Breast cancer risk assessment and prevention: a framework for shared decision-making consultations.
Options for breast cancer prevention, used in combination with screening and surveillance, include lifestyle modifications, chemoprevention with tamoxifen, and prophylactic surgery. Preventive health decisions are often preference driven: patients typically must choose whether to initiate effective treatments that hold the possibility of side effects that can negatively impact quality of life. This situation demands that patients be well informed and have a full understanding of the risks associated with each option. Investigators have developed a comprehensive decision-making framework designed to support breast cancer prevention consultations within a shared decision-making setting. The framework integrates predictive information from current risk models within the context of a woman's general health to appropriately frame breast cancer risk management consultations and outlines the application of available treatments and emerging biomarker information to individual patient decisions. Using an evidence-based approach, specialized risk-benefit projections can be provided in the clinical setting. A more comprehensive individualized risk profile allows for tailored medical management plans and can better prepare patients to make informed decisions. The framework is intended to encourage a shared decision-making approach to prevention consultations, a method for researchers to increase accrual to trials, and to more quickly incorporate new findings into the routine of practice.
Ozanne
Elissa M
EM
Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA. elissa@mgh-ita.org
Klemp
Jennifer R
JR
Esserman
Laura J
LJ
D000367:Age Factors; D000368:Aged; D014408:Biomarkers, Tumor; D001943:Breast Neoplasms / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D003657:Decision Making; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D010347:Patient Care Planning; D010353:Patient Education as Topic; D011788:Quality of Life; D012017:Referral and Consultation; D018570:Risk Assessment
D014408:Biomarkers, Tumor