. 2018 Jul;26(7):972-983.

doi: 10.1038/s41431-017-0057-3. Epub 2018 Mar 30.

Psychological outcomes and surgical decisions after genetic testing in women newly diagnosed with breast cancer with and without a family history

Bettina Meiser¹, Veronica F Quinn², Gillian Mitchell^{3

4}, Kathy Tucker⁵, Kaaren J Watts², Belinda Rahman², Michelle Peate^{2

6}, Christobel Saunders⁷, Elizabeth Geelhoed⁸, Margaret Gleeson⁹, Kristine Barlow-Stewart¹⁰, Michael Field¹¹, Marion Harris¹², Yoland C Antill¹³, Rachel Susman¹⁴, Michael T Bowen^{15

16}, Llew Mills², Judy Kirk^{17

18}; TFGT Collaborative Group

Affiliations

¹ Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, 2052, Australia. b.meiser@unsw.edu.au.
² Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, 2052, Australia.
³ Sir Peter MacCallum Dept of Oncology, Melbourne University, Melbourne, VIC, 3010, Australia.
⁴ Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, 3002, Australia.
⁵ Hereditary Cancer Clinic; Department of Medical Oncology, Prince of Wales Hospital, High Street, Randwick, NSW, 2031, Australia.
⁶ Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, VIC, 3052, Australia.
⁷ School of Surgery, University of Western Australia, Crawley, WA, 6009, Australia.
⁸ School of Population Health, University of Western Australia, Crawley, WA, 6009, Australia.
⁹ Hunter Family Cancer Service, Waratah, NSW, 2298, Australia.
¹⁰ Sydney Medical School-Northern, University of Sydney, Sydney, NSW, 2006, Australia.
¹¹ Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
¹² Monash Health, Clayton, Victoria, 3168, Australia.
¹³ Familial Cancer Centre, Cabrini Health, Melbourne, VIC, 3144, Australia.
¹⁴ Genetic Health Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.
¹⁵ School of Psychology, University of Sydney, Sydney, NSW, 2006, Australia.
¹⁶ Brain and Mind Centre, University of Sydney, Sydney, NSW, 2006, Australia.
¹⁷ Familial Cancer Service, Westmead Hospital, Hawkesbury Road, Westmead, NSW, 2145, Australia.
¹⁸ Centre for Cancer Research, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, 2145, Australia.

PMID: 29599518
PMCID: PMC6018744
DOI: 10.1038/s41431-017-0057-3

Psychological outcomes and surgical decisions after genetic testing in women newly diagnosed with breast cancer with and without a family history

Bettina Meiser et al. Eur J Hum Genet. 2018 Jul.

. 2018 Jul;26(7):972-983.

doi: 10.1038/s41431-017-0057-3. Epub 2018 Mar 30.

Authors

Affiliations

¹ Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, 2052, Australia. b.meiser@unsw.edu.au.
² Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, 2052, Australia.
³ Sir Peter MacCallum Dept of Oncology, Melbourne University, Melbourne, VIC, 3010, Australia.
⁴ Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, 3002, Australia.
⁵ Hereditary Cancer Clinic; Department of Medical Oncology, Prince of Wales Hospital, High Street, Randwick, NSW, 2031, Australia.
⁶ Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, VIC, 3052, Australia.
⁷ School of Surgery, University of Western Australia, Crawley, WA, 6009, Australia.
⁸ School of Population Health, University of Western Australia, Crawley, WA, 6009, Australia.
⁹ Hunter Family Cancer Service, Waratah, NSW, 2298, Australia.
¹⁰ Sydney Medical School-Northern, University of Sydney, Sydney, NSW, 2006, Australia.
¹¹ Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
¹² Monash Health, Clayton, Victoria, 3168, Australia.
¹³ Familial Cancer Centre, Cabrini Health, Melbourne, VIC, 3144, Australia.
¹⁴ Genetic Health Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.
¹⁵ School of Psychology, University of Sydney, Sydney, NSW, 2006, Australia.
¹⁶ Brain and Mind Centre, University of Sydney, Sydney, NSW, 2006, Australia.
¹⁷ Familial Cancer Service, Westmead Hospital, Hawkesbury Road, Westmead, NSW, 2145, Australia.
¹⁸ Centre for Cancer Research, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, 2145, Australia.

