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Zaluzec EK, Sempere LF. Systemic and Local Strategies for Primary Prevention of Breast Cancer. Cancers (Basel) 2024; 16:248. [PMID: 38254741 PMCID: PMC10814018 DOI: 10.3390/cancers16020248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/29/2023] [Accepted: 12/31/2023] [Indexed: 01/24/2024] Open
Abstract
One in eight women will develop breast cancer in the US. For women with moderate (15-20%) to average (12.5%) risk of breast cancer, there are few options available for risk reduction. For high-risk (>20%) women, such as BRCA mutation carriers, primary prevention strategies are limited to evidence-based surgical removal of breasts and/or ovaries and anti-estrogen treatment. Despite their effectiveness in risk reduction, not many high-risk individuals opt for surgical or hormonal interventions due to severe side effects and potentially life-changing outcomes as key deterrents. Thus, better communication about the benefits of existing strategies and the development of new strategies with minimal side effects are needed to offer women adequate risk-reducing interventions. We extensively review and discuss innovative investigational strategies for primary prevention. Most of these investigational strategies are at the pre-clinical stage, but some are already being evaluated in clinical trials and others are expected to lead to first-in-human clinical trials within 5 years. Likely, these strategies would be initially tested in high-risk individuals but may be applicable to lower-risk women, if shown to decrease risk at a similar rate to existing strategies, but with minimal side effects.
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Affiliation(s)
- Erin K. Zaluzec
- Precision Health Program, Michigan State University, East Lansing, MI 48824, USA;
- Department of Pharmacology & Toxicology, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Lorenzo F. Sempere
- Precision Health Program, Michigan State University, East Lansing, MI 48824, USA;
- Department of Radiology, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA
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Estebsari F, Rahimi Khalifehkandi Z, Latifi M, Farhadinasab A, Vasli P, Mostafaie D. Protection motivation theory and prevention of breast cancer: a systematic review. Clin Breast Cancer 2023; 23:e239-e246. [PMID: 37045635 DOI: 10.1016/j.clbc.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/14/2023]
Abstract
Breast cancer is a global health problem with a high rate of incidence and annual death. The protection motivation model (PMT) is a health psychology theory that has been introduced to motivate health behaviors using coping appraisal and threat appraisal. We aimed to systematically review the applicability of PMT to predict and improve the knowledge and intention (the patient's intent to undergo breast cancer screening with self/clinical breast exam or mammography) for protective behaviors among women. A systematic search was performed in May 2022 in electronic databases to investigate the role of PMT in the prediction of protection behaviors in addition to improving the knowledge about the prevention of breast cancer using specific keywords. The relevant studies were then included for data extraction. Seventeen articles including 7 interventional and 10 prediction studies were selected for data assessment. Findings demonstrated that PMT could be used to predict the rate of knowledge and intention about breast cancer risk among women. It was also shown that PMT could be considered as a framework for the prevention of breast cancer by changing the behaviors of individuals by training the participants. Fear arousal, response efficacy, and response cost were found as the main determinants of knowledge and intention rate. PMT can provide a useful framework to evaluate the factors associated with women's intentions about breast cancer. Periodical educational programs should be implemented to improve protection behaviors by increasing the intention of women to regular self-examination.
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Affiliation(s)
- Fatemeh Estebsari
- Operating Room & Anesthesia Department, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Zahra Rahimi Khalifehkandi
- Department of Health Education and Promotion, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
| | - Marzieh Latifi
- Sina Organ Procurement Unit, Tehran University of Medical Sciences, Tehran, Iran.
