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Morgan J, MacInnes E, Erskine S, Walters SJ, Cook J, Collins K, Wyld L. Psychosocial outcomes after varying risk management strategies in women at increased familial breast cancer risk: a mixed methods study of patient and partner outcomes. Ann R Coll Surg Engl 2024; 106:78-91. [PMID: 37458196 PMCID: PMC10757884 DOI: 10.1308/rcsann.2023.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 01/02/2024] Open
Abstract
INTRODUCTION Female carriers of BRCA1/2 genes have an increased lifetime risk of breast cancer. Options for managing risk include imaging surveillance or risk-reducing surgery (RRS). This mixed methods study aimed to identify factors affecting risk-management decisions and the psychosocial outcomes of these decisions for high-risk women and their partners. METHODS Semi-structured qualitative interviews were performed with women at high breast cancer risk who had faced these choices. Partners were also interviewed. Analysis used a framework approach. A bespoke questionnaire was developed to quantify and explore associations. RESULTS A total of 32 women were interviewed. Of these, 27 had partners of whom 7 (26%) agreed to be interviewed. Four main themes arose: perception of risk and impact of increased risk; risk-management strategy decision-making; impact of risk-management strategy; support needs and partner relationship issues. The questionnaire response rate was 36/157 (23%). Decision satisfaction was high in both surveillance and RRS groups. Relationship changes were common but not universal. Common causes of distress following RRS included adverse body image changes. Both groups experienced generalised and cancer-specific anxiety. Drivers for surgery included having children, deaths of close family from breast cancer and higher levels of cancer anxiety. CONCLUSIONS Levels of psychosocial and decision satisfaction were high for women choosing both RRS and surveillance but, for a minority, risk-reducing measures result in long-term psychosocial morbidity. Efforts to recognise women at increased risk of psychological morbidity may allow targeted support.
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Affiliation(s)
| | - E MacInnes
- Leeds Teaching Hospitals NHS Foundation Trust, UK
| | - S Erskine
- East of England School of General Practice, Norwich, UK
| | | | - J Cook
- Sheffield Childrens NHS Foundation Trust, UK
| | | | - L Wyld
- Leeds Teaching Hospitals NHS Foundation Trust, UK
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Kwon JS, Tinker AV, Santos J, Compton K, Sun S, Schrader KA, Karsan A. Germline Testing and Somatic Tumor Testing for BRCA1/2 Pathogenic Variants in Ovarian Cancer: What Is the Optimal Sequence of Testing? JCO Precis Oncol 2022; 6:e2200033. [PMID: 36265114 PMCID: PMC9616645 DOI: 10.1200/po.22.00033] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
In 2020, ASCO recommended that all women with epithelial ovarian cancer have germline testing for BRCA1/2 mutations, and those without a germline pathogenic variant (PV) should have somatic tumor testing to determine eligibility for a poly (ADP-ribose) polymerase inhibitor. Consequently, the majority of patients with ovarian cancer will have both germline testing and somatic testing. An alternate strategy is tumor testing first and then germline testing if there is a PV in the tumor and/or significant family history. The objective was to conduct a cost-effectiveness analysis comparing the two testing strategies. Tumor testing for BRCA pathogenic variants is an efficient, cost-effective triage for germline testing.![]()
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Affiliation(s)
- Janice S. Kwon
- University of British Columbia, Vancouver, British Columbia, Canada,BC Cancer, Vancouver, British Columbia, Canada,Janice S. Kwon, MD, MPH, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of British Columbia, 2775 Laurel St, 6th Floor, Vancouver, BC, Canada V5Z 1M9; e-mail:
| | - Anna V. Tinker
- University of British Columbia, Vancouver, British Columbia, Canada,BC Cancer, Vancouver, British Columbia, Canada
| | - Jennifer Santos
- University of British Columbia, Vancouver, British Columbia, Canada,BC Cancer, Vancouver, British Columbia, Canada
| | - Katie Compton
- University of British Columbia, Vancouver, British Columbia, Canada,BC Cancer, Vancouver, British Columbia, Canada
| | - Sophie Sun
- University of British Columbia, Vancouver, British Columbia, Canada,BC Cancer, Vancouver, British Columbia, Canada
| | - Kasmintan A. Schrader
- University of British Columbia, Vancouver, British Columbia, Canada,BC Cancer, Vancouver, British Columbia, Canada
| | - Aly Karsan
- University of British Columbia, Vancouver, British Columbia, Canada,BC Cancer, Vancouver, British Columbia, Canada
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Liede A, Cai M, Crouter TF, Niepel D, Callaghan F, Evans DG. Risk-reducing mastectomy rates in the US: a closer examination of the Angelina Jolie effect. Breast Cancer Res Treat 2018; 171:435-442. [PMID: 29808287 PMCID: PMC6096880 DOI: 10.1007/s10549-018-4824-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/03/2018] [Indexed: 01/24/2023]
