The acceptability of prophylactic mastectomy among lay people and health professionals: A pilot study

Abstract

IntroductionWomen with certain genetic mutations have a risk of up to 85% of developing breast cancer. Bilateral prophylactic mastectomy is the most effective way to reduce risk of cancer. ObjectiveThis pilot study focuses on the acceptability of prophylactic breast surgery and examines, in a series of concrete cases, the cognitive processes by which health professionals and lay people make their judgments. This research also aims to identify the factors involved in these judgments. An additional objective is to determine whether there are groups with different patterns of responses. MethodWe recruited two samples in France, one comprising 90 lay people and the other 30 health professionals (n=120) and asked them how acceptable it would be for a woman at a high risk of breast cancer to undergo a prophylactic surgery (mastectomy), in each of the 64 scenarios presented to them. The scenarios were all combinations of two levels of age, of marital status, of parenting status, of body appearance investment, of reconstructive surgery and also two levels of the person suggesting oncogenetic diagnosis. ResultsWe found that lay people and health professionals structured the factors in the scenarios in nearly the same way. They assigned importance to three factors: the most important one was reconstructive surgery, and then the age of the woman. The least important factor was the person who requested the genetic test. Furthermore, the age of the participants, and knowing a person who had cancer impacted the degree of acceptability assigned by participants. Being a lay person or a health professional did not have a direct impact on acceptability but influenced the integration of factors. In addition, cluster analysis showed that only a small group was opposed to mastectomy. ConclusionThis pilot study demonstrated that three factors have to be considered when judging the acceptability of prophylactic mastectomy and showed a common cognitive foundation for future discussion, at the levels of both clinical care and health policy, of the conditions under which prophylactic surgery might be acceptable.