Risk-reducing Mastectomy Perceptions and Decision-making Among Women at High Risk of Breast Cancer PDF Download

Author: E. Shaw Nunez
Publisher:
ISBN:
Category :
Languages : en
Pages :

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Author: Claire C. Conley
Publisher:
ISBN:
Category : Breast
Languages : en
Pages : 192

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Book Description
Women with a high risk of breast cancer have options for reducing risk, including surgery (mastectomy and/or oophorectomy), chemoprevention, and lifestyle changes. However, the ways in which women decide whether or not to pursue these options is not well understood. Both cognitive factors (e.g., perceived risk, perceived seriousness, attitudes) and emotional factors (e.g., cancer-related distress, emotion regulation) play a role in the decision-making process, but have not been tested as a single, integrated model. The present study investigates an innovative dual-pathway model of decision-making in a sample of women at high risk for breast cancer (N = 103). A single group, cross-sectional design was used. Participants self-reported cognitions about breast cancer risk (perceived susceptibility, perceived seriousness), attitudes about risk-reducing behaviors, cancer-related distress, emotion regulation, and intentions for risk-reducing behaviors. Mediation analyses examined hypothesized relationships between cognitive variables in predicting behavioral intentions, while moderation analyses examined hypothesized relationships between emotional variables in predicting behavioral intentions. Significant moderating effects of reappraisal were found for emotion-based models predicting mastectomy intentions (p = 0.04; 95% C.I. = [0.01, 0.03]) and chemoprevention intentions (p = 0.02; 95% C.I. = [0.01, 0.03]). No significant effects were observed for cognitive mediation models (all ps > 0.05; 95% C.I. lower bound = -0.03 – -0.01; 95% C.I. upper bound = 0.01 – 0.02). Results indicate that: 1) emotion regulation strategy use plays a significant role in risk-management decision-making; and 2) risk-management decisions are made independent of perceived severity. Results contribute to knowledge of decisional processes among women at high risk for breast cancer and highlight the need for modifications to existing health decision-making models. Specific targets for decision-making support interventions are identified.

Author: Barron H. Lerner
Publisher: Oxford University Press
ISBN: 0195349563
Category : Medical
Languages : en
Pages : 408

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In this riveting narrative, Barron H. Lerner offers a superb medical and cultural history of our century-long battle with breast cancer. Revisiting the past, Lerner argues, can illuminate and clarify the dilemmas confronted by women with--and at risk for--the disease. Writing with insight and compassion, Lerner tells a compelling story of influential surgeons, anxious patients and committed activists. There are colorful portraits of the leading figures, ranging from the acerbic Dr. William Halsted, who pioneered the disfiguring radical mastectomy at the turn of the century to George Crile, Jr., the Cleveland surgeon who shocked the medical establishment by "going public" with his doubts about mastectomy, to Rose Kushner, a brash journalist who relentlessly educated American women about breast cancer. Lerner offers a fascinating account of the breast cancer wars: the insistent efforts of physicians to vanquish the "enemy"; the fights waged by feminists and maverick doctors to combat a paternalistic legacy that discouraged decision-making by patients; and the struggles of statisticians and researchers to generate definitive data in the face of the great risks and uncertainties raised by the disease. As easy as it is to demonize male physicians, the persistence of the radical mastectomy and other invasive treatments has had as much to do with the complicated scientific understandings of breast cancer as with sexism. In Lerner's hands, the fight against breast cancer opens a window on American medical practice over the last century: the pursuit of dramatic cures with sophisticated technologies, the emergence of patients' rights, the ethical and legal challenges raised by informed consent, and the limited ability of scientific knowledge to provide quick solutions for serious illnesses. A searching and profound work on an emotionally charged issue, The Breast Cancer Wars tells a story that remains of vital importance to modern breast cancer patients, their families and the clinicians who strive to treat and prevent this dreaded disease.

