PS5-10-29: Factors Associated with Discussion of Contralateral Prophylactic Mastectomy (CPM) During Surgical Consultations

Abstract Introduction While surgeons endorse that CPM should not be routinely performed, they also acknowledge that perceived benefits of CPM can outweigh risks for some women. Little is known about how CPM conversations occur in practice. The objective is to determine the frequency with which CPM is discussed in practice and identify patient factors associated with discussion. Methods: This study was a secondary analysis of Alliance clinical trial A231701CD. We identified women ≤65 years who underwent breast cancer surgery and whose transcript of their audio-recorded surgical consultation was available. We excluded women with indications for bilateral breast surgery (e.g., bilateral cancer, genetic mutation). Transcripts were reviewed to determine whether CPM was discussed and who initiated the discussion (surgeon vs patient/support person). Two breast surgeons reviewed transcripts to determine candidacy for breast conserving surgery (BCS) and family history (FH). We used multivariable logistic regression to identify factors associated with CPM discussion, controlling for age, BCS candidacy, FH, invasive vs in-situ cancer, race, and socioeconomic disadvantage using the area deprivation index (dichotimized at ≥80th percentile). We generated predictive probabilities to highlight model findings. Chi square test was used to assess initiation of CPM discussion by race. Results: Of the 347 women, median age was 55 (range 28-65), 38% were non-white, and 24% socioeconomically disadvantaged. 49% of consults discussed CPM, most commonly initiated by the surgeon (64%). Younger ages compared with age >55-65 (age >45-55 OR 4.2 [95% CI 2.3-7.7]; age ≤45 OR 6.9 [95% CI 3.7-13.0]), FH (OR 2.7, 95% CI 1.5-4.6), and White as compared to Black race (OR 4.1 [95% CI 2.2-7.6]) were associated with greater odds of discussing CPM. No statistically significant association was observed for non-BCS compared to BCS candidates (OR 1.6 [95% CI 0.9-2.9]), invasive compared with in-situ cancer (OR 0.9 [95% CI 0.5-1.7], or socioeconomic disadvantage (OR 1.1 [95% CI 0.6-2.1). Although trends in the association between age and FH, and whether CPM was discussed were similar for Black versus White patients, an absolute difference by race persisted (Table). There was no statistically significant difference in who initiated the CPM discussion by race. Discussion: The likelihood of discussing CPM is greater for younger patients and those with a FH, aligned with the potential benefit of risk-reduction with CPM. Interestingly, there was a notable difference in likelihood of discussing CPM for White versus Black patients. Surgeons initiated the discussion in the majority of consults, making the difference unlikely to be simply related to patient motivation for CPM. Future work will focus on the CPM discussions themselves to understand the nature of the CPM discussion, as this likely contributes to the high rates of CPM for White women. Citation Format: H. Neuman, F. Dickerson, M. Saucke, C. Breuer, L. Bozzuto, A. Beck, J. Schumacher. Factors Associated with Discussion of Contralateral Prophylactic Mastectomy (CPM) During Surgical Consultations [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-10-29.