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August 28, 2013

Contralateral Prophylactic Mastectomy for Breast Cancer: Addressing Peace of Mind

Author Affiliations
  • 1Departments of Medicine and Health Management and Policy, University of Michigan, Ann Arbor
  • 2Department of Surgery, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, New York, New York
JAMA. 2013;310(8):793-794. doi:10.1001/jama.2013.101055

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 everything they can to leave this intense period of health threat, treatment decision making, and treatment delivery behind—to move on with their lives with greater peace of mind. However, a consequence of this urge to leave it behind is the desire by many patients to quickly embrace all possible cancer treatments regardless of the level of benefit.