Author: Mehmet Ali Ergun
Publisher:
ISBN:
Category :
Languages : en
Pages : 131

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Breast cancer is the most common non-skin cancer and a leading cause of death for U.S. women population. Depending on the personal and hereditary factors, each woman has a different risk of developing a breast cancer and the focus of recent studies has been on identifying the high-risk patients and reducing the mortality and adverse effects due to a breast cancer. For high-risk women, we can prevent breast cancer mortality either by aggressive screening and early detection or by taking preventative treatments such as hormonal therapy (i.e. Tamoxifen, Raloxifene, Exemestane) or a risk reduction surgery (i.e. Bilateral Prophylactic Mastectomy). In Chapter 3, we focus on the problem faced by clinicians and patients who are at higher risk of breast cancer: should a high-risk patient choose to go for a preventative treatment given her current risk estimates, age and treatment history? We formulate this optimal decision-making problem for preventing breast cancer as a discrete time, finite-horizon Markov Decision Process (MDP) model. The objective of this model is to maximize the total expected quality-adjusted life years (QALYs) for a patient while assuming that the decision makers are risk neutral. We use data from literature and Surveillance Epidemiology and End Results (SEER) database for estimating the model parameters. The interventions we consider in the model are tamoxifen and mastectomy for pre-menopausal women and tamoxifen, raloxifene, exemestane and mastectomy for post-menopausal women. The optimal policy in the preliminary results shows that the patients who have 47% or more risk of breast cancer should have a mastectomy if they are between 35-40 years old and have no previous history of preventative treatment. The risk threshold goes up with age for the mastectomy decisions. Among the pharmacological interventions, tamoxifen is optimal for pre-menopausal women around the age of 40 with a lifetime risk of 39% or above which also corresponds to a 5-year risk of 1.6% and above around the age of 40. Exemestane is optimal for post-menopausal women with a lifetime risk of 13% (corresponding 5-year risk of 1%) or above after age of 51. Raloxifene is optimal only when we have elevated risks after age 65 or older. In Chapter 4, we consider optimal breast cancer risk reduction policies when direct and indirect costs associated with the treatments are considered. Although exemestane is the dominant recommendation in QALY maximizing model, the results of the cost model show that it is not cost-efficient up to willingness-to-pay (WTP) ratio of $150,000. We also demonstrated that the optimal policy is very sensitive to the discount factor from which most preventative interventions suffer. In Chapter 5, we investigate the effect of risk-averse behavior on the optimal policies for breast cancer risk reduction. We use two main approaches to model risk aversion. First, we use utility functions with different forms to see the effect of aversion from uncertainty. In the second approach, we utilize dynamic risk measures and explore cases in which aversion is from the cancer risk. While purely risk-averse utility functions lead to myopic decision making, increasing risk-aversion coefficient for dynamic risk measures result in more aggressive treatment policies.

Author: Andrea Patenaude
Publisher: Bloomsbury Publishing USA
ISBN:
Category : Health & Fitness
Languages : en
Pages : 285

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This book presents the candid stories of women at high hereditary risk of breast cancer who chose to have their breasts surgically removed while they were still healthy, rather than risk getting the cancer that had, in many cases, devastated others in their family. Author Andrea Farkas Patenaude, a clinical psychologist at the Dana-Farber Cancer Institute, has spent much time talking with women who decided to have risk-reducing or prophylactic mastectomy rather than undergo a lifetime of repeated screenings—a strategy that can help to detect cancers early, but cannot prevent breast cancer. In Prophylactic Mastectomy: Insights from Women Who Chose to Reduce Their Risk, Patenaude shares many candid stories from these women and documents the risks and benefits of this decision. The potential emotional trauma and lifelong effects on self-concept, body image, and sexual function for those who choose the surgery are profound. While the risks involved are great, these interviews also demonstrate the relief many women find in making this powerful decision. This book supplies much-needed guidance for both patients and physicians in confronting this complex decision, and provides comprehensive information on how women fare emotionally and interpersonally after this life-altering surgery. Interviewed as part of a study funded by the Department of Defense Breast Cancer Research Program and the National Human Genome Research Institute, the subjects are diverse: married and single women, young adults, the middle-aged, parents, and women without children. Every case reveals the ramifications of each individual's difficult but potentially life-saving decision. The women explain why they made their choice, how they adapted to the new look of their bodies, and how they cope with spouses', partners', and family members' reactions to their changed physique.