Abstract
PURPOSE In 2013, Angelina Jolie disclosed in the New York Times (NYT) that she had undergone risk-reducing bilateral mastectomy (RRBM) after learning that she was a BRCA1 mutation carrier. We examined the rates of BRCA testing and RRBM from 1997 to 2016, and quantified trends before and after the Jolie op-ed. METHODS This observational study of insurance claims data representative of the commercially-insured US population (Truven MarketScan® database) measured BRCA testing and RRBM rates among females ≥ 18 years. Censoring events were breast cancer or ovarian cancer diagnosis, last follow-up date (September 2016), or death. Interrupted time series analyses were used to quantify trends before and after the op-ed. RESULTS Angelina Jolie's NYT op-ed led to a statistically significant increase in the uptake of genetic testing and in RRBM among women without previous diagnosis of breast or ovarian cancer in the US population, and in women who did not undergo testing for BRCA (P < 0.0001 for both). The rate (slope) of RRBM among women who were previously tested for BRCA (P = 0.70) was unchanged. After excluding women with in-situ tumors, the editorial's effect became less pronounced, suggesting that high-risk women with in-situ breast cancers were most influenced by Jolie's announcement. CONCLUSION The Angelina Effect-a term coined by Time magazine to describe the rise in internet searches related to breast cancer genetics and counseling-represents a long-lasting impact of celebrity on public health awareness as significant increases in genetic testing and mastectomy rates were observed and sustained in subsequent years.
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Affiliation(s)
- Alexander Liede
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Mona Cai
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Tamara Fidler Crouter
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
- SimulStat Incorporated, Solana Beach, CA, USA
| | | | - Fiona Callaghan
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - D Gareth Evans
- Genomic Medicine, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
- Central Manchester University Hospitals NHS Foundation Trust, Saint Mary's Hospital, Oxford Road, Manchester, M13 9WL, UK.
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Jagsi R, Griffith KA, Kurian AW, Morrow M, Hamilton AS, Graff JJ, Katz SJ, Hawley ST. Concerns about cancer risk and experiences with genetic testing in a diverse population of patients with breast cancer. J Clin Oncol 2015; 33:1584-91. [PMID: 25847940 DOI: 10.1200/jco.2014.58.5885] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate preferences for and experiences with genetic testing in a diverse cohort of patients with breast cancer identified through population-based registries, with attention to differences by race/ethnicity. METHODS We surveyed women diagnosed with nonmetastatic breast cancer from 2005 to 2007, as reported to the SEER registries of metropolitan Los Angeles and Detroit, about experiences with hereditary risk evaluation. Multivariable models evaluated correlates of a strong desire for genetic testing, unmet need for discussion with a health care professional, and receipt of testing. RESULTS Among 1,536 patients who completed the survey, 35% expressed strong desire for genetic testing, 28% reported discussing testing with a health care professional, and 19% reported test receipt. Strong desire for testing was more common in younger women, Latinas, and those with family history. Minority patients were significantly more likely to have unmet need for discussion (failure to discuss genetic testing with a health professional when they had a strong desire for testing): odds ratios of 1.68, 2.44, and 7.39 for blacks, English-speaking Latinas, and Spanish-speaking Latinas compared with whites, respectively. Worry in the long-term survivorship period was higher among those with unmet need for discussion (48.7% v 24.9%; P <.001). Patients who received genetic testing were younger, less likely to be black, and more likely to have a family cancer history. CONCLUSION Many patients, especially minorities, express a strong desire for genetic testing and may benefit from discussion to clarify risks. Clinicians should discuss genetic risk even with patients they perceive to be at low risk, as this may reduce worry.
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Affiliation(s)
- Reshma Jagsi
- Reshma Jagsi, Center for Bioethics and Social Science in Medicine, University of Michigan; Kent A. Griffith, Center for Biostatistics, School of Public Health, University of Michigan; Steven J. Katz, University of Michigan; Sarah T. Hawley, Ann Arbor VA Health Care System, University of Michigan, Ann Arbor, MI; Allison W. Kurian, Stanford University School of Medicine, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Monica Morrow, Memorial Sloan-Kettering Cancer Center, New York, NY; and John J. Graff, Rutgers University, New Brunswick, NJ.
