Risk Reduction Decision Making in Women with BRCA1/2 Gene Mutations

With technological advances in testing for gene mutations, a new population of BRCA1/2 women is becoming aware of their increased risk for developing breast and/or ovarian cancer. A salient issue these women face is which risk-reducing option to choose. Little is known about the decision making factors underlying the choice of prophylactic mastectomy for women with a BRCA1/2 mutation. To address this issue, 137 unaffected, positive BRCA1/2 gene mutation carriers (42 who opted for prophylactic mastectomy, 95 who did not) served as participants. All women completed an on-line battery that assessed the following theory-based decision making variables: advantages and disadvantages of prophylactic mastectomy (normative decision theory), physician recommendation (shared decision making theory), cancer worry (affect theory), and information-seeking coping style. With the exception of information-seeking style (p = .8715), the decision making variables of advantages and disadvantages of prophylactic mastectomy, physician input, and cancer worry did have a significant relationship with risk-reduction option chosen. Women who rated the advantages higher than the disadvantages of prophylactic mastectomy (r = .31, p ≤ .001), whose physician had recommended prophylactic mastectomy exclusively (X² = 11.85; p \u3c .001), and who reported higher cancer worry scores a month after receiving BRCA1/2 positive results (r = .28, p ≤ .001) were more likely to have chosen prophylactic mastectomy. The perceived impact (conflict, regret, cancer worry, and general well-being) of risk-reducing option selected was also explored. The direction of these relationships indicates that having chosen prophylactic mastectomy was associated with less decisional conflict (r = -.38, p ≤ .0001), decisional regret (r = -.58, p ≤ .0001), depressive symptomatology (r = -.19, p ≤ .05), and cancer worry (r = -.39, p ≤ .0001). The results suggest higher assessments of advantages over disadvantages of prophylactic mastectomy, doctor recommendation for prophylactic mastectomy exclusively, and higher cancer worry at time of testing is associated with choosing the risk-reducing option of prophylactic mastectomy. In addition, women who chose prophylactic mastectomy fared better psychologically than those who did not. Continued research addressing decision making variables and the impact of risk-reducing decisions may lead to improved understanding on how best to approach these difficult decisions