Aim:
To investigate women’s preferences for routine monitoring or contralateral prophylactic mastectomy (CPM) to manage breast cancer recurrence risk.
Methods:
A community based discrete choice experiment (DCE) was used with attributes and levels derived from qualitative research with women who had undergone treatment for early stage breast cancer. The DCE presented women with 12 choices that described the underlying characteristics of routine monitoring and CPM: mode and frequency of monitoring; risk of cancer recurrence; risk of pain or loss of breast sensitivity; involvement in decision making; and costs. For each question, women were asked to choose their preferred management option. Women also rated their degree of concern about each of the attributes, including cancer recurrence, when making their choices. Results were analysed using mixed logit and latent class analysis.
Results:
57.5% of women always chose one option, typically routine monitoring (49.1%), with fewer always choosing CPM (8.4%). Women fell into three groups: those preferring routine monitoring; those preferring CPM; and those who were willing to trade between the options (‘traders’). Among traders, choices were most highly influenced by the risk of cancer recurrence; women were less likely to choose an option associated with higher risk. Women were more likely to choose options associated with less intrusive methods of monitoring and where they were involved in decisions about their care. Women who were concerned about cancer recurrence were more likely to choose CPM over routine monitoring.
Conclusions:
Women have strong preferences regarding choice of management for breast cancer recurrence that reflect their concerns about the health effects of ongoing management and the associated experience of care.