| | - Abdollah Farhadinasab
- Behavioral Sciences Research Center, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Parvaneh Vasli
- Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Public Health Safety in Community Living Circles Based on a Behavioral Motivation Perspective: Theoretical Framework and Evaluation System. Behav Sci (Basel) 2022; 13:bs13010026. [PMID: 36661598 PMCID: PMC9855156 DOI: 10.3390/bs13010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/17/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Public health problems, such as the spread of COVID-19 and chronic diseases, are mainly caused by the daily life activities of community residents. Therefore, there is a need to build a healthy and safe community living circle through the evaluation of health behaviors in daily life. This paper proposes a theoretical framework and evaluation system for public health safety in community living circles, from a behavioral motivation perspective. Firstly, based on the behavioral motivation theory, a theoretical framework for the study of public health safety in community living circles is constructed from the perspective of the "project-activity-health" coupling relationship network, regarding community residents' daily life activities. Then, a public health safety evaluation system for community living circles is proposed based on this framework, which includes the following: (1) identifying the scope of community living circles based on Spatio-temporal Activities Analysis; (2) Based on the theory of protection motivation, a health behavior evaluation model based on the three elements of "spatial and temporal geographical environment-daily life activities-public health safety" is established; (3) Based on the hierarchy of public health problems, a public health safety evaluation model of the community living circle is established. The behavioral motivation-based evaluation system explores a new approach and research paradigm for community-scale public health safety theory; this will help to achieve the goal of "healthy communities" when further empirical evidence is available.
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Muturi N. The Influence of Information Source on COVID-19 Vaccine Efficacy and Motivation for Self-Protective Behavior. JOURNAL OF HEALTH COMMUNICATION 2022; 27:241-249. [PMID: 35793310 DOI: 10.1080/10810730.2022.2096729] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This study examined the influence of health information sources on the efficacy of the COVID-19 vaccine and other motivations for self-protective behavior. Based on the protection motivation theory, the study focused on threat appraisal factors (risk perception and perceived severity), response efficacy, and health information sources (media and interpersonal channels) as predictors for vaccine efficacy and self-protective behavior. Data were gathered in Kenya through a self-administered survey (n = 715) that was conducted at the pick of the COVID-19 pandemic. Results show that media sources (newspapers, radio, television, internet, and telephone) were viewed as more useful compared to interpersonal sources (health professionals, family, friends, and other personal influencers) for COVID-19-related information. Additionally, media sources influenced risk perception, perceived severity, response efficacy, vaccine efficacy, and self-protective behavior. Interpersonal sources were also correlated with perceived severity and response efficacy, and self-protective behavior but did not influence vaccine efficacy. The study suggests exploring the use of media and other digital sources including mobile phones to enhance threat appraisal and promote vaccine efficacy among other motivations for self-protection behavior in future pandemics or disease outbreaks, especially in resource-poor settings.
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Affiliation(s)
- Nancy Muturi
- A.Q. Miller School of Media and Communication, Kansas State University, Manhattan, Kansas, USA
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NAZARI MAHIN, GHAZAANI FAHIMEHMAHBOOBI, KAVEH MOHAMMADHOSSEIN, KARIMI MASOUD, GHAHREMANI LEILA. Investigating the predictors of breast cancer screening behaviors (breast self-examination, clinical examination or examination by physician/midwife and mammography) based on protection motivation theory (PMT) in women. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E736-E741. [PMID: 34909502 PMCID: PMC8639128 DOI: 10.15167/2421-4248/jpmh2021.62.3.1857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 06/03/2021] [Indexed: 11/29/2022]
Abstract
Background Breast cancer is one of the most common health problems worldwide. The mortality rate of this disease is due to the lack of knowledge about screening methods and late diagnosis of cancer. Objective The purpose of this study is to determine the predictors of breast cancer screening behaviors using protection motivation theory. Methods and materials The conduction of study was cross-sectional and on 400 women aged 30-59 in Kashan. The data collection instrument was a researcher-made questionnaire based on protection motivation theory. Sampling was performed from all community health service centers in Kashan and the proportional to size sampling method was used as available sampling. The statistical tests were Pearson correlation and linear regression. The software used was version 22 SPSS and the significance level was 0.05. Results The results showed that the average age of women was 39.7 ± 7.9 years. There is a direct and statistically significant relationship between perceived breast cancer screening behaviors and perceived self-efficacy (P < 0.05) and there is an inverse statistically significant relationship between breast cancer screening behaviors and perceived cost (P < 0.05). There is also a direct and significant statistical relationship between motivation of protection and perceived sensitivity, intensity, self-efficacy, cost, and perceived response efficiency (P < 0.05). Perceived self-efficacy, cost, and response efficiency are the predictors of breast cancer screening behaviors. The perceived cost is the negative predictor. Conclusion Overall, health care providers can view PMT as a framework for developing educational interventions aimed at improving behaviors related to breast cancer screening of women.
