Women’s Decision Making about Risk-Reducing Strategies in the Context of Hereditary Breast and Ovarian Cancer: A Systematic Review
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Women who have a mutation in the BRCA1 or BRCA2 genes have up to an 87% lifetime risk of breast cancer and up to a 40% lifetime risk of ovarian cancer. Cancer prevention and early detection strategies are often considered by these women to address this heightened risk. Risk-reducing strategies include risk-reducing mastectomy and oophorectomy, breast and ovarian cancer screening, and chemoprevention. This systematic literature review summarizes the factors and contexts that influence decision making related to cancer risk-reducing strategies among women at high-risk for hereditary breast and ovarian cancer. In the 43 published research articles reviewed, three main types of factors are identified that influence high-risk women’s decisions about risk-reducing strategies: a) medical and physical factors, b) psychological factors and c) social context factors. How these factors operate in women’s lives over time remains unknown, and would best be elucidated through prospective, longitudinal research, as well as qualitative research.
KeywordsBRCA1 BRCA2 Screening Risk-reducing mastectomy Risk-reducing oophorectomy Chemoprevention Risk reduction Decision making
This project was completed while A.F. Howard held a Canadian Institute for Health Research Doctoral Research Award, a Canadian Institute for Health Research (CIHR) Psychosocial Oncology Research Training Fellowship, and a Michael Smith Foundation for Health Research Senior Graduate Studentship. Dr. Balneaves holds a CIHR New Investigator award. We would like to thank Dr. Gregory Haljan and the anonymous reviewers for their helpful comments on different versions of this manuscript.
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