Psychosocial factors associated with the uptake of contralateral prophylactic mastectomy among BRCA1/2 mutation noncarriers with newly diagnosed breast cancer.
Women who are newly diagnosed with breast cancer may consider contralateral prophylactic mastectomy (CPM) to reduce their future risk of cancer in their unaffected breast. Pre-surgical BRCA1/2 genetic testing can provide valuable risk information to guide this choice. However, little is understood about why BRCA1/2 mutation noncarriers, who are generally not at substantially elevated risk of contralateral disease, select CPM.



We examined the uptake of CPM among breast cancer patients identified as BRCA1/2 mutation noncarriers (n = 92) as part of a larger prospective study of the impact of pre-surgical BRCA1/2 testing. Data obtained from self-report questionnaires and patient medical records were used to examine associations between theoretically relevant background and psychosocial factors and BRCA1/2 mutation noncarriers' decisions to undergo CPM.



Among BRCA1/2 mutation noncarriers, 25% (n = 23) elected to undergo CPM. Psychosocial factors including a self-reported physician recommendation for CPM, greater perceived contralateral breast cancer risk, and greater perceived benefits of CPM were all significantly associated with the uptake of CPM.



A sizeable minority of BRCA1/2 mutation noncarriers choose to undergo CPM after learning their mutation status through pre-surgical genetic testing. BRCA1/2 mutation noncarriers' cognitive perceptions and social influences appear to be important in shaping their decisions regarding CPM. This work highlights the importance of several psychosocial factors in influencing patients' surgical decisions. Future research is needed that examines the formation of BRCA1/2 mutation noncarriers' beliefs regarding their disease and available treatment options, and that characterizes the physician-patient communication that occurs in this complex decision-making context.
Behavioral Sciences Service, Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th floor, New York, 10022, NY, USA. hamiltoj@mskcc.org.|Department of Psychiatry, Weill Cornell Medical College, Cornell University, New York, NY, USA. hamiltoj@mskcc.org.
Jada G
JG
Hamilton
Behavioral Sciences Service, Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th floor, New York, 10022, NY, USA.
Margaux C
MC
Genoff
Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Melissa
M
Salerno
Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Kimberly
K
Amoroso
Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Division of Medical Genetics, Department of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Sherry R
SR
Boyar
Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Margaret
M
Sheehan
Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Megan Harlan
MH
Fleischut
Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Beth
B
Siegel
Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Angela G
AG
Arnold
Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Erin E
EE
Salo-Mullen
Behavioral Sciences Service, Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th floor, New York, 10022, NY, USA.|Department of Psychiatry, Weill Cornell Medical College, Cornell University, New York, NY, USA.
Jennifer L
JL
Hay
Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA.
Kenneth
K
Offit
Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA.
Mark E
ME
Robson
D000328:Adult; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000235:genetics / Q000523:psychology* / Q000601:surgery; D003657:Decision Making; D057286:Electronic Health Records; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D006801:Humans; D008875:Middle Aged; D009154:Mutation; D010465:Perception; D000072036:Prophylactic Mastectomy; D011446:Prospective Studies; D012307:Risk Factors; D057566:Self Report
Breast cancer; Decision-making; Genetic testing; Prevention; Prophylactic mastectomy