Time to decide about risk-reducing mastectomy: A case series of BRCA1/2 gene mutation carriers

Data was collected in a pilot study that assessed the response of women to an information booklet about RM and decision-making support strategies. A detailed analysis of three women's descriptions of their decision-making processes and outcomes was conducted.All three women were carriers of a BRCA1/2 gene mutation and, although undecided, were leaning towards RM when initially assessed. Each woman reported a different RM decision outcome at last follow-up. Case #1 decided not to have RM, stating that RM was "too radical" and early detection methods were an effective strategy for dealing with breast cancer risk. Case #2 remained undecided about RM and, over time, she became less prepared to make a decision because she felt she did not have sufficient information about surgical effects. Case #3 had undergone RM by the time of her second follow-up interview and reported that she felt "a load off (her) mind now".RM decision making may shift over time and require decision support over an extended period.As testing for BRCA1/2 gene mutations becomes more widely available as a clinical service, increasing numbers of women are being identified at high risk for breast and ovarian cancer. Female BRCA1/2 carriers are told they have an estimated lifetime risk of breast cancer between 50% and 85% [1]. Risk-reducing mastectomy (RM) is one option for breast cancer risk reduction that is offered to women who learn they are carriers of a BRCA1/2 gene mutation. Although reported interest in RM varies by clinic setting and country, up to half of women at high risk for breast cancer express either the intention to have RM or some uncertainty about this decision [2-4]. Our clinical observations indicate that with increased access to BRCA1/2 genetic testing, more high-risk women are considering RM and the majority of these women request additional information and support with this difficult decision.An emerging body of research describes high-risk women's experiences and satisfaction wit