May 2019 #PRSJournalClub Wrap-Up: Contralateral Prophylactic Mastectomy: Knowledge and Decisions

by Michael S. Hu, MD, MPH, MS
Plastic Surgery Resident, University of Pittsburgh


The May 2019 edition of #PRSJournalClub provided an exciting discussion regarding an important decision women with unilateral breast cancer must make: whether to undergo a contralateral prophylactic mastectomy. The article, entitled “Breast Cancer Knowledge and Decisions Made for Contralateral Prophylactic Mastectomy: A Survey of Surgeons and Women in the General Population” by Rachel C. Hooper, MD, Jessica Hsu, MD, PhD, Anthony Duncan, BA, Jessica M. Bensenhaver, MD, Lisa A. Newman, MD, MPH, Kelly M. Kidwell, PhD, Kevin C. Chung, MD, MS, and Adeyiza O. Momoh, MD, was discussed on the #PRSJournal Facebook page, which allowed the broad Facebook audience to ask questions directly to the authors and interact with the PRS community.

The article can be found for free here.

In this study, Hooper et al. perform a cross sectional survey of three cohorts: laywomen, breast surgeons, and reconstructive surgeons. Using three separate questionnaires tailored to each group, the authors obtain and analyze surveys from 1333 laywomen, 198 plastic surgeons, and 142 breast surgeons. Crowdsourcing through registered workers with Amazon Mechanical Turk is utilized to obtain the laywomen cohort. Using this methodology, the authors find that laywomen significantly favored contralateral prophylactic mastectomy relative to reconstructive surgeons and breast surgeons. Additionally, laywomen with higher levels of breast cancer knowledge had lower odds of choosing contralateral prophylactic mastectomy. This is an incredibly important topic as there has been an increase in contralateral prophylactic mastectomies. Furthermore, studies suggest that this increase is unnecessary. Using a novel crowdsourcing methodology, Hooper et al. obtain data that suggest a knowledge gap may explain the disparity between those who choose or choose not to undergo a contralateral prophylactic mastectomy. Therefore, patient education regarding surgical options should be improved so that well-informed decisions are made. Further studies promise to provide deeper insight into the decision to undergo a contralateral prophylactic mastectomy.

This article was also discussed by the current Resident Ambassadors to the PRS Editorial Board, Raj Parikh, MD, MPHS, Lily Mundy, MD, and Kyle Sanniec, MD, with special guest Terry Myckatyn, MD. Listen to the excellent podcast discussion below:

An engaging and thought-provoking online discussion also took place on the #PRSJournal Facebook page over a two-day period (May 18-19, 2019), where established plastic surgeons and residents were able to ask questions, and get answers from the authors of the article themselves! Don’t worry if you missed it! A summary of the interesting discussion is provided below.

We hope you enjoy the top highlights from the discussion and look forward to seeing you at the next #PRSJournalClub on Facebook!

Sincerely, 
Mike

This May #PRSJournalClub article (as well as other Journal Club selections from May), selected classic pairings and videos, and the entire Facebook Q&A are archived on PRSJournal.com here.

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