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Affiliation(s)
| | | | | | | | - LEILA GHAHREMANI
- Correspondence: Leila Ghahremani, Department of Health Promotion, 3rd Floor, School of Health, Shiraz University of Medical Science, Razi Ave., Shiraz, Iran; Research Center for Health Science, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran - Tel.: +989177923542 - Fax: +98 713-7260225 - E-mail:
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Padamsee TJ, Hils M, Muraveva A. Understanding low chemoprevention uptake by women at high risk of breast cancer: findings from a qualitative inductive study of women's risk-reduction experiences. BMC Womens Health 2021; 21:157. [PMID: 33863327 PMCID: PMC8052843 DOI: 10.1186/s12905-021-01279-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/22/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Chemoprevention is one of several methods that have been developed to help high-risk women reduce their risk of breast cancer. Reasons for the low uptake of chemoprevention are poorly understood. This paper seeks a deeper understanding of this phenomenon by drawing on women's own narratives about their awareness of chemoprevention and their risk-related experiences. METHODS This research is based on a parent project that included fifty in-depth, semi-structured interviews with a purposive sample of African American and White women at elevated risk of breast cancer. This specific study draws on the forty-seven interviews conducted with women at high or severe risk of breast cancer, all of whom are eligible to use chemoprevention for breast cancer risk-reduction. Interviews were analyzed using grounded theory methods. RESULTS Forty-five percent of participants, and only 21% of African American participants, were aware of chemoprevention options. Women who had seen specialists were more likely to be aware, particularly if they had ongoing specialist access. Aware and unaware women relied on different types of sources for prevention-related information. Those whose main source of information was a healthcare provider were more likely to know about chemoprevention. Aware women used more nuanced information gathering strategies and worried more about cancer. Women simultaneously considered all risk-reduction options they knew about. Those who knew about chemoprevention but were reluctant to use it felt this way for multiple reasons, having to do with potential side effects, perceived extreme-ness of the intervention, similarity to chemotherapy, unknown information about chemoprevention, and reluctance to take medications in general. CONCLUSIONS Lack of chemoprevention awareness is a critical gap in women's ability to make health-protective choices. Future research in this field must consider complexities in both women's perspectives on chemoprevention and the reasons they are reluctant to use it.