| | - Kent A Griffith
- Reshma Jagsi, Center for Bioethics and Social Science in Medicine, University of Michigan; Kent A. Griffith, Center for Biostatistics, School of Public Health, University of Michigan; Steven J. Katz, University of Michigan; Sarah T. Hawley, Ann Arbor VA Health Care System, University of Michigan, Ann Arbor, MI; Allison W. Kurian, Stanford University School of Medicine, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Monica Morrow, Memorial Sloan-Kettering Cancer Center, New York, NY; and John J. Graff, Rutgers University, New Brunswick, NJ
| | - Allison W Kurian
- Reshma Jagsi, Center for Bioethics and Social Science in Medicine, University of Michigan; Kent A. Griffith, Center for Biostatistics, School of Public Health, University of Michigan; Steven J. Katz, University of Michigan; Sarah T. Hawley, Ann Arbor VA Health Care System, University of Michigan, Ann Arbor, MI; Allison W. Kurian, Stanford University School of Medicine, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Monica Morrow, Memorial Sloan-Kettering Cancer Center, New York, NY; and John J. Graff, Rutgers University, New Brunswick, NJ
| | - Monica Morrow
- Reshma Jagsi, Center for Bioethics and Social Science in Medicine, University of Michigan; Kent A. Griffith, Center for Biostatistics, School of Public Health, University of Michigan; Steven J. Katz, University of Michigan; Sarah T. Hawley, Ann Arbor VA Health Care System, University of Michigan, Ann Arbor, MI; Allison W. Kurian, Stanford University School of Medicine, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Monica Morrow, Memorial Sloan-Kettering Cancer Center, New York, NY; and John J. Graff, Rutgers University, New Brunswick, NJ
| | - Ann S Hamilton
- Reshma Jagsi, Center for Bioethics and Social Science in Medicine, University of Michigan; Kent A. Griffith, Center for Biostatistics, School of Public Health, University of Michigan; Steven J. Katz, University of Michigan; Sarah T. Hawley, Ann Arbor VA Health Care System, University of Michigan, Ann Arbor, MI; Allison W. Kurian, Stanford University School of Medicine, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Monica Morrow, Memorial Sloan-Kettering Cancer Center, New York, NY; and John J. Graff, Rutgers University, New Brunswick, NJ
| | - John J Graff
- Reshma Jagsi, Center for Bioethics and Social Science in Medicine, University of Michigan; Kent A. Griffith, Center for Biostatistics, School of Public Health, University of Michigan; Steven J. Katz, University of Michigan; Sarah T. Hawley, Ann Arbor VA Health Care System, University of Michigan, Ann Arbor, MI; Allison W. Kurian, Stanford University School of Medicine, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Monica Morrow, Memorial Sloan-Kettering Cancer Center, New York, NY; and John J. Graff, Rutgers University, New Brunswick, NJ
| | - Steven J Katz
- Reshma Jagsi, Center for Bioethics and Social Science in Medicine, University of Michigan; Kent A. Griffith, Center for Biostatistics, School of Public Health, University of Michigan; Steven J. Katz, University of Michigan; Sarah T. Hawley, Ann Arbor VA Health Care System, University of Michigan, Ann Arbor, MI; Allison W. Kurian, Stanford University School of Medicine, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Monica Morrow, Memorial Sloan-Kettering Cancer Center, New York, NY; and John J. Graff, Rutgers University, New Brunswick, NJ
| | - Sarah T Hawley
- Reshma Jagsi, Center for Bioethics and Social Science in Medicine, University of Michigan; Kent A. Griffith, Center for Biostatistics, School of Public Health, University of Michigan; Steven J. Katz, University of Michigan; Sarah T. Hawley, Ann Arbor VA Health Care System, University of Michigan, Ann Arbor, MI; Allison W. Kurian, Stanford University School of Medicine, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Monica Morrow, Memorial Sloan-Kettering Cancer Center, New York, NY; and John J. Graff, Rutgers University, New Brunswick, NJ
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Prophylactic Salpingectomy and Delayed Oophorectomy as an Alternative for BRCA Mutation Carriers. Obstet Gynecol 2013; 121:14-24. [DOI: 10.1097/aog.0b013e3182783c2f] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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6
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Heiniger L, Butow PN, Price MA, Charles M. Distress in unaffected individuals who decline, delay or remain ineligible for genetic testing for hereditary diseases: a systematic review. Psychooncology 2012; 22:1930-45. [DOI: 10.1002/pon.3235] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 11/04/2012] [Accepted: 11/06/2012] [Indexed: 12/31/2022]
Affiliation(s)
- Louise Heiniger
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology; University of Sydney; New South Wales Australia
- School of Psychology; University of Sydney; New South Wales Australia
| | - Phyllis N. Butow
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology; University of Sydney; New South Wales Australia
- School of Psychology; University of Sydney; New South Wales Australia
| | - Melanie A. Price
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology; University of Sydney; New South Wales Australia
- School of Psychology; University of Sydney; New South Wales Australia
| | - Margaret Charles
- School of Psychology; University of Sydney; New South Wales Australia
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7
