Decision‐making for bilateral risk‐reducing mastectomy for an increased lifetime breast cancer risk: A qualitative metasynthesis

Abstract Objective Previvor is a term applied to a person with an identified, elevated lifetime cancer risk but without an actual cancer diagnosis. Previvorship entails the selection of risk management strategies. For women with a genetic mutation that increases their predisposition for a breast cancer diagnosis, bilateral risk‐reducing mastectomy (BRRM) is the most effective prevention strategy. However, BRRM can change a woman's breast appearance and function. The purpose of this qualitative metasynthesis (QMS) was to better understand the decision‐making process for BRRM among previvors. Methods A theory‐generating QMS approach was used to analyze and synthesize qualitative findings. Research reports were considered for inclusion if: (1) women over 18 years of age possessed a genetic mutation increasing lifetime breast cancer risk or a strong family history of breast cancer; (2) the sample was considering, or had completed, BRRM; (3) the results reported qualitative findings. Exclusion criteria were male gender, personal history of breast cancer, and research reports which did not separate findings based on cancer diagnosis and/or risk‐reduction surgery. Results A theory and corresponding model emerged, comprised of seven themes addressing the decision‐making process for or against BRRM. While some factors to decision‐making were decisive for surgery, others were more indefinite and contributed to women changing, processing, or suspending their decision‐making for a period of time. Conclusions Regardless of the decision previvors make about BRRM, physical and psychosocial well‐being should be considered and promoted through shared decision‐making in the clinical setting.