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Affiliation(s)
- Tasleem J. Padamsee
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH 43210 USA
| | - Megan Hils
- Lutheran Social Services of Central Ohio, Worthington, OH USA
| | - Anna Muraveva
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH USA
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Best M, Newson AJ, Meiser B, Juraskova I, Goldstein D, Tucker K, Ballinger ML, Hess D, Schlub TE, Biesecker B, Vines R, Vines K, Thomas D, Young MA, Savard J, Jacobs C, Butow P. The PiGeOn project: protocol for a longitudinal study examining psychosocial, behavioural and ethical issues and outcomes in cancer tumour genomic profiling. BMC Cancer 2018; 18:389. [PMID: 29621994 PMCID: PMC5887192 DOI: 10.1186/s12885-018-4310-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 03/26/2018] [Indexed: 12/25/2022] Open
Abstract
Background Genomic sequencing in cancer (both tumour and germline), and development of therapies targeted to tumour genetic status, hold great promise for improvement of patient outcomes. However, the imminent introduction of genomics into clinical practice calls for better understanding of how patients value, experience, and cope with this novel technology and its often complex results. Here we describe a protocol for a novel mixed-methods, prospective study (PiGeOn) that aims to examine patients’ psychosocial, cognitive, affective and behavioural responses to tumour genomic profiling and to integrate a parallel critical ethical analysis of returning results. Methods This is a cohort sub-study of a parent tumour genomic profiling programme enrolling patients with advanced cancer. One thousand patients will be recruited for the parent study in Sydney, Australia from 2016 to 2019. They will be asked to complete surveys at baseline, three, and five months. Primary outcomes are: knowledge, preferences, attitudes and values. A purposively sampled subset of patients will be asked to participate in three semi-structured interviews (at each time point) to provide deeper data interpretation. Relevant ethical themes will be critically analysed to iteratively develop or refine normative ethical concepts or frameworks currently used in the return of genetic information. Discussion This will be the first Australian study to collect longitudinal data on cancer patients’ experience of tumour genomic profiling. Findings will be used to inform ongoing ethical debates on issues such as how to effectively obtain informed consent for genomic profiling return results, distinguish between research and clinical practice and manage patient expectations. The combination of quantitative and qualitative methods will provide comprehensive and critical data on how patients cope with ‘actionable’ and ‘non-actionable’ results. This information is needed to ensure that when tumour genomic profiling becomes part of routine clinical care, ethical considerations are embedded, and patients are adequately prepared and supported during and after receiving results. Trial registration Not required for this sub-study, parent trial registration ACTRN12616000908437.
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Affiliation(s)
- Megan Best
- Psycho-oncology Co-operative Research Group (PoCoG), University of Sydney, Level 6 North, Lifehouse (C39Z), Sydney, NSW, 2006, Australia. .,Sydney Health Ethics, Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia.
| | - Ainsley J Newson
- Sydney Health Ethics, Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Bettina Meiser
- Prince of Wales Clinical School, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Ilona Juraskova
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED - Psychology), University of Sydney, Camperdown, NSW, 2006, Australia
| | - David Goldstein
- Prince of Wales Clinical School, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Kathy Tucker
- Prince of Wales Clinical School, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Mandy L Ballinger
- Cancer Division, Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, NSW, 2021, Australia
| | - Dominique Hess
- Cancer Division, Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, NSW, 2021, Australia
| | - Timothy E Schlub
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Barbara Biesecker
- The National Human Genome Research Institute, National Institutes of Health, 31 Center Drive, MSC 2073, Bethesda, MD, 20892, USA
| | - Richard Vines
- Rare Cancers, PO Box 440, Bowral, NSW, 2576, Australia
| | - Kate Vines
- Rare Cancers, PO Box 440, Bowral, NSW, 2576, Australia
| | - David Thomas
- Cancer Division, Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, NSW, 2021, Australia
| | - Mary-Anne Young
- Genome One, Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, NSW, 2021, Australia
| | - Jacqueline Savard
- Sydney Health Ethics, Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Chris Jacobs
- Prince of Wales Clinical School, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Phyllis Butow
- Psycho-oncology Co-operative Research Group (PoCoG), University of Sydney, Level 6 North, Lifehouse (C39Z), Sydney, NSW, 2006, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED - Psychology), University of Sydney, Camperdown, NSW, 2006, Australia
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Padamsee TJ, Wills CE, Yee LD, Paskett ED. Decision making for breast cancer prevention among women at elevated risk. Breast Cancer Res 2017; 19:34. [PMID: 28340626 PMCID: PMC5366153 DOI: 10.1186/s13058-017-0826-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Several medical management approaches have been shown to be effective in preventing breast cancer and detecting it early among women at elevated risk: 1) prophylactic mastectomy; 2) prophylactic oophorectomy; 3) chemoprevention; and 4) enhanced screening routines. To varying extents, however, these approaches are substantially underused relative to clinical practice recommendations. This article reviews the existing research on the uptake of these prevention approaches, the characteristics of women who are likely to use various methods, and the decision-making processes that underlie the differing choices of women. It also highlights important areas for future research, detailing the types of studies that are particularly needed in four key areas: documenting women's perspectives on their own perceptions of risk and prevention decisions; explicit comparisons of available prevention pathways and their likely health effects; the psychological, interpersonal, and social processes of prevention decision making; and the dynamics of subgroup variation. Ultimately, this research could support the development of interventions that more fully empower women to make informed and values-consistent decisions, and to move towards favorable health outcomes.
