Prophylactic Mastectomy or Screening in Women Suspected to Have the BRCA1/2 Mutation

Ivana Unic, Lia C.G. Verhoef, Peep F.M. Stalmeier and Willem A.J. Van Daal

Medical Decision Making, 2000, vol. 20, issue 3, 251-262

Abstract: Background. Women suspected to have the BRCA1/2 mutation may choose between two management options: breast cancer screening and prophylactic mastectomy (PM). Objectives . To compare women's treatment choices with medical and decision-analytic recommendations and to explore variables related to the women's choices. Methods. After provision of information, individual time-tradeoff values for the health outcome "living after PM" were assessed and incorporated into a decision-analytic model, which compared the management options PM and screening with respect to their effects on quality-adjusted life expectancy. Results. Of the 54 women suspected to have the mutation, 51 completed the shared-decision-making procedure. Quality-adjusted life expectancy after PM management was longer for 67% of proven carriers and for 58% of women awaiting the DNA-test result. Twelve proven carriers made definitive treatment choices: eight (67%) chose PM and four (33%) chose screening. All carriers' treatment choices agreed with the normative decision-analytic recommendations. Four (33%) disagreed with the medical recommendations. Of the 36 women awaiting DNA-test results, 32 made hypothetical treatment choices. The agreement between these hypothetical treatment choices and the decision-analytic recommendations was good (78%). Combining data from all 48 women, being married (OR = 14.00, p = 0.006), having children (OR = 4.71, p = 0.02), low desire to participate (OR = 0.14, p = 0.004), high decisional stress (OR = 5.22, p = 0.01), a lower estimate of the "probability of cure for screen-detected breast cancer" (OR = 0.13, p = 0.004), and higher time-tradeoff values for PM (OR = 182, p

Date: 2000
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:20:y:2000:i:3:p:251-262

DOI: 10.1177/0272989X0002000301

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