Original articlePsychological factors associated with the intention to choose for risk-reducing mastectomy in family cancer clinic attendees
Introduction
Women who carry a BRCA1 or BRCA2 mutation have a significantly higher risk of developing breast cancer and ovarian cancer and a higher risk to develop cancer earlier in life, compared to the general population [1], [2], [3], [4], [5]. BRCA1/2 mutation carriers have to decide between the two main risk management options to cope with the increased breast cancer risk: breast cancer surveillance aimed at the early detection of breast cancer, and risk-reducing mastectomy (RRM) aimed at preventing breast cancer [6], [7].
RRM results in an actual breast cancer risk reduction of about 90% [8], [9] and a decrease of general and breast cancer specific distress [10], but is also associated with a negative impact on the sexual relationship, sexual satisfaction and body image [10], [11], [12]. Previously, sociodemographic (e.g. age, having children) and medical factors (e.g. mutation status, previous breast or ovarian cancer) have been found to influence the RRM decision-making process [13]. However, only limited research has been done to identify the psychological factors associated with the decision for RRM. So far, this research has primarily focused on perceived risk, anxiety & worry [13].
Specifically, a higher perceived cancer risk has been associated with uptake of, or intention to choose for RRM [14], [15], [16], [17], [18], [19], [20], [21], [22]. Furthermore, increased cancer-related distress, (cancer specific) anxiety and cancer worry are associated with a preference for RRM [17], [19], [21], [22], [23].
As several studies have emphasized the role of emotions and underlying affect on medical decision-making [24], [25], [26], [27], it is very plausible that more psychological factors, such as affect, influence the decision to undergo RRM. Identifying these factors is important for health care professionals providing decisional support and permits improved shared decision-making. This study specifically investigated which psychological factors are related to the intention to choose for RRM.
Section snippets
Population
The population of the current study was recruited in the context of the Breast Cancer Risk Communication (BRISC) study, which is a prospective study carried out in three academic familial cancer clinics in the Netherlands, i.e. University Medical Center Groningen, VU University Medical Center Amsterdam and Leiden University Medical Center [28]. Included in the BRISC study were women with a family history of breast cancer who sought first time genetic counseling concerning their breast cancer
Description of the population
The analyses included 486 women and population characteristics are given in Table 1. Of these women, 125 (25.7%) women had an intention to choose for RRM when indicated and 260 (54.5%) women perceived their breast cancer risk as high (Table 1).
Predictors of the intention to choose for RRM
In the univariate analysis, having children (OR = 2.21, 95%CI = 1.35–3.60), not being highly educated (OR = 1.59, 95%CI = 1.03–2.45), a high perceived risk (OR = 1.89, 95%CI = 1.25–2.88), experiencing high cancer worry (OR = 2.20, 95%CI = 1.45–3.32), a
Discussion
The objective of this study was to identify psychological factors associated with the intention to choose for RRM, as research so far has mainly been limited to sociodemographic and medical factors.
Of the participants 25.7% had an intention to choose for RRM if indicated due to a BRCA1/2 mutation. Next to having children, the following psychological factors were associated with the intention to choose for RRM: high positive and high negative affect, experiencing a high level of personal
Ethical approval
The Medical Ethics Committees University Medical Center Groningen, VU University Medical Center Amsterdam and Leiden University Medical Center approved the BRISC study protocol in 2005.
Conflict of interest
All authors have no conflicts of interest to declare.
References (58)
- et al.
Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case Series unselected for family history: a combined analysis of 22 studies
Am J Hum Genet
(2003) - et al.
Body image and psychological distress after prophylactic mastectomy and breast reconstruction in genetically predisposed women: a prospective long-term follow-up study
Eur J Cancer
(2012) - et al.
Risk-reducing surgery in women with familial susceptibility for breast and/or ovarian cancer
Eur J Cancer
(2006) - et al.
Predictors of and satisfaction with bilateral prophylactic mastectomy
Prev Med (Baltim)
(1995) - et al.
The validity of the Hospital Anxiety and Depression Scale. An updated literature review
J Psychosom Res
(2002) - et al.
The affect heuristic
Eur J Oper Res
(2007) - et al.
Risky feelings: why a 6% risk of cancer does not always feel like 6%
Patient Educ Couns
(2010) - et al.
Reasons for risk-reducing mastectomy versus MRI-screening in a cohort of women at high hereditary risk of breast cancer
Breast
(2011) - et al.
Presymptomatic DNA testing and prophylactic surgery in families with a BRCA1 or BRCA2 mutation
Lancet (London, England)
(2000) - et al.
Bilateral prophylactic oophorectomy and bilateral prophylactic mastectomy in a prospective cohort of unaffected BRCA1 and BRCA2 mutation carriers
Clin Breast Cancer
(2007)
Time to prophylactic surgery in BRCA1/2 carriers depends on psychological and other characteristics
Genet Med
Risk-reducing mastectomy in BRCA1/2 mutation carriers: factors influencing uptake and timing
Maturitas
Progesterone and neuroprotection
Horm Behav
Meta-analysis of BRCA1 and BRCA2 penetrance
J Clin Oncol
Penetrance of breast cancer, ovarian cancer and contralateral breast cancer in BRCA1 and BRCA2 families: high cancer incidence at older age
Breast Cancer Res Treat
Cancer risks for BRCA1 and BRCA2 mutation carriers: results from prospective analysis of EMBRACE
J Natl Cancer Inst
Variation in mutation spectrum partly explains regional differences in the breast cancer risk of female BRCA mutation carriers in The Netherlands
Cancer Epidemiol Biomarkers Prev
Randomized trial of a shared decision-making intervention consisting of trade-offs and individualized treatment information for BRCA1/2 mutation carriers
J Clin Oncol
Prophylactic mastectomy: indications, options, and reconstructive alternatives
Plast Reconstr Surg
Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE study group
J Clin Oncol
Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer
N Engl J Med
The short-term psychological impact of complications after breast reconstruction
Psychooncology
Psychological reactions, quality of life, and body image after bilateral prophylactic mastectomy in women at high risk for breast cancer: a prospective 1-year follow-up study
J Clin Oncol
Women's decision making about risk-reducing strategies in the context of hereditary breast and ovarian cancer: a systematic review
J Genet Couns
“You don't want to lose your ovaries because you think ‘I might become a man’.” Women's perceptions of prophylactic surgery as a cancer risk management option
Psychooncology
Attitudes to prophylactic surgery and chemoprevention in Australian women at increased risk for breast cancer
J Women’s Heal
Prophylactic mastectomy or screening in women suspected to have the BRCA1/2 mutation: a prospective pilot study of women's treatment choices and medical and decision-analytic recommendations
Med Decis Mak
Genetic counselling and the intention to undergo prophylactic mastectomy: effects of a breast cancer risk assessment
Br J Cancer
Decision making regarding prophylactic mastectomy: stability of preferences and the impact of anticipated feelings of regret
J Clin Oncol
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