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Zhu P, Ji Q, Liu X, Xu T, Wu Q, Wang Y, Gao X, Zhou Z. “I’m walking on eggshells”: challenges faced by mothers with breast cancer in interacting with adolescent daughters. BMC Womens Health 2022; 22:385. [PMID: 36127684 PMCID: PMC9490998 DOI: 10.1186/s12905-022-01872-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 07/01/2022] [Indexed: 11/12/2022] Open
Abstract
Background With breast cancer becoming the most diagnosed cancer in the world, the number of breast cancer-afflicted mothers with adolescent daughters is also rising. Further, adolescent daughters’ mothers serve as role models for in identity formation processes, especially concerning gender and sexuality. Nevertheless, breast cancer threats mother’s health, including such a key symbol of her womanhood—the breast—which may adversely affect the development of an adolescent daughter’s own sense of personal identity and womanhood. However, few researchers and practitioners have paid attention to mother-daughter interactions in the context of breast cancer. Therefore, this study aimed to uncover the nuances of the interactive challenges with adolescent daughters from breast cancer-afflicted mothers’ perspective. Methods We conducted a qualitative study following the sample saturation principle, collecting data through semi-structured interviews with 21 breast cancer patients who met the inclusion criteria. We utilized thematic analysis and partially integrated the Foucauldian discourse approach to analyze the data. Results Three major themes emerged from the data: (1) mothers are lost in chaos (inability to handle the shock of cancer, feelings of powerlessness about the uncertainty of their life span, and confusion about how to respond to daughter’s curiosity); (2) mothers struggle to maintain balance (torn between protecting daughters and letting them be independent, and making a tough choice between being a mother or a patient); and (3) mothers are immersed in guilt (increasing daughters’ risk of cancer, influencing daughters’ development, and imposing burdens on daughters). Conclusions Our research explored the interactive experience of breast cancer-afflicted mothers and adolescent daughters. The insights uncovered by this study will help mothers enhance interaction with their daughters and assist health practitioners in devising interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01872-1.
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Mozersky J, Meyer MN, Rahm AK, O'Dell SM, Buchanan A. Balancing External Validity and Concern for Psychosocial Harms in Translational Genetic Research. Ethics Hum Res 2021; 43:43-48. [PMID: 33683017 DOI: 10.1002/eahr.500086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Jessica Mozersky
- Assistant professor in the Bioethics Research Center and a Faculty Scholar in the Institute of Public Health at Washington University School of Medicine
| | - Michelle N Meyer
- Assistant professor and associate director of research ethics at the Center for Translational Bioethics & Health Care Policy, a faculty codirector of the Behavioral Insights Team at the Steele Institute for Healthcare Innovation, and an assistant professor of bioethics at the Geisinger Commonwealth School of Medicine
| | | | - Sean M O'Dell
- Associate in the Department of Psychiatry and Behavioral Health and an assistant professor of clinical research in the Department of Population Health Sciences at Geisinger
| | - Adam Buchanan
- Associate professor and the director of the Genomic Medicine Institute at Geisinger
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Knight JA, Kehm RD, Schwartz L, Frost CJ, Chung WK, Colonna S, Keegan THM, Goldberg M, Houghton LC, Hanna D, Glendon G, Daly MB, Buys SS, Andrulis IL, John EM, Bradbury AR, Terry MB. Prepubertal Internalizing Symptoms and Timing of Puberty Onset in Girls. Am J Epidemiol 2021; 190:431-438. [PMID: 33057572 DOI: 10.1093/aje/kwaa223] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/02/2020] [Accepted: 10/09/2020] [Indexed: 11/12/2022] Open
Abstract
Stressful environments have been associated with earlier menarche. We hypothesized that anxiety, and possibly other internalizing symptoms, are also associated with earlier puberty in girls. The Lessons in Epidemiology and Genetics of Adult Cancer From Youth (LEGACY) Girls Study (2011-2016) included 1,040 girls aged 6-13 years at recruitment whose growth and development were assessed every 6 months. Prepubertal maternal reports of daughter's internalizing symptoms were available for breast onset (n = 447), pubic hair onset (n = 456), and menarche (n = 681). Using Cox proportional hazard regression, we estimated prospective hazard ratios and 95% confidence intervals for the relationship between 1 standard deviation of the percentiles of prepubertal anxiety, depression, and somatization symptoms and the timing of each pubertal outcome. Multivariable models included age, race/ethnicity, study center, maternal education, body mass index percentile, and family history of breast cancer. Additional models included maternal self-reported anxiety. A 1-standard deviation increase in maternally reported anxiety in girls at baseline was associated with earlier subsequent onset of breast (hazard ratio (HR) = 1.22, 95% confidence interval (CI): 1.09, 1.36) and pubic hair (HR = 1.15, 95% CI: 1.01, 1.30) development, but not menarche (HR = 0.94, 95% CI: 0.83, 1.07). The association of anxiety with earlier breast development persisted after adjustment for maternal anxiety. Increased anxiety in young girls may indicate risk for earlier pubertal onset.