Author: Akron Akron Press
Publisher:
ISBN: 9781548786786
Category :
Languages : en
Pages : 142

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This article collection reviews the prevention of breast cancer and includes 20 papers by various authors. Topics include: Decision making for breast cancer prevention among women at elevated risk; Omega-3 fatty acids for breast cancer prevention and survivorship; Using Twitter for breast cancer prevention: an analysis of breast cancer awareness month; Future possibilities in the prevention of breast cancer: Intervention strategies in BRCA1 and BRCA2 mutation carriers; Beliefs and perceptions about the causes of breast cancer: a case-control study; Awareness and correlates of the role of physical activity in breast cancer prevention among Japanese women: results from an internet-based cross-sectional survey; Future possibilities in the prevention of breast cancer: Role of genetic variation in breast cancer prevention; Breast cancer prevention in the developing world; Ongoing data from the breast cancer prevention trials: opportunity for breast cancer risk reduction; Future possibilities in the prevention of breast cancer: Luteinizing hormone-releasing hormone agonists; Estrogen- and stress-induced DNA damage in breast cancer and chemoprevention with dietary flavonoid; Longer term effects of the Angelina Jolie effect: increased risk-reducing mastectomy rates in BRCA carriers and other high-risk women; Decision aids for breast cancer chemoprevention; Role of a polyphenol-enriched preparation on chemoprevention of mammary carcinoma through cancer stem cells and inflammatory pathways modulation; Exploring breast cancer preventive lifestyle and social support of Iranian women: a study protocol for a mixed-methods approach; Breast cancer treatment-associated cardiovascular toxicity and effects of exercise countermeasures; Vitamin D and breast cancer: interpreting current evidence; Awareness of preventive medication among women at high risk for breast cancer and their willingness to consider transdermal or oral tamoxifen: a focus group study; Prevention of breast cancer by recapitulation of pregnancy hormone levels; Integrating precision cancer medicine into healthcare-policy, practice, and research challenges. Proceeds from the sale of this book go to the support of an elderly disabled person.

Author: Sahar Sajadi
Publisher:
ISBN:
Category :
Languages : en
Pages :

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"Women diagnosed with breast cancer who carry a mutation in the genes BRCA1/2 are at an increased risk of developing cancer in the contralateral breast. Undergoing bilateral mastectomy significantly reduces the risk of developing second primary breast cancer in these women. Rapid genetic counseling and testing can provide newly affected women the opportunity to know their carrier status before undergoing any primary surgery so they can avoid an additional second surgery.Method: Forty-four women newly diagnosed with breast cancer were offered rapid genetic testing and counseling. Several psychological factors were measured at baseline and during follow-up in order to investigate the influencing factors on decision-making to undergo bilateral mastectomy in newly diagnosed women.Result: Seven out of 44 participants were identified as mutation carriers. All of the carriers underwent prophylactic surgery. Results showed no difference in cancer-related stress and general anxiety in patients opting for bilateral mastectomy compared to those who did not. All of the women were satisfied with undergoing rapid genetic counseling and testing and thought that it was offered to them at an appropriate time.Conclusion: Carrier status knowledge plays a determining role on decision-making for undergoing bilateral mastectomy. Participating in genetic testing right after diagnosis does not impose an additional distress on women." --

Author: William J. Gradishar
Publisher: Springer Science & Business Media
ISBN: 9780792378907
Category : Medical
Languages : en
Pages : 230