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Caruso A, Vigna C, Bigazzi V, Leone C, Maggi G, Martayan A, Sega FM, Cognetti F, Savarese A. Factors associated with an individuals’ decision to withdraw from genetic counseling for BRCA1 and BRCA2 genes mutations: are personality traits involved? Fam Cancer 2011; 10:581-9. [DOI: 10.1007/s10689-011-9454-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Kwon JS, Gutierrez-Barrera AM, Young D, Sun CC, Daniels MS, Lu KH, Arun B. Expanding the criteria for BRCA mutation testing in breast cancer survivors. J Clin Oncol 2010; 28:4214-20. [PMID: 20733129 DOI: 10.1200/jco.2010.28.0719] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Every year approximately 25% of women diagnosed with breast cancer are younger than 50 years of age, and almost 10% of them have a BRCA mutation. Not all potential carriers are identified by existing criteria for BRCA testing. We estimated the costs and benefits of different BRCA testing criteria for women with breast cancer younger than 50 years. METHODS We developed a Markov Monte Carlo simulation to compare six criteria for BRCA mutation testing: (1) no testing (reference); (2) medullary breast cancer in patients younger than 50 years; (3) any breast cancer in patients younger than 40 years; (4) triple negative (TN) breast cancer in patients younger than 40 years; (5) TN breast cancer in patients younger than 50 years; (6) any breast cancer in patients younger than 50 years. Net health benefits were life expectancy and quality-adjusted life expectancy, and primary outcome was the incremental cost-effectiveness ratio (ICER). The model estimated the number of new breast and ovarian cancer cases. RESULTS BRCA mutation testing for all women with breast cancer who were younger than 50 years could prevent the highest number of breast and ovarian cancer cases, but with unfavorable ICERs. Testing women with TN breast cancers who were younger than 50 years was cost-effective with an ICER of $8,027 per year of life gained ($9,084 per quality-adjusted life-year), and could reduce subsequent breast and ovarian cancer risks by 23% and 41%, respectively, compared with the reference strategy. CONCLUSION Testing women with TN breast cancers who were younger than 50 years for BRCA mutations is a cost-effective strategy and should be adopted into current guidelines for genetic testing.
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Affiliation(s)
- Janice S Kwon
- Division of Gynecologic Oncology, University of British Columbia and British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
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9
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Wang CW, Hui EC. Ethical, legal and social implications of prenatal and preimplantation genetic testing for cancer susceptibility. Reprod Biomed Online 2010; 19 Suppl 2:23-33. [PMID: 19891845 DOI: 10.1016/s1472-6483(10)60274-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
With the progress in cancer genetics and assisted reproductive technologies, it is now possible for cancer gene mutation carriers not only to reduce cancer mortality through the targeting of surveillance and preventive therapies, but also to avoid the birth of at-risk babies through the choice of different means of reproduction. Thus, the incidence of hereditary cancer syndromes may be decreased in the future. The integration of cancer genetic testing and assisted reproductive technologies raises certain ethical, legal and social issues beyond either genetic testing or assisted reproductive technology itself. In this paper, the reproductive decisions/choices of at-risk young couples and the ethical, legal and social concerns of prenatal genetic testing and preimplantation genetic diagnosis for susceptibility to hereditary cancer syndromes are discussed. Specifically, three ethical principles related to the integration of cancer genetic testing and assisted reproductive technologies, i.e. informed choice, beneficence to children and social justice, and their implications for the responsible translation of these medical techniques into common practice of preventive medicine are highlighted.
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Affiliation(s)
- C-W Wang
- Medical Ethics Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
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10
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Kwon JS, Daniels MS, Sun CC, Lu KH. Preventing future cancers by testing women with ovarian cancer for BRCA mutations. J Clin Oncol 2009; 28:675-82. [PMID: 19841329 DOI: 10.1200/jco.2008.21.4684] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Women with ovarian cancer have a 10% probability of carrying a BRCA mutation. If a mutation is identified, unaffected family members can undergo genetic testing and cancer risk-reducing strategies. We estimated the net health benefits and cost-effectiveness of different criteria for BRCA mutation testing in women with ovarian cancer, and the downstream benefits for their first-degree relatives (FDRs). METHODS We developed a Markov Monte Carlo simulation model to compare four criteria for BRCA testing in women with ovarian cancer: no testing (reference); only if personal history of breast cancer, family history of breast/ovarian cancer, or Ashkenazi Jewish ancestry; only if invasive serous cancer; any invasive nonmucinous epithelial cancer. Net health benefit was life expectancy for FDRs and primary outcome was the incremental cost-effectiveness ratio (ICER). The model estimated the number of future breast and ovarian cancer cases in FDRs. RESULTS BRCA testing based on personal/family history and ancestry could prevent future cases in FDRs with an ICER of $32,018 per year of life (LY) gained compared with the reference strategy. BRCA testing based on serous or any nonmucinous epithelial ovarian cancer could prevent more cancer cases, but at ICERs of $128,465 and $148,363 per LY gained, respectively. CONCLUSION BRCA testing of women with ovarian cancer based on personal/family history of cancer or Ashkenazi Jewish ancestry is a cost-effective strategy to prevent future breast and ovarian cancers among FDRs. More inclusive testing strategies prevent additional cancer cases but at significant cost.
