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Breast cancer patients’ decisions to undergo a preventive mastectomy are often driven by negative emotions associated with the disease rather than rational evaluation of available treatment options.

Despite evidence supporting less invasive surgery for early-stage breast cancer, more and more breast cancer patients are choosing to undergo contralateral prophylactic mastectomy (CPM). CPM involves removing the unaffected breast following a breast cancer diagnosis and is often performed at the same time as the removal of the affected breast in a bilateral or double mastectomy procedure. This trend is particularly noticeable among women with a low risk of future breast cancer who do not carry a BRCA mutation or have a strong family history of breast cancer. However, studies have shown that CPM provides no survival benefit over other less-invasive surgical options. A study published in the journal Medical Decision Making concluded that patients with stronger negative emotions towards breast cancer tend to choose CPM over other surgical options.

Characteristics of the Study’s Participants

The study included women with an average age of 44.14 years, with a standard deviation of 9.23. The majority of participants, 65.1%, identified as White/Caucasian, while 12.7% identified as Black/African American, 8.5% as Hispanic, and 6.7% as Asian.

Majority of Women With Early-Stage Breast Cancer Chose Lumpectomy

The study investigated the treatment preferences of women diagnosed with early-stage breast cancer. The findings revealed that the majority of women, approximately 63.1%, opted for lumpectomy, while approximately 12.8% opted for single mastectomy. In contrast, approximately 24.2% of women preferred bilateral mastectomy, which involves mastectomy plus contralateral prophylactic mastectomy (CPM), as a hypothetical treatment for their breast cancer.

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Positive Narratives Can Reduce Negative Affect Towards Breast Cancer

This study examined the effect of different narrative manipulations on participants’ negative affect towards breast cancer. Participants reported their feelings on a scale from 1 to 4, with results indicating that all groups felt negatively towards breast cancer. However, those exposed to positive narratives felt less negative compared to those in the neutral and negative groups. ANOVA testing showed statistically significant differences among the groups in reported negative affect towards breast cancer. (F(1, 1024) = 9.17, P < 0.001, η2 = 0.02).

Positive Attitude: Can It Reduce Unnecessary Cancer Treatments?

More participants in the negative and neutral conditions (26.9% and 26.4%, respectively) chose CPM compared to those in the positive condition (19.1%). The inclusion of affect as a predictor improved the model fit, and participants in the positive condition were less likely to choose CPM than those in the negative and neutral conditions. 

Affective Motivation Influences Choice of Breast Cancer Treatment

The study found that affect would be a motivator in the choice of CPM to treat breast cancer. However, the study did not support a hypothesis that suggested that a positive narrative manipulation would result in less negative effects towards CPM. 


Silverstein, M. C., Lee, C. N., Scherer, L. D., Phommasathit, C., Merrill, A. L., & Peters, E. (2023). Operating on Anxiety: Negative Affect toward Breast Cancer and Choosing Contralateral Prophylactic Mastectomy. Medical Decision Making, 43(2), 152-163. https://doi.org/10.1177/0272989×221121134