Choosing Between Medical Surveillance and Preventive Surgical Interventions Among Asymptomatic BRCA Positive Women

Women with a known BRCA 1 or BRCA 2 genetic mutation are at an increased risk for the development of cancer, most commonly breast and uterine types. Risk reduction strategies to manage cancer risk include increased medical surveillance and various preventive surgeries. This is a deeply personal decision and one that is influenced by a variety of factors. The aim of this literature review is to identify the key factors impacting the decision-making process of a woman with a BRCA mutation and how a woman ultimately decides between the cancer risk management strategies. Six electronic databases were used to obtain the highest levels of evidence to answer the clinical question at stake. A total of 13 research articles met inclusion criteria and were examined for key findings. Upon review of the literature, it is evident that themes exist when examining the decision-making process of women carrying a BRCA mutation. The most common factor appearing to influence women’s decisions is when a woman has experienced a family member diagnosed with cancer or has experienced the death of a family member from cancer; these women tend to choose a preventive surgery. Other factors that affect women in their decision-making are their stage of life with regards to relationship status and parity, the value placed on body image and the female body parts, and a variety of psychosocial factors. Medical professionals can also heavily influence how women make decisions. The findings of this review are significant for all health care providers as they engage in shared decision-making and support women with a BRCA genetic mutation who must decide upon a risk reducing strategy