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Affiliation(s)
- Janice S Kwon
- Division of Gynecologic Oncology, University of British Columbia, British Columbia, Canada.
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Mellon S, Gold R, Janisse J, Cichon M, Tainsky MA, Simon MS, Korczak J. Risk perception and cancer worries in families at increased risk of familial breast/ovarian cancer. Psychooncology 2009; 17:756-66. [PMID: 18613300 DOI: 10.1002/pon.1370] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
While families at increased risk for familial breast/ovarian cancer continue to overestimate their cancer risk with increased cancer worries about the future, few studies have examined factors that affect inherited cancer risk perception and cancer worries in both survivors and unaffected female relatives. The purpose of this study was to examine variables that may affect cancer worries and risk perceptions from a family-based perspective in a racially diverse, community-based, random sample of 146 dyads consisting of adult female breast and/or ovarian cancer survivors and their unaffected female relatives (N=292). Results indicated that coping style, self-efficacy, partner's income, family role relationship, and cancer risk perception were significant contributors to the survivors' and their unaffected relatives' cancer worries. Significant variables for perception of cancer risk for both survivors and relatives included income, race, family history of cancer, and cancer worries. Relatives had a higher perception of cancer risk, whereas survivors had more cancer worries. Additionally, the level of cancer worries reported by one member of the dyad was related to the amount of worries reported by the other. The results from this study underscore the importance of clinicians addressing concerns of both affected and unaffected members of families at increased risk of cancer to assist them in managing cancer worries and having realistic risk appraisals to make informed decisions about their own and their family's health surveillance options.
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Affiliation(s)
- Suzanne Mellon
- College of Health Professions, University of Detroit Mercy, Detroit, Michigan 48221-3038, USA.
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12
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Experiences and Decisions that Motivate Women at Increased Risk of Breast Cancer to Participate in an Experimental Screening Program. J Genet Couns 2009; 18:160-72. [DOI: 10.1007/s10897-008-9202-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Accepted: 10/29/2008] [Indexed: 10/21/2022]
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Ishiyama I, Nagai A, Muto K, Tamakoshi A, Kokado M, Mimura K, Tanzawa T, Yamagata Z. Relationship between public attitudes toward genomic studies related to medicine and their level of genomic literacy in Japan. Am J Med Genet A 2008; 146A:1696-706. [PMID: 18546279 DOI: 10.1002/ajmg.a.32322] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The aim of this study was to assess public attitudes toward the promotion of genomic studies related to medicine and to examine the relationship between public attitudes and the level of genomic literacy by analyzing data from a nationwide opinion survey. The participants comprised 4,000 people (age, 20-69) selected from the Japanese general population by using the two-step stratified random sampling method. They were queried on the following topics in a mail survey: (1) pros and cons of the promotion of genomic studies related to medicine, (2) level of scientific literacy in genomics, (3) demographic and socioeconomic background, and (4) knowledge and attitudes toward science in general and genetic testing in particular. We examined the relationship between the approval of promotion and literacy level, using logistic regression models stratified by gender. Our results showed the response rate was 54.3% (2,171/4,000), and 69.4% participants favored the promotion of genomic studies related to medicine. Only 1.3% participants expressed a negative attitude. Multivariate analysis revealed that approval of promotion was related to a high literacy score. This relationship was stronger in males than in females (the highest quartile of score vs. the lowest: adjusted odds ratio, 3.36 for males and 1.86 for females; 95% confidence interval, 1.88-5.98 for males and 1.17-2.95 for females). We determined that a majority of the Japanese participants currently approved of the promotion of genomic studies related to medicine and that people with a high level of genomic literacy tended to approve the promotion.
