{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:47:43Z","timestamp":1760060863716,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background: Despite evidence discouraging contralateral prophylactic mastectomy (CPM) in average-risk patients, its use is increasing globally. While well-studied in Western settings, little is known about the factors influencing CPM decisions in the Middle East and North Africa (MENA) region. This study explores clinical, psychosocial, and communication-related factors associated with CPM choices among women with early-stage breast cancer. Methods: We conducted a retrospective study of 253 early-stage breast cancer patients who underwent mastectomy, with or without CPM, at the American University of Beirut Medical Center. Clinical and demographic data were extracted from medical records, and decision-making factors were assessed through tailored patient questionnaires. Associations were analyzed using chi-square tests and multivariable logistic regression. Results: Of the 253 women included in the study, 37 underwent CPM, while 216 had unilateral mastectomy (UM). Compared to the UM group, women who chose CPM were more likely to have a college education (96.9% vs. 57.6%, p &lt; 0.001), be employed (69.7% vs. 41.3%, p = 0.002), and report a family history of breast cancer (55.6% vs. 30.2%, p = 0.003). Immediate reconstruction was significantly more common among CPM patients (67.6% vs. 16.4%, p &lt; 0.001), and the 30-day rehospitalization rate was also higher (16.2% vs. 6.1%, p = 0.031). Women in the CPM group were more likely to prioritize extending life (84.6% vs. 56.7%, p = 0.007) and achieving peace of mind (80.8% vs. 49.3%, p = 0.003). Although all CPM patients cited risk reduction as a primary motivator, only 46.2% believed they had a lower recurrence risk than their peers (vs. 20% of UM patients, p &lt; 0.001). Decisions to undergo UM were more frequently influenced by physicians\u2019 recommendations (95.3% vs. 53.8%, p &lt; 0.001), whereas CPM decisions appeared to be more patient-driven. Additionally, CPM patients reported more negative expectations and higher dissatisfaction with pain (57.7% vs. 32.0%, p = 0.012) and reconstructive outcomes (54.5% vs. 27.5%, p = 0.035). Conclusions: In this first study from the MENA region exploring CPM decision-making, choices were largely driven by personal preferences rather than clinical risk. These findings highlight the need for improved risk communication, shared decision-making, and broader integration of genetic counseling in surgical planning.<\/jats:p>","DOI":"10.3390\/medsci13040225","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T07:56:29Z","timestamp":1759996589000},"page":"225","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Understanding Patient Decision-Making in Breast Cancer Surgery: Risk Perception, Communication, and Psychosocial Influences"],"prefix":"10.3390","volume":"13","author":[{"given":"Eman","family":"Sbaity","sequence":"first","affiliation":[{"name":"Department of General Surgery, American University of Beirut Medical Center, Beirut P.O. Box 11-0236, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2837-7563","authenticated-orcid":false,"given":"Tasnim","family":"Diab","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hematology and Oncology, Naef K Bassile Cancer Institute, American University of Beirut Medical Center, Beirut P.O. Box 11-0236, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8753-5659","authenticated-orcid":false,"given":"Jana","family":"Haroun","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, American University of Beirut, Beirut P.O. Box 11-0236, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3790-5027","authenticated-orcid":false,"given":"Nagham","family":"Ramadan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hematology and Oncology, Naef K Bassile Cancer Institute, American University of Beirut Medical Center, Beirut P.O. Box 11-0236, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2912-6800","authenticated-orcid":false,"given":"Ghina","family":"Khalil","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, American University of Beirut, Beirut P.O. Box 11-0236, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathalie","family":"Chamseddine","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hematology and Oncology, Naef K Bassile Cancer Institute, American University of Beirut Medical Center, Beirut P.O. Box 11-0236, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rawan","family":"Diab","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, American University of Beirut, Beirut P.O. Box 11-0236, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hadi","family":"Mansour","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, American University of Beirut, Beirut P.O. Box 11-0236, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohyeddine","family":"El Sayed","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, American University of Beirut, Beirut P.O. Box 11-0236, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maya","family":"Charafeddine","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hematology and Oncology, Naef K Bassile Cancer Institute, American University of Beirut Medical Center, Beirut P.O. Box 11-0236, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4606-5796","authenticated-orcid":false,"given":"Jaber","family":"Abbas","sequence":"additional","affiliation":[{"name":"Department of General Surgery, American University of Beirut Medical Center, Beirut P.O. Box 11-0236, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8483-0938","authenticated-orcid":false,"given":"Hazem I.","family":"Assi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hematology and Oncology, Naef K Bassile Cancer Institute, American University of Beirut Medical Center, Beirut P.O. Box 11-0236, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1941","DOI":"10.1002\/ijc.31937","article-title":"Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods","volume":"144","author":"Ferlay","year":"2019","journal-title":"Int. J. 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