Decision‐making for bilateral risk‐reducing mastectomy for an increased lifetime breast cancer risk: A qualitative metasynthesis

Objective Previvor is a term applied to a person with an identified, elevated lifetime cancer risk but without an actual cancer diagnosis. Previvorship entails the selection of risk management strategies. For women with a genetic mutation that increases their predisposition for a breast cancer diagn...

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Bibliographic Details
Published in:Psycho-oncology (Chichester, England) England), 2024-03, Vol.33 (3), p.e6311-n/a
Main Authors: Torrisi, Christa, Wareg, Nuha K., Anbari, Allison Brandt
Format: Article
Language:English
Subjects:
Adolescent
Adult
BRCA gene and oncology
Breast cancer
breast cancer risk management
Breast Neoplasms - genetics
Breast Neoplasms - prevention & control
Breast Neoplasms - surgery
decision‐making in breast cancer
Family medical history
Female
Genetic disorders
genetic predisposition to breast cancer
hereditary breast and ovarian cancer syndrome
Humans
Male
Mastectomy
Mastectomy - psychology
Medical diagnosis
Mutation
Ovarian cancer
Prevention
prophylactic mastectomy to decrease cancer risk
Psychosocial factors
Risk
Risk management
Risk reduction
Risk Reduction Behavior
Surgery
Women
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Summary:Objective Previvor is a term applied to a person with an identified, elevated lifetime cancer risk but without an actual cancer diagnosis. Previvorship entails the selection of risk management strategies. For women with a genetic mutation that increases their predisposition for a breast cancer diagnosis, bilateral risk‐reducing mastectomy (BRRM) is the most effective prevention strategy. However, BRRM can change a woman's breast appearance and function. The purpose of this qualitative metasynthesis (QMS) was to better understand the decision‐making process for BRRM among previvors. Methods A theory‐generating QMS approach was used to analyze and synthesize qualitative findings. Research reports were considered for inclusion if: (1) women over 18 years of age possessed a genetic mutation increasing lifetime breast cancer risk or a strong family history of breast cancer; (2) the sample was considering, or had completed, BRRM; (3) the results reported qualitative findings. Exclusion criteria were male gender, personal history of breast cancer, and research reports which did not separate findings based on cancer diagnosis and/or risk‐reduction surgery. Results A theory and corresponding model emerged, comprised of seven themes addressing the decision‐making process for or against BRRM. While some factors to decision‐making were decisive for surgery, others were more indefinite and contributed to women changing, processing, or suspending their decision‐making for a period of time. Conclusions Regardless of the decision previvors make about BRRM, physical and psychosocial well‐being should be considered and promoted through shared decision‐making in the clinical setting.
ISSN:1057-9249
1099-1611
DOI:10.1002/pon.6311