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Damghanian M, Mahmoodzadeh H, Khakbazan Z, Khorsand B, Motaharinezhad M. Self-care behaviors in high-risk women for breast cancer: A randomized clinical trial using health belief model education. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2020; 9:265. [PMID: 33282970 PMCID: PMC7709765 DOI: 10.4103/jehp.jehp_76_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/13/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Breast cancer is the most common cancer in Iranian women. The number of people with this disease is increasing across the world. Positive family history is one of the risk factors for developing breast cancer. However, early detection is the main method to fight this disease. This study was conducted to examine the effect of education based on the health belief model (HBM) on self-care behaviors among first-degree relatives of patients with breast cancer. METHODS This clinical trial was conducted in 2016 on 80 women in Tehran city, Iran. Data were collected using a three-part questionnaire regarding demographic data, the HBM, and self-care behaviors. The educational program based on the HBM was held in 4 ninety-minute training sessions through lectures, group discussions, question and answer, image presentations, and PowerPoint presentations. The questionnaires were completed before and 2 months following the intervention by intervention and control groups. Data were analyzed using descriptive and inferential statistics through the SPSS16 software. RESULTS The mean score of the HBM constructs before the intervention in the groups had no statistically significant differences (P > 0.05). Eight weeks after the intervention, the mean score of the constructs of the HBM in the intervention group significantly increased and a statistically significant increase in the mean score of self-care in the intervention group compared to the preintervention was found, so that the self-care behavior score in the intervention group was 0.69 ± 0.09 before the intervention and was changed to 0.74 ± 0.09 after the intervention (P < 0.0001). CONCLUSION Our results suggest that education based on the HBM was effective in promoting self-care behaviors among first-degree relatives of breast cancer patients. Therefore, education based on HBM may have an important implication for breast cancer prevention in Iran.
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Affiliation(s)
- Maryam Damghanian
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Habibollah Mahmoodzadeh
- Department of General Surgery, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Khakbazan
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Behjat Khorsand
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohadese Motaharinezhad
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Tercyak KP, Bronheim SM, Kahn N, Robertson HA, Anthony BJ, Mays D, O’Neill SC, Peterson SK, Miesfeldt S, Peshkin BN, DeMarco TA. Cancer genetic health communication in families tested for hereditary breast/ovarian cancer risk: a qualitative investigation of impact on children's genetic health literacy and psychosocial adjustment. Transl Behav Med 2019; 9:493-503. [PMID: 31094441 PMCID: PMC6520800 DOI: 10.1093/tbm/ibz012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Children's literacy about the genetics of late-onset hereditary breast/ovarian cancer (HBOC) often develops through conversations with parents about BRCA gene testing and adults' cancer diagnoses. These conversations may promote early understanding of HBOC, but the long-term impact on children's psychosocial adjustment remains unclear. We investigated cancer genetic health communication in BRCA-tested families to consider benefits, risks, and moderating influences on children's understanding and well-being. Adolescent and young adult children (ages 12-24) of mothers who underwent BRCA testing 1+ years previously completed qualitative interviews that were transcribed, coded (intercoder K ≥ .70), and content-analyzed (N = 34). Children readily recalled conversations about BRCA testing and HBOC (100%) that they considered important (94%), but implications for children were ambiguous and obfuscated their concerns. Psychosocial impacts were muted, multifaceted, and displayed a range of favorable (82%), neutral (71%), and unfavorable (59%) response-frequently co-occurring within the same child over different aspects (e.g., medical, concern for self and others). Children verbalized active (50%) and avoidant (38%) coping strategies: about 1:5 endorsed transient thoughts about vulnerability to HBOC, 1:3 had not further considered it, and all reported specific actions they had or would undertake to remain healthy (e.g., diet/exercise). A majority (94%) of children had or would consider genetic testing for themselves, usually later in life (59%). Long-term outcomes highlighted benefits (awareness of HBOC, psychological hardiness, healthier lifestyle behaviors), as well as some psychosocial concerns that could be managed through interventions promoting genetic health literacy.
