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Intentions for bilateral mastectomy among newly diagnosed breast cancer patients

Authors

  • Lesley King BS,

    1. Department of Oncology, Jess and Mildred Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
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  • Suzanne C. O'Neill PhD,

    Corresponding author
    1. Department of Oncology, Jess and Mildred Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
    • Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007. Fax: 202-687-0305.===

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  • Elizabeth Spellman BA,

    1. Department of Oncology, Jess and Mildred Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
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  • Beth N. Peshkin MS, CGC,

    1. Department of Oncology, Jess and Mildred Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
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  • Heiddis Valdimarsdottir PhD,

    1. Department of Oncological Sciences, Mount Sinai School of Medicine, New York, New York
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  • Shawna Willey MD,

    1. Department of Surgery, Jess and Mildred Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
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  • Kara Grace Leventhal BA,

    1. Department of Oncology, Jess and Mildred Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
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  • Tiffani DeMarco MS,

    1. Department of Oncology, Jess and Mildred Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
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  • Rachel Nusbaum MS, CGC,

    1. Department of Oncology, Jess and Mildred Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
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  • Elizabeth Feldman MD,

    1. Department of Surgery, Jess and Mildred Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
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  • Lina Jandorf MA,

    1. Department of Oncological Sciences, Mount Sinai School of Medicine, New York, New York
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  • Marc D. Schwartz PhD

    1. Department of Oncology, Jess and Mildred Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
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Abstract

Background

Recent trends suggest that bilateral mastectomy (BM) is on the rise among women diagnosed with unilateral breast cancer. Few studies have investigated the factors associated with the decision to have more aggressive surgery among young, high risk patients.

Methods

As part of a larger study, 284 women aged 50 and under completed an initial survey within 6 weeks of a breast cancer diagnosis. We assessed sociodemographics, medical and family history variables, treatment recommendations, preferences and concerns, distress, perceived risk, knowledge, and neuroticism. We used multiple regression with backward entry to assess the relationship between these variables and our outcomes of decisional conflict and intentions for BM.

Results

Higher decisional conflict was associated with being less educated, unmarried, more anxious and less likely to have received a surgical recommendation. Preference for BM was associated with higher neuroticism, perceived risk for contralateral breast cancer, pre-testing risk of carrying a BRCA1/2 mutation, having received either a surgical recommendation (vs. no recommendation), and lower preference for lumpectomy.

Conclusions

For younger women, a surgical recommendation is associated with lower decisional conflict and stronger intention for BM. Results highlight the importance of effective risk communication and decision support between a woman and her surgeon. J. Surg. Oncol. 2013;107:772–776. © 2012 Wiley Periodicals, Inc.

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