Abstract
BACKGROUND: Despite bilateral mastectomy (BLM) for early-stage breast cancer (BC) showing no survival benefit and increased risk compared to breast conserving surgery, some patients still choose this treatment. This study examined whether emotion reactivity and regulation influence treatment decision making among newly diagnosed women with breast cancer. METHODS: Cross-sectional survey data were analyzed as part of a larger study. Measures included the Contralateral Prophylactic Mastectomy (CPM) survey, PROMIS Anxiety scale, and Emotion Regulation Questionnaire (ERQ) Cognitive Reappraisal and Emotional Suppression subscales. Primary analysis included a logistic regression model predicting treatment choice (BLM vs. non-BLM). RESULTS: Participants (N = 137) with unilateral BC (Stages 0-III) were divided between BLM (n = 66) versus breast conserving surgery (i.e., non-BLM, n = 71) treatment groups. Compared to the non-BLM group, the BLM group was younger, more likely to be partnered, and had a higher household income. Women with high levels of BC-specific worry were 3.6 times more likely to choose BLM compared to women with low levels of worry (OR = 3.09, 95% CI: 1.07-0.8.93). Those who used cognitive reappraisal were 10% less likely to choose BLM compared to women who did not use cognitive reappraisal (OR = 0.90, 95% CI: 0.82-0.99). There were no group differences in levels of generalized anxiety (OR = 0.93, 95% CI: 0.87-0.99) or emotional suppression (OR = 1.02, 95% CI: 0.90-1.16). CONCLUSIONS: Findings suggest the choice of BLM may be due, in part, to negative emotional experiences after a BC diagnosis and lesser use of reappraisal to reframe cancer-related fears. These may be important targets of intervention to support women making BC treatment decisions.