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Affiliation(s)
- Tasleem J. Padamsee
- Division of Health Services Management & Policy, College of Public Health, The Ohio State University, 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH 43220 USA
| | - Celia E. Wills
- College of Nursing, The Ohio State University, Columbus, OH USA
| | - Lisa D. Yee
- College of Medicine, The Ohio State University, Columbus, OH USA
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Paquet L, Simmonds L, Yang C, Verma S. An exploratory study of patients' views about being at high-risk for breast cancer and risk management beliefs and intentions, before and after risk counselling: Preliminary evidence of the influence of beliefs on post-counselling prevention intentions. PATIENT EDUCATION AND COUNSELING 2017; 100:575-582. [PMID: 27756584 DOI: 10.1016/j.pec.2016.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 09/24/2016] [Accepted: 10/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES 1) To describe how women at high-risk for breast cancer (BC) perceive their at-risk status and the options available to manage this risk, before and after risk counselling; 2) to explore the contributions of pre-counselling demographic, clinical, cognitive and emotional factors to post-counselling risk management intentions. METHODS 58 of 173 eligible patients (34%) enrolled and were asked to fill surveys including measures of 1) subjective risk, 2) illness (being at high-risk for BC) and 3) treatment (surveillance, lifestyle modifications, and chemoprevention) cognitions, 4) BC fear and 5) future risk management intentions, prior to and 3 months after risk consultation. RESULTS 48 of 58 participants (83%) completed both surveys. Beliefs and emotions about their condition and its management were stable over time. Surveillance and lifestyle were associated with stronger intentions, higher perceived need, and lower concerns than chemoprevention (all ps <0.001). The strongest predictors of intentions strengths were the women's beliefs about the risk reduction methods, especially for lifestyle and chemoprevention (all ps <0.01). CONCLUSIONS The findings emphasize the importance of patients' beliefs in risk management decisions. PRACTICAL IMPLICATIONS Patients' treatment beliefs appear to influence their choice of BC risk reduction strategies and should be discussed during risk reduction consultations.
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Affiliation(s)
- Lise Paquet
- Department of Psychology, Carleton University, Ottawa K1S 5B6, Canada.
| | - Lisa Simmonds
- Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Canada
| | - Charles Yang
- Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Canada
| | - Shailendra Verma
- Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Canada
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Ager B, Butow P, Jansen J, Phillips KA, Porter D. Contralateral prophylactic mastectomy (CPM): A systematic review of patient reported factors and psychological predictors influencing choice and satisfaction. Breast 2016; 28:107-20. [PMID: 27290619 DOI: 10.1016/j.breast.2016.04.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 03/19/2016] [Accepted: 04/12/2016] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Conduct a systematic review of quantitative and qualitative studies exploring patient reported factors and psychological variables influencing the decision to have contralateral prophylactic mastectomy (CPM), and satisfaction with CPM, in women with early stage breast cancer. METHODS Studies were identified via databases: Medline, CINAHL, Embase and PsycINFO. Data were extracted by one author and crosschecked by two additional authors for accuracy. The quality of included articles was assessed using standardised criteria by three authors. RESULTS Of the 1346 unique citations identified, 17 were studies that met the inclusion criteria. Studies included were primarily cross-sectional and retrospective. No study utilised a theoretical framework to guide research and few studies considered psychological predictors of CPM. Fear of breast cancer was the most commonly cited reason for CPM, followed by cosmetic reasons such as desire for symmetry. Overall, women appeared satisfied with CPM, however, adverse/diminished body image, poor cosmetic result, complications, diminished sense of sexuality, emotional issues and perceived lack of education regarding alternative surveillance/CPM efficacy were cited as reasons for dissatisfaction. CONCLUSION Current literature has begun to identify patient-reported reasons for CPM; however, the relative importance of different factors and how these factors relate to the process underlying the decision to have CPM are unknown. Of women who considered CPM, limited information is available regarding differences between those who proceed with or ultimately decline CPM.
