Impact of telehealth genetic counseling on contralateral prophylactic mastectomy rates among multi-ethnic breast cancer patients

Contralateral prophylactic mastectomy (CPM) reduces contralateral breast cancer risk but improves survival only among young BRCA1/2 carriers. With expanded germline testing (GT) and increased use of oncologist-led and telehealth genetic services post-COVID, concerns remain about patients' understanding of results and the impact on surgical decisions. We conducted a retrospective cohort study of 1,054 women with unilateral breast cancer who underwent GT at Columbia University Irving Medical Center from 2013-2022. Mean age was 51.2; 40.5% were non-Hispanic White (NHW), 28.4% Hispanic, 12.1% Black, and 10.3% Asian. Overall, 28% underwent CPM. Testing shifted from 99.7% in-person to 73.9% oncologist-led and 20.1% telehealth post-COVID. In multivariable analysis, CPM was associated with younger age, advanced stage, and pathogenic/likely pathogenic variants, but not with service delivery or VUS results. A trend toward higher CPM rates was observed among Hispanic versus NHW patients (OR = 1.34, 95% CI = 0.99-1.81, p = 0.055). Despite care delivery shifts, CPM rates remained stable.