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Affiliation(s)
- Kenneth P Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
- Center for Child and Human Development, Georgetown University Medical Center, Washington, DC, USA
| | - Suzanne M Bronheim
- Center for Child and Human Development, Georgetown University Medical Center, Washington, DC, USA
| | - Nicole Kahn
- Center for Child and Human Development, Georgetown University Medical Center, Washington, DC, USA
| | - Hillary A Robertson
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC, USA
| | - Bruno J Anthony
- Center for Child and Human Development, Georgetown University Medical Center, Washington, DC, USA
| | - Darren Mays
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Suzanne C O’Neill
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Susan K Peterson
- Department of Behavioral Science, MD Anderson Cancer Center, Houston, TX, USA
| | - Susan Miesfeldt
- Scarborough Campus, Maine Medical Center Cancer Institute, Scarborough, ME, USA
| | - Beth N Peshkin
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
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Houghton LC, Knight JA, Wei Y, Romeo RD, Goldberg M, Andrulis IL, Bradbury AR, Buys SS, Daly MB, John EM, Chung WK, Santella RM, Stanczyk FZ, Terry MB. Association of Prepubertal and Adolescent Androgen Concentrations With Timing of Breast Development and Family History of Breast Cancer. JAMA Netw Open 2019; 2:e190083. [PMID: 30794303 PMCID: PMC6484611 DOI: 10.1001/jamanetworkopen.2019.0083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE Early breast development is a risk factor for breast cancer, and girls with a breast cancer family history (BCFH) experience breast development earlier than girls without a BCFH. OBJECTIVES To assess whether prepubertal androgen concentrations are associated with timing of breast development (analysis 1) and to compare serum androgen concentrations in girls with and without a BCFH (analysis 2). DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of 104 girls aged 6 to 13 years at baseline using data collected between August 16, 2011, and March 24, 2016, from the Lessons in Epidemiology and Genetics of Adult Cancer From Youth (LEGACY) Girls Study, New York site. EXPOSURES Analysis 1 included serum concentrations of dehydroepiandrosterone sulfate, androstenedione, and testosterone (free and total) measured before breast development and divided at the median into high and low categories. Analysis 2 included the degree of BCFH: first-degree was defined as having a mother with breast cancer and second-degree was defined as having a grandmother or aunt with breast cancer. MAIN OUTCOMES AND MEASURES Analysis 1 included age at onset of breast development measured using the Pubertal Development Scale (scores range from 1-4; scores ≥2 indicate breast development), and analysis 2 included serum androgen concentrations. We also assessed breast cancer-specific distress using the 8-item Child Impact of Events Scale. RESULTS Our analyses included 36 girls for the prospective model, 92 girls for the cross-sectional model, and 104 girls for the longitudinal model. Of the 104 girls, the mean (SD) age at baseline was 10.3 (2.5) years, and 41 (39.4%) were non-Hispanic white, 41 (39.4%) were Hispanic, 13 (12.5%) were non-Hispanic black, and 9 (8.7%) were other race/ethnicity. Forty-two girls (40.4%) had a positive BCFH. Girls with prepubertal androstenedione concentrations above the median began breast development 1.5 years earlier than girls with concentrations below the median (Weibull survival model-estimated median age, 9.4 [95% CI, 9.0-9.8] years vs 10.9 [95% CI, 10.4-11.5] years; P = .001). Similar patterns were observed for dehydroepiandrosterone sulfate (1.1 years earlier: age, 9.6 [95% CI, 9.1-10.1] years vs 10.7 [95% CI, 10.2-11.3] years; P = .009), total testosterone (1.4 years earlier: age, 9.5 [95% CI, 9.1-9.9] years vs 10.9 [95% CI, 10.4-11.5] years; P = .001), and free testosterone (1.1 years earlier: age, 9.7 [95% CI, 9.2-10.1] years vs 10.8 [95% CI, 10.2-11.4] years; P = .01). Compared with girls without BCFH, girls with a first-degree BCFH, but not a second-degree BCFH, had 240% higher androstenedione concentrations (geometric means: no BCFH, 0.49 ng/mL vs first-degree BCFH, 1.8 ng/mL vs second-degree, 1.6 ng/mL; P = .01), 10% higher total testosterone concentrations (12.7 ng/dL vs 14.0 ng/dL vs 13.7 ng/dL; P = .01), and 92% higher free testosterone concentrations (1.3 pg/mL vs 2.5 pg/mL vs 0.3 pg/mL; P = .14). The dehydroepiandrosterone sulfate concentration did not differ between BCFH-positive and BCFH-negative girls but was elevated in girls with breast cancer-specific distress. CONCLUSIONS AND RELEVANCE Our findings suggest that androgen concentrations may differ between girls with and without a BCFH and that elevated hormone concentrations during adolescence may be another factor to help explain the familial clustering of breast cancer.
