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

Mara Tynan; Beth N. Peshkin; Claudine Isaacs; Shawna Willey; Heiddis B. Valdimarsdottir; Rachel Nusbaum; Gillian Hooker; Suzanne C. O’Neill; Lina Jandorf; Scott P. Kelly; Jessica Heinzmann; Sarah Kelleher; Elizabeth Poggi; Marc D. Schwartz

doi:10.1007/s10549-019-05515-2

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

Mara Tynan, Beth N. Peshkin, Claudine Isaacs, Shawna Willey, Heiddis B. Valdimarsdottir, Rachel Nusbaum, Gillian Hooker, Suzanne C. O’Neill, Lina Jandorf, Scott P. Kelly, Jessica Heinzmann, Sarah Kelleher, Elizabeth Poggi, Marc D. Schwartz^*

^*Corresponding author for this work

Department of Psychology

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

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.

Original language	English
Pages (from-to)	177-185
Number of pages	9
Journal	Breast Cancer Research and Treatment
Volume	180
Issue number	1
DOIs	https://doi.org/10.1007/s10549-019-05515-2
Publication status	Published - 1 Feb 2020

Bibliographical note

Funding Information:
The authors are grateful to all the women who participated in this study. The authors would like to acknowledge contributions of Dr. Colette Magnant, Dr. Elizabeth Feldman, Ms. Tamara Drazin and Ms. Aliza Zidell in providing access to their patients. We would also like to acknowledge the contributions of Dr. Kara-Grace Leventhal for conducting study telephone surveys. This study was supported by Grants (R01 CA74861 and P30 CA051008) from the National Cancer Institute and by the Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.

Publisher Copyright:
© 2020, Springer Science+Business Media, LLC, part of Springer Nature.

Other keywords

Breast cancer
Contralateral prophylactic mastectomy
Decision making
Genetic testing

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10.1007/s10549-019-05515-2

Cite this

Tynan, M., Peshkin, B. N., Isaacs, C., Willey, S., Valdimarsdottir, H. B., Nusbaum, R., Hooker, G., O’Neill, S. C., Jandorf, L., Kelly, S. P., Heinzmann, J., Kelleher, S., Poggi, E., & Schwartz, M. D. (2020). Predictors of contralateral prophylactic mastectomy in genetically high risk newly diagnosed breast cancer patients. Breast Cancer Research and Treatment, 180(1), 177-185. https://doi.org/10.1007/s10549-019-05515-2

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title = "Predictors of contralateral prophylactic mastectomy in genetically high risk newly diagnosed breast cancer patients",

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{\textquoteright}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.",

keywords = "Breast cancer, Contralateral prophylactic mastectomy, Decision making, Genetic testing",

author = "Mara Tynan and Peshkin, {Beth N.} and Claudine Isaacs and Shawna Willey and Valdimarsdottir, {Heiddis B.} and Rachel Nusbaum and Gillian Hooker and O{\textquoteright}Neill, {Suzanne C.} and Lina Jandorf and Kelly, {Scott P.} and Jessica Heinzmann and Sarah Kelleher and Elizabeth Poggi and Schwartz, {Marc D.}",

note = "Funding Information: The authors are grateful to all the women who participated in this study. The authors would like to acknowledge contributions of Dr. Colette Magnant, Dr. Elizabeth Feldman, Ms. Tamara Drazin and Ms. Aliza Zidell in providing access to their patients. We would also like to acknowledge the contributions of Dr. Kara-Grace Leventhal for conducting study telephone surveys. This study was supported by Grants (R01 CA74861 and P30 CA051008) from the National Cancer Institute and by the Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. Publisher Copyright: {\textcopyright} 2020, Springer Science+Business Media, LLC, part of Springer Nature.",

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Tynan, M, Peshkin, BN, Isaacs, C, Willey, S, Valdimarsdottir, HB, Nusbaum, R, Hooker, G, O’Neill, SC, Jandorf, L, Kelly, SP, Heinzmann, J, Kelleher, S, Poggi, E & Schwartz, MD 2020, 'Predictors of contralateral prophylactic mastectomy in genetically high risk newly diagnosed breast cancer patients', Breast Cancer Research and Treatment, vol. 180, no. 1, pp. 177-185. https://doi.org/10.1007/s10549-019-05515-2

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AU - Tynan, Mara

AU - Peshkin, Beth N.

AU - Isaacs, Claudine

AU - Willey, Shawna

AU - Valdimarsdottir, Heiddis B.

AU - Nusbaum, Rachel

AU - Hooker, Gillian

AU - O’Neill, Suzanne C.

AU - Jandorf, Lina

AU - Kelly, Scott P.

AU - Heinzmann, Jessica

AU - Kelleher, Sarah

AU - Poggi, Elizabeth

AU - Schwartz, Marc D.

N1 - Funding Information: The authors are grateful to all the women who participated in this study. The authors would like to acknowledge contributions of Dr. Colette Magnant, Dr. Elizabeth Feldman, Ms. Tamara Drazin and Ms. Aliza Zidell in providing access to their patients. We would also like to acknowledge the contributions of Dr. Kara-Grace Leventhal for conducting study telephone surveys. This study was supported by Grants (R01 CA74861 and P30 CA051008) from the National Cancer Institute and by the Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. Publisher Copyright: © 2020, Springer Science+Business Media, LLC, part of Springer Nature.

PY - 2020/2/1

Y1 - 2020/2/1

N2 - 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.

AB - 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.

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

Abstract

Bibliographical note

Other keywords

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Cite this