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Affiliation(s)
- Izumi Ishiyama
- Department of Health Sciences, School of Medicine, University of Yamanashi, Yamanashi, Japan
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Barriers to participating in genetic counseling and BRCA testing during primary treatment for breast cancer. Genet Med 2007; 9:766-77. [DOI: 10.1097/gim.0b013e318159a318] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lessick M. Genetic testing for breast and ovarian cancer: ethical, legal, and psychosocial considerations. Nurs Womens Health 2007; 11:390-9; quiz 400-1. [PMID: 17883756 DOI: 10.1111/j.1751-486x.2007.00204.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Mira Lessick
- College of Nursing, University of Toledo, Toledo, OH, USA
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McKinnon W, Naud S, Ashikaga T, Colletti R, Wood M. Results of an intervention for individuals and families with BRCA mutations: a model for providing medical updates and psychosocial support following genetic testing. J Genet Couns 2007; 16:433-56. [PMID: 17594133 DOI: 10.1007/s10897-006-9078-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2006] [Accepted: 11/16/2006] [Indexed: 01/07/2023]
Abstract
: Providing medical management updates and long-term support to families with hereditary cancer syndromes in rural areas is a challenge. To address this, we designed a one-day retreat for BRCA1/2 carriers in our region. The retreat included educational updates about medical management, genetic privacy and discrimination, and addressed psychological and family issues. Evaluations completed at the conclusion of the retreat were overwhelmingly positive with requests for a similar event in the future. The impact of this retreat on a variety of health behaviors was assessed. Eligible participants completed questionnaires before and 6 months after the retreat. Questionnaires focused on lifestyle, cancer screening and prevention practices, psychological history and distress, decision-making regarding genetic testing, and family communication issues. For individuals who completed both the pre and post retreat questionnaires, one-half made lifestyle changes and nearly two-thirds increased cancer screening, initiated chemoprevention, completed or planned to complete preventative surgery in the future. We conclude that this type of forum provides a valuable opportunity for BRCA carriers and their families to receive updated medical information, share personal experiences, provide and receive support, as well as change health behaviors.
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Affiliation(s)
- Wendy McKinnon
- Department of Pediatrics, University of Vermont College of Medicine, Burlington, VT 05401, USA.
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Godard B, Pratte A, Dumont M, Simard-Lebrun A, Simard J. Factors associated with an individual's decision to withdraw from genetic testing for breast and ovarian cancer susceptibility: implications for counseling. ACTA ACUST UNITED AC 2007; 11:45-54. [PMID: 17394392 DOI: 10.1089/gte.2006.9998] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Our study aimed to examine why individuals withdraw from genetic testing for breast and ovarian cancer susceptibility. We explored the characteristics of 334 individuals from high-risk breast and ovarian cancer families who declined genetic testing for BRCA1/2 mutations, when, and why they did so. Individuals who declined genetic testing were older, and a greater proportion had never developed breast or ovarian cancer. Fifty one per cent (51.1%) of individuals withdrew after the first genetic counseling session. Most of those who declined were afraid of the psychological effects of genetic testing (36.3%). The next most-cited explanations concerned logistic problems such as a limited ability to travel, lack of time, personal issues, advanced age, or health problems (21.7%). The third category included individuals who did not see any advantage in being tested (14.5%). Insurability was a concern (5.9%), mainly for men. Surprisingly, confidentiality was not a frequently reported issue (1.3%). Sixty eight per cent (68%) of individuals belonging to a family in which at least one individual has been tested withdrew after the presence of a deleterious BRCA1/2 mutation in a relative was disclosed, compared to 42% after the disclosure of a nonconclusive test result in at least one relative. Concern about the psychological effects of the result was still one of the major reasons. Several factors may influence an individual's decision to decline genetic testing; a greater understanding of these issues may help health professionals to better meet the needs and concerns of individuals from high-risk families, thus possibly improving their health outcomes.
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Affiliation(s)
- Béatrice Godard
- Department of Preventive and Social Medicine, Bioethics Programs, University of Montreal, Montreal, Quebec, Canada.
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Lewis MJ, Peterson SK. Perceptions of genetic testing for cancer predisposition among Ashkenazi Jewish women. Public Health Genomics 2007; 10:72-81. [PMID: 17380056 DOI: 10.1159/000099084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Clinical genetic testing can help identify individuals who are predisposed to a variety of diseases and conditions; thus, it is important to understand attitudes and perceptions of individuals who may consider or who may be offered such testing. METHODS We examined knowledge and attitudes about cancer genetic testing among 59 women of Ashkenazi Jewish descent (age 25-80 years) through six focus group discussions. Participants were asked about their knowledge and experience with hereditary conditions and genetic testing, and attitudes regarding risk management options, genetic privacy, and potential discrimination issues. RESULTS Although 54% reported having a personal and/or some family history of breast, ovarian, or colorectal cancer, none had undergone cancer genetic counseling or testing and few expressed an interest or intention in doing so. While most endorsed benefits of genetic testing for those with a significant cancer family history, women also expressed concerns over the possible distress of learning that one carried a cancer-predisposing mutation and suggested that increasing cancer screening practices may be preferable to having genetic testing. Participants doubted the ability of state genetic privacy legislation to protect against insurance or employment discrimination. CONCLUSION Findings underscore the need for public education on the broad range of benefits and limitations associated with genetic testing, in order to help consumers to appropriately interpret complex information and make decisions about these services.
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Affiliation(s)
- M Jane Lewis
- University of Medicine and Dentistry of New Jersey, School of Public Health, Piscataway, NJ, USA.
