Decision making nei nuovi scenari in oncologia: il rischio genetico : come accompagnare sorveglianza, farmaco prevenzione e chirurgia profilattica

Prophylactic mastectomy to reduce the risk of developing breast cancer in the presence of a BRCA mutation has been available for many years. Yet, immediately after Angelina Jolie’s announcement of her decision to undergo a bilateral prophylactic mastectomy, the level of women’s interest in genetic testing and/or preventive surgical intervention soared incredibly as witnessed by the increased number of information requests followed the announcement.. Many physicians report that cancer genetic clinics have seen an uptake in women seeking BRCA 1/2 genetic testing following Ms. Jolie’s disclosure. Cognitive science, more accurately than medicine itself, can provide an explanation for this phenomenon. In fact, according to the descriptive theories of decision, Jolie’s story emphasizes how the role played by heuristics in driving human decisions can become stronger than that played by rationality. Tversky and Kahneman would have attributed this choice to the availability heuristic, a mental shortcut occurring when people make judgments about the probability of events by how easy it is to think of examples. A second point emerging from Jolie story regards the psychological effect that a celebrity’s decision can have on other individuals. Using the representativeness heuristic [1] people tend to relate to her and think they have the same problem (and thus tend to look for the same solution) even though their situation is totally unconnected. A third point is the anchoring heuristic [1], a cognitive bias occurring when individuals tend to rely too heavily on the first piece of information (the "anchor") they receive when making decisions. Once an anchor is set, people make their choice by adjusting away from that anchor, often resulting in insufficient adjustments and consequently in biases toward interpreting other information around it. In conclusion, we argue that, in order to help patients make the most effective and rational decisions, best practice and physician communication skills should be focused on the personalization of information with the aim of educating patients about the meaning of multiple personal risks and the pros and cons of the various risk-reducing measures (radical versus conservative) according to their specific health status.