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Affiliation(s)
- Lauren C. Houghton
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Julia A. Knight
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld–Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Ying Wei
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Russell D. Romeo
- Psychology and the Neuroscience and Behavior Program, Barnard College of Columbia University, New York, New York
| | - Mandy Goldberg
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Irene L. Andrulis
- Lunenfeld–Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Angela R. Bradbury
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Division of Hematology/Oncology, Department of Medicine, The Perelman School of Medicine of the University of Pennsylvania, Philadelphia
| | - Saundra S. Buys
- Department of Medicine, University of Utah Health Sciences Center, Huntsman Cancer Institute, Salt Lake City
| | - Mary B. Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Esther M. John
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Wendy K. Chung
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York
- Department of Pediatrics, Columbia University Medical Center, New York, New York
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Regina M. Santella
- Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Frank Z. Stanczyk
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Mary Beth Terry
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York
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Schwartz LA, Henry-Moss D, Egleston B, Patrick-Miller L, Markman E, Daly M, Tuchman L, Moore C, Rauch PK, Karpink K, Sands CB, Domchek SM, Bradbury A. Preventative Health and Risk Behaviors Among Adolescent Girls With and Without Family Histories of Breast Cancer. J Adolesc Health 2019; 64:116-123. [PMID: 30301677 PMCID: PMC7597848 DOI: 10.1016/j.jadohealth.2018.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 06/02/2018] [Accepted: 07/12/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare health behaviors (smoking, alcohol use, fruit and vegetable intake, and exercise frequency) and breast self-exam (BSE) between girls with breast cancer family history (BCFH+) and without (BCFH-) and assess associates of behaviors across all girls. METHODS A total of 208 BCFH+ girls (11-19 years old), with first- or second-degree relatives with breast cancer or a mother with a BRCA1/2 mutation, and 112 BCFH- peers reported their health behaviors, beliefs, and psychosocial function. RESULTS Despite higher BCFH+ girls' greater perceived breast cancer risk, there were no differences between BCFH+ and BCFH- girls on diet, exercise, alcohol initiation, or BSE. BCFH+ girls were slightly more likely to report trying cigarettes (11% vs. 5%, p = .04). In multivariable models with all girls, categorical associations with behaviors included the following: developmental and demographic factors with smoking, alcohol, diet, and exercise; family breast cancer history and experience with smoking, alcohol, and diet; psychosocial factors with smoking; girls perceptions of cancer controllability and mother support for health behaviors with alcohol, diet, exercise, and BSE; and mother behaviors with diet. CONCLUSIONS Adolescent girls from BCFH+ families reported similar health behaviors to BCFH- peers, signaling that they are not translating their higher perceived risk into cancer control behaviors. Both uncontrollable (i.e., breast cancer experiences) and modifiable factors relate to health behaviors and warrant further investigation. Results indicate that interventions with teens and parents that target modifiable variables such as controllability perceptions, maternal modeling, and communication may relate to better health behaviors and reduced future breast cancer risk.