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Affiliation(s)
- Brittany Ager
- School of Psychology, The University of Sydney, Australia.
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence Based Decision-Making, The University of Sydney, Australia; Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Australia
| | - Jesse Jansen
- Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Australia; Sydney Medical School, The University of Sydney, Australia
| | - Kelly-Anne Phillips
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - David Porter
- Dept of Medical Oncology, Auckland Hospital, Auckland, New Zealand; Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
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Tesson S, Richards I, Porter D, Phillips KA, Rankin N, Musiello T, Marven M, Butow P. Women's preferences for contralateral prophylactic mastectomy: An investigation using protection motivation theory. PATIENT EDUCATION AND COUNSELING 2016; 99:814-822. [PMID: 27529090 DOI: 10.1016/j.pec.2015.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Most women diagnosed with unilateral breast cancer without BRCA1 or BRCA2 mutations are at low risk of contralateral breast cancer. Contralateral Prophylactic Mastectomy (CPM) decreases the relative risk of contralateral breast cancer, but may not increase life expectancy; yet international uptake is increasing. This study applied protection motivation theory (PMT) to determine factors associated with women's intentions to undergo CPM. METHODS Three hundred eighty-eight women previously diagnosed with unilateral breast cancer and of negative or unknown BRCA1 or BRCA2 status were recruited from an advocacy group's research database. Participants completed measures of PMT constructs based on a common hypothetical CPM decision-making scenario. RESULTS PMT constructs explained 16% of variance in intentions to undergo CPM. Response efficacy (CPM's advantages) and response costs (CPM's disadvantages) were unique individual predictors of intentions. CONCLUSION Decision-making appears driven by considerations of the psychological, cosmetic and emotional advantages and disadvantages of CPM. Overestimations of threat to life from contralateral breast cancer and survival benefit from CPM also appear influential factors. PRACTICE IMPLICATIONS Patients require balanced and medically accurate information regarding the pros and cons of CPM, survival rates, and recurrence risks to ensure realistic and informed decision-making.
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Holmberg C. Decision making in the context of breast cancer chemoprevention: patient perceptions and the meaning of risk. Am Soc Clin Oncol Educ Book 2016:e59-64. [PMID: 25993227 DOI: 10.14694/edbook_am.2015.35.e59] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chemoprevention with selective estrogen receptor modulators (SERMs) is considered one of the most promising risk reduction options to date in the United States. Tamoxifen and raloxifene are both approved by the U.S. Food and Drug Administration (FDA) for breast cancer risk reduction. However, despite endorsement from the American Society for Clinical Oncology and the National Comprehensive Cancer Network, uptake remains low. Decision aids have been successful in improving women's understanding and knowledge about the risk-benefit trade-offs in decision making regarding SERMs. However, increased knowledge does not lead to increased uptake of chemoprevention for the purpose of reducing breast cancer risk; instead, women become more reluctant to take medication that is itself associated with risks. Reasons for this include a lack of awareness that SERMs are effective in reducing breast cancer risk, an unwillingness to increase the risk of other disease, reluctance to take a daily medication, and the perception of tamoxifen as a "cancer drug." In studies on hypothetical decision making in the context of chemoprevention women indicate greater willingness to take a SERM when they are determined to be at risk. These findings suggest a differential understanding of what risk means among the general public, health professionals, and researchers. Feeling at risk is related to bodily signs and symptoms and not to population-derived probabilities. Such differential understanding may in part explain women's perception of the low efficacy of SERMs and their decision making regarding SERM use.
