moved forward with a CPM.

A commitment to patient well-being must ensure that women are made aware of all risks and possibilities – in both treatment and prevention. “Doctors need to address the jaw-dropping gap between knowledge of contralateral prophylactic mastectomy and the perception of what their surgeons are telling them,” commented Steven Katz, professor of internal medicine and of health management and policy at the University of Michigan. Abundant research literature suggests culturally competent and innovative ways to improve patient-provider communications.

Breast Cancer Action will continue to serve as a watchdog until all women have access to unbiased, evidence-based medical information to support their individual health decisions: decisions that can only be made by each individual woman according to her individual needs and perspectives.

This entry was posted in BCA News.