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Affiliation(s)
- Lisa A. Schwartz
- The Children’s Hospital of Philadelphia and the Perelman School of Medicine of the University of Pennsylvania, 3501 Civic Center Blvd, CTRB 10311, Philadelphia, PA19104;
| | - Dare Henry-Moss
- The Perelman School of Medicine of the University of Pennsylvania, 3400 Civic Center Blvd, PCAM 10, Philadelphia, PA 19104;
| | - Brian Egleston
- Fox Chase Cancer Center of Temple University Health, 333 Cottman Avenue, Philadelphia, PA 19111;
| | | | - Elisabeth Markman
- The Children’s Hospital of Philadelphia, 3501 Civic Center Blvd, CTRB 10311, Philadelphia, PA19104;
| | - Mary Daly
- Fox Chase Cancer Center of Temple University Health, 333 Cottman Avenue, Philadelphia, PA 19111;
| | - Lisa Tuchman
- Children’s National Medical Center, 111 Michigan Ave, NW, Washington, DC 20010;
| | - Cynthia Moore
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114;
| | - Paula K. Rauch
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114;
| | - Kelsey Karpink
- The Perelman School of Medicine of the University of Pennsylvania, 3400 Civic Center Blvd, PCAM 10, Philadelphia, PA;
| | - Colleen Burke Sands
- The Perelman School of Medicine of the University of Pennsylvania, 3400 Civic Center Blvd, PCAM 10, Philadelphia, PA;
| | - Susan M. Domchek
- The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, 3400 Civic Center Blvd, PCAM 3 SPE, Philadelphia, PA;
| | - Angela Bradbury
- The Perelman School of Medicine of the University of Pennsylvania, 3400 Civic Center Blvd, PCAM 10, Philadelphia, PA;
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Bester JC, Sabatello M, van Karnebeek CD, Lantos JD. Please Test My Child for a Cancer Gene, but Don't Tell Her. Pediatrics 2018. [PMID: 29535250 PMCID: PMC5882554 DOI: 10.1542/peds.2017-2238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A 38-year-old woman is diagnosed with Li-Fraumeni syndrome, an autosomal dominant genetic condition that predisposes to a variety of cancers. The woman has an 11-year-old daughter. The geneticist recommends that the child be tested for the Li-Fraumeni genetic variant. The mother is concerned about the impact of testing and diagnosis on Karen's psychological well-being. She describes Karen as "highly strung" and as "a worrier." The child has been diagnosed with an anxiety disorder and is managed by a psychologist for counseling. The child is otherwise well. The mother requests that testing be done without disclosing it to the child by adding the test on to routine blood work done for another reason and requests that the results only be revealed if they are positive. Experts in genetics, law, and bioethics discuss whether it is permissible to test the child without her knowledge or assent.
