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Operating on Anxiety: Negative Affect toward Breast Cancer and Choosing Contralateral Prophylactic Mastectomy

Author

Listed:
  • Michael C. Silverstein

    (Department of Psychology, Center for Science Communication Research, University of Oregon, Eugene, OR, USA)

  • Clara N. Lee

    (Department of Plastic and Reconstructive Surgery, College of Medicine, Division of Health Services Management and Policy, College of Public Health, OSU Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA)

  • Laura D. Scherer

    (School of Medicine on the Anschutz Medical Campus, University of Colorado, VA Denver Center for Innovation, Aurora, CO, USA)

  • Crystal Phommasathit

    (Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA)

  • Andrea L. Merrill

    (Department of Surgery, Boston Medical Center, Boston, MA, USA)

  • Ellen Peters

    (Center for Science Communication Research, School of Journalism and Communication, University of Oregon, Eugene, OR, USA)

Abstract

Background Rates of contralateral prophylactic mastectomy (CPM)—removal of the healthy breast following breast cancer diagnosis—have increased, particularly among women for whom CPM provides no survival benefit. Affective (i.e., emotional) decision making is often blamed for this increase. We studied whether greater negative breast cancer affect could motivate uptake of CPM through increased cancer risk perceptions and biased treatment evaluations. Methods We randomly assigned healthy women with average breast-cancer risk ( N = 1,030; M age = 44.14, SD = 9.23 y) to 1 of 3 affect conditions (negative v. neutral v. positive narrative manipulation) in a hypothetical online experiment in which they were asked to imagine being diagnosed with cancer in one breast. We assessed 1) treatment choice, 2) affect toward CPM, and 3) perceived risk of future breast cancer in each breast (cancer affected and healthy) following lumpectomy, single mastectomy, and CPM. Results The manipulation caused women in the negative and neutral narrative conditions (26.9% and 26.4%, respectively) to choose CPM more compared with the positive narrative condition (19.1%). Across conditions, women’s CPM affect did not differ. However, exploratory analyses addressing a possible association of affect toward cancer-related targets suggested that women in the negative narrative condition may have felt more positively toward CPM than women in the positive narrative condition. The manipulation did not have significant effects on breast cancer risk perceptions. Limitations The manipulation of affect had a small effect size, possibly due to the hypothetical nature of this study and/or strong a priori knowledge and attitudes about breast cancer and its treatment options. Conclusion Increased negative affect toward breast cancer increased choice of CPM over other surgical options and might have motivated more positive affective evaluations of CPM. Highlights This study used narratives to elicit different levels of negative integral affect toward breast cancer to investigate the effects of affect on breast cancer treatment choices. Increased negative affect toward breast cancer increased the choice of double mastectomy over lumpectomy and single mastectomy to treat a hypothetical, early-stage cancer. The narrative manipulation of negative affect toward breast cancer did not change the perceived risks of future cancer following any of the surgical interventions. Negative affect toward breast cancer may have biased affective evaluations of double mastectomy.

Suggested Citation

  • Michael C. Silverstein & Clara N. Lee & Laura D. Scherer & Crystal Phommasathit & Andrea L. Merrill & Ellen Peters, 2023. "Operating on Anxiety: Negative Affect toward Breast Cancer and Choosing Contralateral Prophylactic Mastectomy," Medical Decision Making, , vol. 43(2), pages 152-163, February.
    • Handle: RePEc:sae:medema:v:43:y:2023:i:2:p:152-163
    DOI: 10.1177/0272989X221121134
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    References listed on IDEAS

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    1. Paul Slovic & Melissa L. Finucane & Ellen Peters & Donald G. MacGregor, 2004. "Risk as Analysis and Risk as Feelings: Some Thoughts about Affect, Reason, Risk, and Rationality," Risk Analysis, John Wiley & Sons, vol. 24(2), pages 311-322, April.
    2. Abigail T Evans & Ellen Peters & Andrew A Strasser & Lydia F Emery & Kaitlin M Sheerin & Daniel Romer, 2015. "Graphic Warning Labels Elicit Affective and Thoughtful Responses from Smokers: Results of a Randomized Clinical Trial," PLOS ONE, Public Library of Science, vol. 10(12), pages 1-23, December.
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