Decision making for breast cancer prevention among women at elevated risk.
Several medical management approaches have been shown to be effective in preventing breast cancer and detecting it early among women at elevated risk: 1) prophylactic mastectomy; 2) prophylactic oophorectomy; 3) chemoprevention; and 4) enhanced screening routines. To varying extents, however, these approaches are substantially underused relative to clinical practice recommendations. This article reviews the existing research on the uptake of these prevention approaches, the characteristics of women who are likely to use various methods, and the decision-making processes that underlie the differing choices of women. It also highlights important areas for future research, detailing the types of studies that are particularly needed in four key areas: documenting women's perspectives on their own perceptions of risk and prevention decisions; explicit comparisons of available prevention pathways and their likely health effects; the psychological, interpersonal, and social processes of prevention decision making; and the dynamics of subgroup variation. Ultimately, this research could support the development of interventions that more fully empower women to make informed and values-consistent decisions, and to move towards favorable health outcomes.
Division of Health Services Management & Policy, College of Public Health, The Ohio State University, 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43220, USA. padamsee.1@osu.edu.
Tasleem J
0000-0001-6644-8084
TJ
Padamsee
College of Nursing, The Ohio State University, Columbus, OH, USA.
Celia E
CE
Wills
College of Medicine, The Ohio State University, Columbus, OH, USA.
Lisa D
LD
Yee
College of Medicine, The Ohio State University, Columbus, OH, USA.
Electra D
ED
Paskett
D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology*; D002755:Choice Behavior; D003657:Decision Making; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D005820:Genetic Testing / Q000379:methods; D006801:Humans; D012306:Risk