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Affiliation(s)
- Johan C. Bester
- Director of Bioethics, School of Medicine, University of Nevada, Las Vegas
| | - Maya Sabatello
- Department of Psychiatry, Columbia University, New York, NY
| | - Clara D.M. van Karnebeek
- Department of Pediatrics and Clinical Genetics, Academic Medical Centre, University of Amsterdam, Amsterdam NL
| | - John D. Lantos
- Children’s Mercy Bioethics Center, Children’s Mercy Kansas City, MO 64108
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Abstract
The United States' ambitious Precision Medicine Initiative proposes to accelerate exponentially the adoption of precision medicine, an approach to health care that tailors disease diagnosis, treatment, and prevention to individual variability in genes, environment, and lifestyle. It aims to achieve this by creating a cohort of volunteers for precision medicine research, accelerating biomedical research innovation, and adopting policies geared toward patients' empowerment. As strategies to implement the PMI are formulated, critical consideration of the initiative's ethical and sociopolitical dimensions is needed. Drawing on scholarship of nationalism and democracy, we discuss the PMI's construction of what we term "genomic citizenship"; the possible normative obligations arising therefrom; and the ethical, legal, and social challenges that will ensue. Although the PMI is a work in progress, discussion of the existing and emerging issues can facilitate the development of policies, structures, and procedures that can maximize the initiative's ability to produce equitable and socially sensitive outcomes. Our analysis can also be applied to other population-based, precision medicine research programs.
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Terry MB, Bradbury A. Family-based Breast Cancer Prevention Efforts in Adolescence. Pediatrics 2016; 138:S78-S80. [PMID: 27940980 DOI: 10.1542/peds.2015-4268k] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; and
| | - Angela Bradbury
- Departments of Medicine and Hematology/Oncology and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Bradbury AR, Patrick-Miller L, Schwartz LA, Egleston BL, Henry-Moss D, Domchek SM, Daly MB, Tuchman L, Moore C, Rauch PK, Shorter R, Karpink K, Sands CB. Psychosocial Adjustment and Perceived Risk Among Adolescent Girls From Families With BRCA1/2 or Breast Cancer History. J Clin Oncol 2016; 34:3409-16. [PMID: 27551110 DOI: 10.1200/jco.2015.66.3450] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To evaluate the impact of breast cancer family history and maternal BRCA1/2 mutation on the psychosocial adjustment and perceived risk in girls age 11 to 19 years old. MATERIALS AND METHODS Girls age 11 to 19 years old with one or more relatives with breast cancer or a familial BRCA1/2 mutation (breast cancer family history [BCFH] positive, n = 208; n = 69 with BRCA1/2-positive mother), peers (BCFH negative, n = 112), and their mothers completed assessments of psychosocial adjustment, breast cancer-specific distress, and perceived risk of breast cancer. RESULTS General psychosocial adjustment did not differ significantly between BCFH-positive and BCFH-negative girls, either by self-report or mother report, except for higher self-esteem among BCFH-positive girls (P = .01). BCFH-positive girls had higher breast cancer-specific distress than BCFH-negative girls (P < .001), but girls from BRCA1/2-positive families did not differ from other BCFH-positive peers. BCFH-positive girls were more likely to report themselves at increased self-risk for breast cancer in adulthood than BCFH-negative peers (74% v 33%, respectively; P ≤ .001). Girls from BRCA1/2-positive families were more likely than other BCFH-positive and BCFH-negative peers to report themselves at increased risk (P < .001). In all groups, perceived risk of breast cancer was associated with older age. Higher breast cancer-specific distress among adolescent girls was associated with higher self-perceived risk of breast cancer and higher maternal breast cancer-specific distress. CONCLUSION Adolescent girls from BRCA1/2-positive and breast cancer families have higher self-esteem and do not have poorer psychosocial adjustment than peers. However, they do experience greater breast cancer-specific distress and perceived risk of breast cancer, particularly among older girls. Understanding the impact is important to optimize responses to growing up in families at familial and genetic risk for breast cancer, particularly given the debate over the genetic testing of children for cancer susceptibility in adulthood.
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Affiliation(s)
- Angela R Bradbury
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA.
| | - Linda Patrick-Miller
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA
| | - Lisa A Schwartz
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA
| | - Brian L Egleston
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA
| | - Dare Henry-Moss
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA
| | - Susan M Domchek
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA
| | - Mary B Daly
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA
| | - Lisa Tuchman
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA
| | - Cynthia Moore
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA
| | - Paula K Rauch
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA
| | - Rebecca Shorter
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA
| | - Kelsey Karpink
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA
| | - Colleen Burke Sands
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA
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