PURPOSE: Little is known about how women with hereditary breast and/or ovarian 
cancer who test positive for a BRCA gene manage the impact of a positive test 
result on their everyday lives and in the longer term. This study defined the 
experience and needs of women with hereditary breast and ovarian cancer and a 
positive BRCA test over time.
METHODS: A grounded theory approach was taken using qualitative interviews (n = 
49) and reflective diaries. Data collected from December 2006 until March 2010 
was analysed using the constant comparative technique to trace the development 
of how women manage their concerns of inherited cancer.
RESULTS: A four stage substantive theory of maximising survival was generated 
that defines the experience of women and how they resolve their main concerns. 
The process of maximising survival begins prior to genetic testing in women from 
high risk families as they expect to get a cancer diagnosis at some time. Women 
with cancer felt they had experienced the worst with a cancer diagnosis and 
altruistically tested for the sake of their children but a positive test result 
temporarily shifted their focus to decision-making around their personal health 
needs.
CONCLUSION: This study adds to clinical practice through raising awareness and 
adding insights into how women cope with living with inherited cancer risk and 
the personal and familial ramifications that ensue from it. A clear 
multi-professional structured care pathway for women from genetic testing result 
disclosure to undergoing risk-reducing surgery and/or surveillance should be 
developed.