title: Intentions for bilateral mastectomy among newly diagnosed breast cancer patients.
abstract: BACKGROUND
  Recent trends suggest that bilateral mastectomy (BM) is on the rise among women diagnosed with unilateral breast cancer. Few studies have investigated the factors associated with the decision to have more aggressive surgery among young, high risk patients.
  
  
  METHODS
  As part of a larger study, 284 women aged 50 and under completed an initial survey within 6 weeks of a breast cancer diagnosis. We assessed sociodemographics, medical and family history variables, treatment recommendations, preferences and concerns, distress, perceived risk, knowledge, and neuroticism. We used multiple regression with backward entry to assess the relationship between these variables and our outcomes of decisional conflict and intentions for BM.
  
  
  RESULTS
  Higher decisional conflict was associated with being less educated, unmarried, more anxious and less likely to have received a surgical recommendation. Preference for BM was associated with higher neuroticism, perceived risk for contralateral breast cancer, pre-testing risk of carrying a BRCA1/2 mutation, having received either a surgical recommendation (vs. no recommendation), and lower preference for lumpectomy.
  
  
  CONCLUSIONS
  For younger women, a surgical recommendation is associated with lower decisional conflict and stronger intention for BM. Results highlight the importance of effective risk communication and decision support between a woman and her surgeon.
authors.affiliation: Department of Oncology, Jess and Mildred Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia 20007, USA.
authors.forename: Lesley
authors.initials: L
authors.lastname: King
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: O'Neill
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Spellman
authors.forename: Beth N
authors.initials: BN
authors.lastname: Peshkin
authors.forename: Heiddis
authors.initials: H
authors.lastname: Valdimarsdottir
authors.forename: Shawna
authors.initials: S
authors.lastname: Willey
authors.forename: Kara Grace
authors.initials: KG
authors.lastname: Leventhal
authors.forename: Tiffani
authors.initials: T
authors.lastname: DeMarco
authors.forename: Rachel
authors.initials: R
authors.lastname: Nusbaum
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Feldman
authors.forename: Lina
authors.initials: L
authors.lastname: Jandorf
authors.forename: Marc D
authors.initials: MD
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D001008:Anxiety Disorders; D001943:Breast Neoplasms / Q000175:diagnosis / Q000523:psychology / Q000601:surgery*; D003220:Conflict, Psychological; D003657:Decision Making; D004522:Educational Status; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006801:Humans; D033182:Intention; D016014:Linear Models; D017533:Marital Status; D015411:Mastectomy, Modified Radical; D015412:Mastectomy, Segmental; D008875:Middle Aged; D000075384:Neuroticism; D010358:Patient Participation; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D011795:Surveys and Questionnaires; D014481:United States