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Kieran S, Loescher LJ, Lim KH. The Role of Financial Factors in Acceptance of Clinical BRCA Genetic Testing. ACTA ACUST UNITED AC 2007; 11:101-10. [PMID: 17394399 DOI: 10.1089/gte.2006.9999] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Many women who are offered BRCA genetic testing by genetics professionals do not have the test, possibly for financial reasons. We explored financial factors implicated in non-uptake of BRCA testing in women who had received genetic counseling in a clinical setting. Specifically, we described financial factors (affordability, health insurance, other) involved with BRCA testing; compared nonfinancial factors (disease, sociodemographic, risk assessment) in women who did not have BRCA testing (nontesters) with women who had the test (testers); showed associations of financial and nonfinancial factors with BRCA testing; and identified predictors of non-uptake of BRCA testing. The sample of 100 women (64 nontesters and 36 testers) completed an anonymous mailed survey on financial factors; 52 of the nontesters answered questions about nonfinancial factors. Testers had significantly better affordability and insurance coverage (p < 0.001), more diagnoses of breast or ovarian cancer (p < 0.05) and higher rates of receiving post-counseling risk estimates (p < 0.05), than nontesters. Non-uptake was 5.5-fold more likely in women that could not afford full or partial payment for the test and was 15.5-fold more likely in women that did not recall receiving risk estimates post-counseling. For many women having risk factors for breast/ovarian cancer, affordability of BRCA testing and insurance coverage for the test remain problematic. Post-counseling reminders of risk estimates may contribute to uptake of testing.
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Affiliation(s)
- Shannon Kieran
- Bay Area Gynecology Oncology Regional Tumor Risk Program, San Jose, CA, USA
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Schlich-Bakker KJ, ten Kroode HFJ, Ausems MGEM. A literature review of the psychological impact of genetic testing on breast cancer patients. PATIENT EDUCATION AND COUNSELING 2006; 62:13-20. [PMID: 16242293 DOI: 10.1016/j.pec.2005.08.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2005] [Revised: 08/23/2005] [Accepted: 08/25/2005] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Easier access and increased awareness results in more referral for genetic testing for hereditary breast cancer in healthy at-risk women and breast cancer patients. To investigate the psychological impact of genetic testing on breast cancer patients, literature pertaining to this group was reviewed. METHOD Medline and PsychInfo databases were searched over the period 1995-2004 for studies aimed at breast cancer patients referred for genetic testing. Qualitative and quantitative psychological outcome measures were identified. RESULTS Eight papers were identified focusing on women affected by breast cancer and undergoing genetic counseling and DNA testing. CONCLUSION Genetic testing does not lead to an increase in psychological distress in breast cancer patients. However, a recent breast cancer diagnosis adds to general and cancer-specific distress prior to genetic counseling and after DNA test disclosure. PRACTICE IMPLICATIONS Clinicians need to be aware of possible high psychological distress and additional counseling needs of recently diagnosed breast cancer patients taking part in genetic testing. Further research should focus on patients who decline genetic counseling or receive an inconclusive test result, including age upon and time since diagnosis.
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Claes E, Evers-Kiebooms G, Decruyenaere M, Denayer L, Boogaerts A, Philippe K, Legius E. Surveillance behavior and prophylactic surgery after predictive testing for hereditary breast/ovarian cancer. Behav Med 2006; 31:93-105. [PMID: 16252621 DOI: 10.3200/bmed.31.3.93-106] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This article describes breast or ovarian cancer surveillance practices and prophylactic surgery involving 34 carriers and 34 noncarriers of a BRCA1/2 mutation within the year after predictive testing. It also evaluates the effect of the predictive test result on cancer screening practices and provides insight into factors important in the decision-making process about health-related behavior. Within the year following predictive testing, 9% (3 of 34) of the carriers decided to have a prophylactic mastectomy. The majority of the carriers was adherent to recommendations regarding regular cancer surveillance following predictive testing. Furthermore, carriers' adherence to clinical breast examination and mammography recommendations significantly increased from pre- to posttest and was significantly higher than noncarriers' utilization after testing. Of the carriers eligible for prophylactic salpingo-oophorectomy, 75% had this operation. All carriers who were advised to have regular surveillance of the ovaries had ovarian ultrasounds. The authors gave major attention to factors playing a part in the decision-making process about health-related behavior.
