Impact of BRCA Status on Reproductive Decision-Making and Self-Concept: A Mixed-Methods Study Informing the Development of Tailored Interventions
1
Department of Sociology, Boston College, Chestnut Hill, MA 02467, USA
2
Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA 01003, USA
3
Department of Measurement, Evaluation, Statistics and Assessment, Boston College, Chestnut Hill, MA 02467, USA
4
School of Social Work, Boston College, Chestnut Hill, MA 02467, USA
5
William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02467, USA
6
Harvard Center for Reproductive Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Academic Editor: Maria C. Katapodi
Cancers 2022, 14(6), 1494; https://doi.org/10.3390/cancers14061494
Received: 22 January 2022
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Revised: 11 March 2022
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Accepted: 13 March 2022
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Published: 15 March 2022
(This article belongs to the Special Issue Precision Health Care and Interventions in Hereditary Breast and Ovarian Cancer and Lynch Syndrome)
Simple Summary
Reproductive decision-making is a complex process and is influenced by personal, medical, and sociocultural factors. Relatively little is known about reproductive decision-making in women harboring mutations in the BRCA1 and/or BRCA2—pathogenic variants that confer different cancer risk profiles and underlie hereditary breast and ovarian cancer. A deeper understanding of BRCA+ women’s experiences is needed to develop tailored approaches to reproductive decision-making—a central aspect of precision health. This study provides findings to guide tailored interventions to enhance precision health for BRCA+ women of reproductive age.
This mixed-methods study sought to deepen our understanding of self-concept and experiences in balancing cancer risk/reproductive decisions after learning of BRCA+ status. First, a quantitative survey of BRCA+ women (n = 505) examined the childbearing status, risk-reducing surgery, and self-concept. At the time of testing, 307/505 (60.8%) women were of reproductive age (<40 years-old), 340/505 (67.3%) had children, and 317/505 (62.8%) had undergone risk-reducing surgery. A younger age at the time of the testing was significantly associated with the decision to have children after learning BRCA+ status or undergoing risk-reducing surgery (p < 0.001). Compared to older women, BRCA+ women of reproductive age, exhibited a more negative self-concept with significantly higher vulnerability ratings (p < 0.01). Women with a cancer diagnosis exhibited a more negative mastery ratings and worse vulnerability ratings (p < 0.01) than women without a cancer history. Compared to childless counterparts, significantly higher vulnerability ratings were observed among BRCA+ women who had children before learning their BRCA status and/or undergoing risk-reducing surgery (p < 0.001). Subsequently, a subset of women (n = 40) provided in-depth interviews to explore their experiences in decision-making. The interviews provided insights into the effects of BRCA status on decisions regarding relationships, childbearing, cancer risk management, and communicating BRCA risk to children. Integrating quantitative and qualitative findings identifies targets for tailored interventions to enhance precision health for BRCA+ women of reproductive age.
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Keywords:
BRCA mutation; precision health; reproductive decision-making; risk-reducing surgery; self-concept
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MDPI and ACS Style
Hesse-Biber, S.; Seven, M.; Jiang, J.; Schaik, S.V.; Dwyer, A.A. Impact of BRCA Status on Reproductive Decision-Making and Self-Concept: A Mixed-Methods Study Informing the Development of Tailored Interventions. Cancers 2022, 14, 1494. https://doi.org/10.3390/cancers14061494
AMA Style
Hesse-Biber S, Seven M, Jiang J, Schaik SV, Dwyer AA. Impact of BRCA Status on Reproductive Decision-Making and Self-Concept: A Mixed-Methods Study Informing the Development of Tailored Interventions. Cancers. 2022; 14(6):1494. https://doi.org/10.3390/cancers14061494
Chicago/Turabian StyleHesse-Biber, Sharlene, Memnun Seven, Jing Jiang, Sara Van Schaik, and Andrew A. Dwyer. 2022. "Impact of BRCA Status on Reproductive Decision-Making and Self-Concept: A Mixed-Methods Study Informing the Development of Tailored Interventions" Cancers 14, no. 6: 1494. https://doi.org/10.3390/cancers14061494
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