The EBCC 13 Manifesto will focus on “How to control the ‘epidemic’ of contralateral prophylactic mastectomy (CPM)”. Today more and more women are asking for CPM following a breast cancer diagnosis. This creates an uneasy balance for surgeons as they must respect patients’ fears as well as their wishes, but they must also maintain the principle of Primum non Nocere. Many times, the patient’s anxiety and fear of recurrence in the contralateral breast leads them to ask for CPM as they believe that this will reduce their risk despite the lack of evidence for improved outcomes for survival.
It is important that physicians have a discussion with their patients about the physical impact of surgery, acute effects of surgical techniques as well as the long post operatory recovery period and the lack of knowledge about the magnitude of bilateral skin-sparing surgery. Most importantly, the psychological impact needs to be addressed; the patients fears, quality of life and body image before and after CPM. Physicians must also address their own prejudices and anxieties that may lead them to encourage CPM.
In 2021, Europa Donna conducted a survey assessing the reasons women consider undergoing CPM, discussions with surgeon, etc. More than 600 women responded to the survey which will be used to write the manifesto. It was clear from the results that shared decision making regarding genetic and surgical counselling are critical to tailoring surgical treatment. Clinical characteristics should also be considered in addition to familial and psychosocial considerations.
Patients require time to consider and discuss available options based on thorough knowledge and understanding of risk perception. Surgeons can have a major impact on decision making and patients’ understanding of risk and regret. Behavioral science suggests that patient decision making can be improved through the language used for careful communication of low-probability events. Publicity of medical issues through influential advocates can increase both awareness and anxiety, and should be accompanied by appropriate education, advice and triage. EBCC-13 Manifesto aims to provide insight from experts and patients advocates to this demanding clinical issue.
Why is appropriate healthcare inaccessible for many European breast cancer patients?
Genetic risk prediction testing in breast cancer
European Breast Cancer Conference manifesto on breast centres/units
Optimal breast cancer pathology manifesto