Contralateral prophylactic mastectomy for breast cancer addressing peace of mind

摘要

Addressing patients' fears and concerns about the effects of disease and its treatments on their lives and on their families is an important goal of cancer management. This is challenging for clinicians because these issues are complicated and difficult to explore in brief visits. A diagnosis of breast cancer and the sudden escalation of decisions trigger powerful emotional reactions from patients. Patients generally feel well at the time of diagnosis but suddenly confront a major health threat, a complicated decision context, and an arduous treatment course. Virtually all treatments that confer lifetime benefit are initiated in the first few months after diagnosis, and the decision-making process is generally compressed into the first few weeks. A sense of urgency in treatment planning is reinforced by the experiences of family and friends, by the powerful messages in the media, and by some clinicians who advise patients to initiate treatment quickly. The increasing use of the time from an abnormal mammogram to definitive cancer surgery as a quality measure in some systems further reinforces the impression that any delay may result in a worsening of prognosis. Consequently, it is understandable that many patients want to do prophylactic mastectomy for patients with unilateral breast cancer has increased markedly in recent years and is much more frequently performed than bilateral prophylactic mastectomy for women without a diagnosis of breast cancer. In a study using the National Inpatient Sample, the rate of CPM for unilateral breast cancer increased from 39 to 207 per 1000 mastectomies between 1998 and 2008, representing about 20 000 patients in 2008. In contrast, the rate of bilateral prophylactic mastectomy increased from 5 to 18 per 1000 mastectomies during the same period.