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Mirkarimi K, Mostafavi F, Eshghinia S, Vakili MA, Ozouni-Davaji RB, Aryaie M. Effect of Motivational Interviewing on a Weight Loss Program Based on the Protection Motivation Theory. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e23492. [PMID: 26380106 PMCID: PMC4568028 DOI: 10.5812/ircmj.23492v2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 09/29/2014] [Accepted: 10/20/2014] [Indexed: 01/26/2023]
Abstract
Background: The prevalence of overweight and obesity is on the increase the world over, which imposes an ever-increasing burden on societies and health care systems. Objectives: This study sought to investigate the effect of motivational interviewing (MI) on a weight-loss program based on the protection motivation theory (PMT). Patients and Methods: This randomized clinical trial study, comprising pretest-posttest with a control group, was conducted on 150 overweight and obese women attending a private nutrition clinic for the first time. Samples were randomly selected using the clinic’s records and then allocated to three groups (50 women in each group) receiving: 1) a standard weight-control program; 2) motivational interviewing; and 3) MI plus intention intervention. Data were collected using a researcher-made questionnaire through in-person interviews and were analyzed using SPSS (version 11) and statistical tests, including the Kruskal-Wallis test, one-way analysis of variance, paired t-test, and linear regression model. Results: In the two intervention groups, the PMT construct scores, namely susceptibility (P = 0.001), severity (P = 0.001), rewards (P =0.004), self-efficacy (P = 0.001), response efficacy (P = 0.001), and costs (P = 0.014), were significantly increased compared to those in the control group. The anthropometric status was statistically significant in the MI group (P = 0.001) and the MI plus intention-intervention group (P = 0.001) at 2 months’ follow-up, while in the control group, weight was meaningfully different after the intervention (P = 0.027). Weight was different between the groups after the intervention, with the Tukey test demonstrating that the differences were statistically significant between the control group and the MI group. Conclusions: Our results demonstrated that MI, combined with the implementation of intention intervention, increased weight loss and PMT construct scores in our study population.
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Affiliation(s)
- Kamal Mirkarimi
- Department of Health Education and Promotion, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Firoozeh Mostafavi
- Department of Health Education and Promotion, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, IR Iran
- Corresponding Author: Firoozeh Mostafavi, Department of Health Education and Promotion, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, IR Iran. Tel: +98-9132118364, Fax: +98-1732421657, E-mail:
| | - Samira Eshghinia
- Metabolic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran
| | - Mohammad Ali Vakili
- Department of Health and Medical Sciences, Golestan University of Medical Sciences, Gorgan, IR Iran
| | - Rahman Berdi Ozouni-Davaji
- Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran
| | - Mohammad Aryaie
- Deputyship of Research, Golestan University of Medical Sciences, Gorgan, IR Iran
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Abstract
PURPOSE OF REVIEW Breast cancer is the most common cancer in women worldwide. This review will focus on current prevention strategies for women at high risk. RECENT FINDINGS The identification of women who are at high risk of developing breast cancer is key to breast cancer prevention. Recent findings have shown that the inclusion of breast density and a panel of low-penetrance genetic polymorphisms can improve risk estimation compared with previous models. Preventive therapy with aromatase inhibitors has produced large reductions in breast cancer incidence in postmenopausal women. Tamoxifen confers long-term protection and is the only proven preventive treatment for premenopausal women. Several other agents, including metformin, bisphosphonates, aspirin and statins, have been found to be effective in nonrandomized settings. SUMMARY There are many options for the prevention of oestrogen-positive breast cancer, in postmenopausal women who can be given a selective oestrogen receptor modulator or an aromatase inhibitor. It still remains unclear how to prevent oestrogen-negative breast cancer, which occurs more often in premenopausal women. Identification of women at high risk of the disease is crucial, and the inclusion of breast density and a panel of genetic polymorphisms, which individually have low penetrance, can improve risk assessment.
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Affiliation(s)
- Ivana Sestak
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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