This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Unic, I. Articles by Van Daal, W. A.J. Search for Related Content PubMed PubMed Citation Articles by Unic, I. Articles by Van Daal, W. A.J. Social Bookmarking                   What's this?

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

A Prospective Pilot Study of Women's Treatment Choices and Medical and Decision-analytic Recommendations

Lia C.G. Verhoef, MD, PhD

Peep F.M. Stalmeier, PhD

Willem A.J. Van Daal, MD, PhD

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 < 0.0001) made a choice for PM more likely. Conclusions. The complete agreement between the decision-analytic recommendations and the carriers' choices suggests that women act in accordance with normative decision theory. The disagreement between the carriers' choices and the medical recommendations suggests that women's choices and physicians' recommendations were guided by different arguments. The strong association between time-tradeoff value and treatment choice suggests that the time-tradeoff is a valid method to assess preferences. Key words: breast cancer; prophylactic mastectomy; screening; shared decision making, utilities; time preferences. (Med Decis Making 2000;20:251-262)

Medical Decision Making, Vol. 20, No. 3, 251-262 (2000)
DOI: 10.1177/0272989X0002000301


CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				M. Helfand Shared Decision Making, Decision Aids, and Risk Communication Med Decis Making, October 1, 2007; 27(5): 516 - 521. [PDF]

				C. Wang, D. J. Bowen, and S. L. R. Kardia Research and Practice Opportunities at the Intersection of Health Education, Health Behavior, and Genomics Health Educ Behav, October 1, 2005; 32(5): 686 - 701. [Abstract] [PDF]

				M.S. van Roosmalen, P.F.M. Stalmeier, L.C.G. Verhoef, J.E.H.M. Hoekstra-Weebers, J.C. Oosterwijk, N. Hoogerbrugge, U. Moog, and W.A.J. van Daal Randomized Trial of a Shared Decision-Making Intervention Consisting of Trade-Offs and Individualized Treatment Information for BRCA1/2 Mutation Carriers J. Clin. Oncol., August 15, 2004; 22(16): 3293 - 3301. [Abstract] [Full Text] [PDF]

				M. Gurevich, G. M. Devins, C. Wilson, D. McCready, C. R. Marmar, and G. M. Rodin Stress Response Syndromes in Women Undergoing Mammography: A Comparison of Women With and Without a History of Breast Cancer Psychosom Med, January 1, 2004; 66(1): 104 - 112. [Abstract] [Full Text] [PDF]

				L. G. Singer, J. Theodore, and M. K. Gould Validity of Standard Gamble Utilities as Measured by Transplant Readiness in Lung Transplant Candidates Med Decis Making, September 1, 2003; 23(5): 435 - 440. [Abstract] [PDF]