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Book Description
The optimal management of breast cancer patients relies on the expertise of a team of medical specialists including radiologists, surgeons, radiation therapists and medical oncologists. Much of the progress in breast cancer management made over the last several years reflects the translation of observations made in the laboratory to the clinic. Critically evaluating the impact of new treatment approaches relies on a commitment to well-designed clinical trials. In this volume, Advances in Breast Cancer Management, a renowned group of breast cancer experts have been asked to provide their perspective on management issues that directly effect patients on a day-to-day basis. Dr. Melody Cobleigh discusses the consequences of estrogen deprivation and the ways of ameliorating secondary symptoms and the potential long-term morbidity. Drs. Haigh and Guiliano review the sentinel lymph node biopsy technique including results from their extensive experience. Dr. Abram Recht places into perspective the potential benefit of post-mastectomy radiotherapy and reviews recent trials that address this issue. Dr. Dennis Slamon takes from us from the laboratory to the clinic in explaining the development of Herceptin as a paradigm for therapy targeted to specific molecular characteristics of breast cancer tumor cells. Drs. Nieto, Shpall, Crump and Pritchard offer different perspectives on the future of high-dose chemotherapy with stem cell transplantation as a treatment for breast cancer patients. Drs.

Author: Janice Famorca-Tran
Publisher:
ISBN:
Category : BRCA genes
Languages : en
Pages : 296

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Approximately 5% to 10% of breast cancer cases will be a result of a mutation in the breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2). An individual with a mutation in either of these genes has a greater probability of malignant transformation and the subsequent development of breast cancer. Once a woman is genetically tested and discovers she has inherited a BRCA mutation, she is confronted with a number of challenging decisions. One of the most distressing decisions is whether or not to pursue a prophylactic bilateral mastectomy to decrease her breast cancer risk. The purpose of this study was to explore the decision-making processes of BRCA positive women, 50 years of age or younger, and their decision to elect to have a prophylactic bilateral mastectomy. Seventeen BRCA positive women were interviewed in order to understand the decision-making process in electing to have a prophylactic mastectomy. Grounded theory methodology using Strauss and Corbin’s method with Feminist epistemology as the philosophical framework was utilized. Semi-structured interviews were conducted. Data analysis was performed utilizing open, axial, and selective coding. Three major categories or decision-making processes evolved: influential others, knowledge and awareness, and ownership of body. The core category was identified as taking charge. Considering the timing of their surgery in view of significant life events or stages was also essential to taking charge. The collective experience eventually progresses to situated decision-making among BRCA positive women. The concept of timing and situated decision-making among BRCA positive women seemed to vary or fluctuate depending on the unique experiences of each individual. The theory recognizes that although fear and anxiety developed in these women as a result of being BRCA positive, they took proactive measures and positively changed their mindset in order to help alleviate their concerns. The collective experience of all these processes provided these women the necessary knowledge and information needed in order to make an informed decision based on their current life situation progressing to the Situated Decision-making Among BRCA Women Grounded Theory.

Author:
Publisher:
ISBN:
Category :
Languages : en
Pages : 131

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The study described perceived breast cancer risk compared subjective and objective risk estimates and examined the influence of heuristic reasoning in women's narratives. The survey used three probability scales (Verbal Comparative Numerical) and the Gail model to measure perceived and objective risk. Aim 3 was addressed with argument and heuristic reasoning analysis. We recruited a multicultural educated sample of 184 English-speaking women from community settings. Fifty four provided an in-depth interview. Participants held an optimistic bias regarding their breast cancer risk (comparative optimism and better-than-average) and underestimated their objective risk calculated with the Gail model. Breast cancer worry was a significant predictor of breast cancer risk. Better-educated and higher-income women reported lower levels of worry while Black women were more likely than Asian and White women to report higher levels of worry but not higher levels of perceived risk. Most participants did not know that older age is a breast cancer risk factor and older women did not perceive higher risk. These findings imply that women's knowledge of breast cancer risk factors was incomplete despite their high educational level. Age and family history are independent predictors of sporadic and hereditary/familial breast cancer risk; yet women could not distinguish between the two forms of the disease. Most participants (70%) were adherent to mammography and clinical breast exam (CBE) screening guidelines which can be attributed to high access to screening services and efforts from health care providers. Age having health insurance and higher 5-year Gail scores were significant predictors of frequency of screening mammograms and CBEs. Distrust of the health system was the single most important predictor of predisposition to use health services which in turn was another significant predictor of screening mammograms and CBEs.