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Invited Commentary
June 2014

Contralateral Prophylactic Mastectomy: An Opportunity for Shared Decision Making

Author Affiliations
  • 1Dana-Farber Cancer Institute, Boston, Massachusetts
JAMA Surg. 2014;149(6):589-590. doi:10.1001/jamasurg.2013.5713

Most women who have contralateral prophylactic mastectomy (CPM) do not have clear clinical indications for undergoing the procedure, fueling concerns about overuse, as highlighted in the article by Hawley and colleagues.1 Focusing on improving informed decision making is one starting point. However, breast cancer surgical decisions are made at an emotional time when fully understanding and weighing the true risks (eg, surgical complications, self-image, and sexual effects) and benefits (eg, reduced risk of contralateral cancer) associated with CPM might be difficult for some patients. Anxiety and fear certainly hamper optimal decision making,2,3 and greater psychological and emotional support may prove invaluable in this setting. Further complicating informed decision making is the tendency for people to not believe that risk estimates apply to them personally.4

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