Elsevier

The Breast

Volume 30, December 2016, Pages 66-72
The Breast

Original article
Psychological factors associated with the intention to choose for risk-reducing mastectomy in family cancer clinic attendees

https://doi.org/10.1016/j.breast.2016.08.016Get rights and content

Highlights

  • Novel findings concerning psychological predictors of risk-reducing mastectomy.

  • It is important to clarify affect during counseling to facilitate decision-making.

  • Personal control is a predictor for an intention for risk-reducing mastectomy.

Abstract

Objectives

Women seeking counseling because of familial breast cancer occurrence face difficult decisions, such as whether and when to opt for risk-reducing mastectomy (RRM) in case of BRCA1/2 mutation. Only limited research has been done to identify the psychological factors associated with the decision for RRM. This study investigated which psychological factors are related to the intention to choose for RRM.

Materials & methods

A cohort of 486 cancer-unaffected women with a family history of breast cancer completed the following questionnaires prior to genetic counseling: the Cancer Worry Scale, Positive And Negative Affect Scale, Perceived Personal Control Scale, Hospital Anxiety and Depression Scale and State Anxiety Scale and questions regarding socio-demographic characteristics, family history, risk perception and RRM intention. Multivariate logistic regression was used to analyze the relation between psychological factors and women's intention to choose for RRM.

Results

Factors associated with RRM intention were high positive affect (OR = 1.86, 95%CI = 1.12–3.08), high negative affect (OR = 2.52, 95%CI = 1.44–4.43), high cancer worry (OR = 1.65, 95%CI = 1.00–2.72), high perceived personal control (OR = 3.58, 95%CI = 2.18–5.89), high risk-perception (OR = 1.85, 95%CI = 1.15–2.95) and having children (OR = 2.06, 95%CI = 1.21–3.50).

Conclusion

Negative and positive affects play an important role in the intention for RRM.

Furthermore, perceived personal control over the situation is associated with an intention for RRM. In addition to focusing on accurate risk communication, counseling should pay attention to the influence of perceived control and emotions to facilitate decision-making.

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.

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