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Affiliation(s)
- Erna Claes
- Psychosocial Genetics Unit, Center for Human Genetics, University of Leuven, Belgium
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Bleiker E, Wigbout G, van Rens A, Verhoef S, Van't Veer L, Aaronson N. Withdrawal from genetic counselling for cancer. Hered Cancer Clin Pract 2005; 3:19-27. [PMID: 20223026 PMCID: PMC2837064 DOI: 10.1186/1897-4287-3-1-19] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Accepted: 02/10/2005] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A substantial minority of individuals who initially apply for genetic counselling for breast/ovarian cancer withdraw at an early stage from the counselling process. This study investigated the self-reported reasons for early withdrawal and the factors associated significantly with such withdrawal. METHODS Self-report questionnaires were mailed to 83 women who had applied for genetic counselling for breast/ovarian cancer but who subsequently withdrew from the counselling process (the "withdrawers"). A comparison group of 105 women who had completed the genetic counselling (the "attendees") received a similar questionnaire. The questionnaire assessed sociodemographic characteristics, reasons for applying for genetic counselling, general distress (MHI-5), cancer-specific distress (IES), and cancer worries. For those women who discontinued the counselling, reasons for withdrawal were also assessed. RESULTS The primary reasons given for withdrawing from counselling were difficulties in anticipating the consequences of genetic counselling (28%), and worries about being unable to adequately cope with an unfavourable test result (20%). Compared to the attendees, the withdrawers were significantly younger, more frequently asymptomatic, more often the first and only member of the family to apply for counselling, and less worried about cancer. Current levels of cancer-specific distress and general distress were comparable between the two groups. CONCLUSION Younger women, those without a history of cancer, and those who are first in their family to apply are more likely to withdraw prematurely from genetic counselling for breast/ovarian cancer. These withdrawers have no elevated levels of distress. However, a substantial percentage of individuals discontinue counselling due to concerns about their (in)ability to cope with a possible unfavourable test outcome. This suggests that greater attention should be paid to ways of coping with test results during the very first contact with the clinic.
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Affiliation(s)
- Eveline Bleiker
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
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van Oostrom I, Tibben A. A Counselling Model for BRCA1/2 Genetic Susceptibility Testing. Hered Cancer Clin Pract 2004; 2:19-23. [PMID: 20233480 PMCID: PMC2839990 DOI: 10.1186/1897-4287-2-1-19] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2004] [Accepted: 02/20/2004] [Indexed: 11/12/2022] Open
Abstract
When BRCA1/2 genetic susceptibility testing was introduced in the clinic in the mid-nineties, the "Huntington protocol" was used in the counselling of individuals applying for genetic testing. This protocol includes at least three sessions with a certain reflection period before blood sampling. Evidence on the psychological impact of BRCA1/2 genetic susceptibility testing has been accumulating in the last years. We will give a short overview of these psychological studies in order to reflect the need of using the extensive Huntington protocol in the counselling of individuals applying for BRCA1/2 genetic susceptibility testing. A shortened and more flexible BRCA1/2 counselling protocol is delineated, in which the attention is focused on the needs and strengths of the individual.
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Affiliation(s)
- Iris van Oostrom
- Department of Clinical Genetics, Department of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, the Netherlands.
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van Oostrom I, Meijers-Heijboer H, Lodder LN, Duivenvoorden HJ, van Gool AR, Seynaeve C, van der Meer CA, Klijn JGM, van Geel BN, Burger CW, Wladimiroff JW, Tibben A. Long-Term Psychological Impact of Carrying a BRCA1/2 Mutation and Prophylactic Surgery: A 5-Year Follow-Up Study. J Clin Oncol 2003; 21:3867-74. [PMID: 14551306 DOI: 10.1200/jco.2003.10.100] [Citation(s) in RCA: 206] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: To explore long-term psychosocial consequences of carrying a BRCA1/2 mutation and to identify possible risk factors for long-term psychological distress. Patients and Methods: Five years after genetic test disclosure, 65 female participants (23 carriers, 42 noncarriers) of our psychological follow-up study completed a questionnaire and 51 participants were interviewed. We assessed general and hereditary cancer-related distress, risk perception, openness to discuss the test result with relatives, body image and sexual functioning. Results: Carriers did not differ from noncarriers on several distress measures and both groups showed a significant increase in anxiety and depression from 1 to 5 years follow-up. Carriers having undergone prophylactic surgery (21 of 23 carriers) had a less favorable body image than noncarriers and 70% reported changes in the sexual relationship. A major psychological benefit of prophylactic surgery was a reduction in the fear of developing cancer. Predictors of long-term distress were hereditary cancer-related distress at blood sampling, having young children, and having lost a relative to breast/ovarian cancer. Long-term distress was also associated with less open communication about the test result within the family, changes in relationships with relatives, doubting about the validity of the test result, and higher risk perception. Conclusion: Our findings support the emerging consensus that genetic predisposition testing for BRCA1/2 does not pose major mental health risks, but our findings also show that the impact of prophylactic surgery on aspects such as body image and sexuality should not be underestimated, and that some women are at risk for high distress, and as a result, need more attentive care.
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Affiliation(s)
- Iris van Oostrom
- Department of Clinical Genetics, Erasmus MC, Rotterdam, the Netherlands.
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