title: Bilateral prophylactic mastectomy decision making: A vignette study.
abstract: BACKGROUND
  Little is known about the perception of bilateral prophylactic mastectomy (BPM), and whether perceptions are influenced by a family history of breast cancer. It is also unclear what factors may play a role in selecting BPM for follow-up care.
  
  
  METHODS
  Samples of predominantly Caucasian, well-educated women with (n = 129) and without (n = 104) family histories of breast cancer were provided a vignette of a woman at increased risk. They selected one of two follow-up options: (1) clinical breast examination, breast self exam, and annual mammography or (2) BPM.
  
  
  RESULTS
  The samples did not differ on the decision to select BPM (29.5% vs 22.1%). The family history sample reported worry about breast cancer as a problem (34.4%) more often than women with no history (15.7%). Multivariate analysis found worry and estimated 10-year risk of the woman in the vignette as significant predictors of selecting BPM.
  
  
  CONCLUSIONS
  Approximately 25% of our sample selected BPM as the preferred option. The majority supported the need to discuss BPM among women at increased risk. Finally, both factors associated with the selection of BPM (worry, risk assessment) are potentially amenable to psychosocial or educational approaches. There is a clear need for assessment of worry and risk perception prior to surgical decision making.
authors.affiliation: Behavioral Research Program, Division of Cancer Control and Population Services, National Cancer Institute, 6130 Executive Boulevard/EPN 211, Bethesda, Maryland, 20892, USA. ms496r@nih.gov
authors.forename: M
authors.initials: M
authors.lastname: Stefanek
authors.forename: C
authors.initials: C
authors.lastname: Enger
authors.forename: J
authors.initials: J
authors.lastname: Benkendorf
authors.forename: S
authors.initials: S
authors.lastname: Flamm Honig
authors.forename: C
authors.initials: C
authors.lastname: Lerman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000517:prevention & control* / Q000523:psychology*; D016022:Case-Control Studies; D003657:Decision Making; D005260:Female; D020022:Genetic Predisposition to Disease / Q000523:psychology*; D006801:Humans; D008408:Mastectomy / Q000523:psychology*; D008875:Middle Aged; D017060:Patient Satisfaction; D018570:Risk Assessment; D012309:Risk-Taking; D013223:Statistics as Topic