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Cracking open the eristic rhetoric of contralateral prophylactic mastectomy research or why surgeons should not be so certain about this controversial breast cancer treatment
  1. Kelly Pender
  1. English, Virginia Tech, Blacksburg, USA
  1. Correspondence to Dr Kelly Pender, English, Virginia Tech, Blacksburg, USA; pender{at}


Contralateral prophylactic mastectomy (CPM) is a controversial breast cancer treatment in which both breasts are removed when only one is affected by cancer. Rates of CPM have been rising since the late 1990s, despite surgeons’ strong agreement that the procedure should not be performed for average-risk women. This essay analyses that agreement as it is demonstrated in the surgical literature on CPM, arguing that it forms a ‘rhetoric of certainty’ built on the stark epistemological divide between objective and subjective forms of knowledge that operates in some areas of medicine. Further, the essay argues that this rhetoric of certainty has the potential to function as a kind of eristic rhetoric in which the right conclusion is known prior to any rhetorical exchange. As a way to ‘crack open’ this certainty, the essay compares the rhetoric of the surgical literature on CPM to the rhetoric of uncertainty in the radiological literature on breast cancer screening for women with a personal history of the disease. The goal of this comparison is not to suggest surgeons should support all choices for CPM. Rather, the aim is to demonstrate that choices against the procedure are not as straightforward as the surgical literature indicates and that the uncertainty affecting women’s preferences for CPM is not solely the result of patient misunderstanding and/or emotional instability.

  • Cancer care
  • Medical humanities
  • Surgery

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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  • Contributors KP is the sole author.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.