Females with a BRCA1/2 (BRCA) pathogenic variant have high lifetime risks for cancer. Regularly updated guidelines are in place that recommend screening and/or surgery to monitor and/or significantly reduce breast or ovarian cancer risk. Follow-up care decision making among this population is important to explore to understand the multi-faceted influences guiding cancer screening behaviors and risk-reducing surgery decisions. Using lived-experience theory and cognitive anthropology, this study explored emotional and social influences on decision making and behavioral adherence to guideline recommendations among twenty-seven female BRCA carriers. Ethnographic data from in-depth interviews were analyzed in parallel with self-reported survey data on perceived threat, response efficacy, and self-efficacy constructs. Survey results demonstrated high rates of adherence to guideline recommendations and high levels of perceived threat and response efficacy with lower levels of self-efficacy, while interview data revealed multi-faceted motivators and challenges associated with behavioral adherence. These findings unearth complex lived-experiences within the context of perceived threat, response efficacy, and self-efficacy and explore the cognitive relationship between motivators and challenges to inherited cancer follow-up care decision making and behavioral adherence. This study demonstrates how anthropological practice can aid in inherited cancer research and be used to support the development of interventions that consider cognitive influences on behavior.

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