PMID: 29599518
PMCID: PMC6018744
DOI: 10.1038/s41431-017-0057-3

Abstract

In patients with early breast cancer, personal and tumour characteristics other than family history are increasingly used to prompt genetic testing to guide women's cancer management (treatment-focused genetic testing, 'TFGT'). Women without a known strong family history of breast and/or ovarian may be more vulnerable to psychological sequelae arising from TFGT. We compared the impact of TFGT in women with (FH+) and without (FH-) a strong family history on psychological adjustment and surgical decisions. Women aged <50 years with high-risk features were offered TFGT before definitive breast cancer surgery and completed self-report questionnaires at four time points over 12 months. All 128 women opted for TFGT. TFGT identified 18 carriers of a disease-causing variant (50.0% FH+) and 110 non-carriers (59.1% FH+). There were no differences based on family history in bilateral mastectomy (BM) uptake, p = .190, or uptake of risk-reducing bilateral salpingo-oophorectomy (RRBSO), p = .093. FH- women had lower decreases in anxiety a year after diagnosis, p = .011, and regret regarding their decision whether to undergo BM, p = .022, or RRBSO, p = .016 than FH + women. FH- carriers reported significantly higher regret regarding their TFGT choice (p = .024) and test-related distress (p = .012) than FH + carriers, but this regret/distress could not be attributed to a concern regarding a possible worse prognosis. These findings indicate that FH- women may require additional counselling to facilitate informed decisions. Carriers without a family history may require additional follow-up counselling to facilitate psychological adjustment to their positive variant results, extra support in making surgical decisions, and counselling about how best to communicate results to family members.

PubMed Disclaimer

Conflict of interest statement

BM, KT and MG have remunerated consultant roles with the company Astrazeneca with respect to unrelated projects. The remaining authors declare that they have no competing intersts.

Figures

**Fig. 1. Flow of participants through the study**
RC research co-ordinator; T1 = baseline questionnaire; T2 = within 1 week of receiving education; T3 = 2 weeks post-disclosure of testing result; T4 = 12 months after study enrolment

**Fig. 2. Time point simple effects for Impact of Event Scale scores**
Note *p = .006, **p < .001

**Fig. 3. Time point simple effects for Hospital Anxiety and Depression Scale scores**
Note *p < .01, **p < .001

**Fig. 4. Time point simple effects for Test-Related Positive and Experiences and Distress scores**
Note *p < .001

See this image and copyright information in PMC

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References

1. Trainer A, Lewis C, Tucker K, Meiser B, Friedlander M, Ward R. Treatment-focused genetic assessment in breast cancer - the evolving role of the familial cancer services. Nat Rev Clin Oncol. 2010;7:708–17. doi: 10.1038/nrclinonc.2010.175. - DOI - PubMed
1. Metcalfe K, Lynch H, Ghadirian P, et al. Risk of ipsilateral breast cancer in BRCA1 and BRCA2 mutation carriers. Breast Cancer Res Tr. 2011;127:287–96. doi: 10.1007/s10549-010-1336-7. - DOI - PubMed
1. van den Broek A, van’t Veer L, Hooning M, et al. Impact of age at primary breast cancer on contralateral breast cancer risk in BRCA1/2 mutation carriers. J Clin Oncol. 2015;34:409–18. doi: 10.1200/JCO.2015.62.3942. - DOI - PubMed
1. Metcalfe K, Gershman S, Ghadirian P, et al. Contralateral mastectomy and survival after breast cancer in carriers of BRCA1 and BRCA2 mutations: retrospective analysis. BMJ. 2014;348:226. doi: 10.1136/bmj.g226. - DOI - PMC - PubMed
1. Evans D, Ingham S, Baildam A, et al. Contralateral mastectomy improves survival in women with BRCA1/2-associated breast cancer. Breast Cancer Res Treat. 2013;140:135–42. doi: 10.1007/s10549-013-2583-1. - DOI - PubMed

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Psychological outcomes and surgical decisions after genetic testing in women newly diagnosed with breast cancer with and without a family history

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Psychological outcomes and surgical decisions after genetic testing in women newly diagnosed with breast cancer with and without a family history

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