Cancer Causes & Control

, Volume 19, Issue 10, pp 1227–1232 | Cite as

Tolerance for ambiguity could influence awareness of breast cancer genetic testing and inform health education

  • John M. Quillin
  • Judy Silberg
  • Resa M. Jones
  • Diane Baer Wilson
  • Hermine Maes
  • Deborah Bowen
  • Joann Bodurtha
Original Paper

Abstract

Objective

This exploratory study assessed relationships among education, tolerance for ambiguity, and genetic testing awareness in light of implications for cancer genetics education.

Methods

Cross-sectional analyses were conducted from self-administered written survey data of a breast cancer risk communication trial, including 899 Women’s Health patients recruited from 2003 to 2005. The modifying effect of tolerance for ambiguity on the relationship between educational background and breast cancer genetic testing awareness was assessed through logistic regression.

Results

There was a statistically significant main effect of education (< 0.05), but not tolerance for ambiguity, on genetic testing awareness. However, the relationship between education and awareness was stronger among those with high tolerance for ambiguity (p for interaction <0.05), even when controlling for age, race, and breast cancer family history. Among persons with high (>1 SD above the mean) and medium tolerance for ambiguity, the relationship between education and awareness was positive and significant (= 0.048 and 0.002, respectively). Among participants with low tolerance for ambiguity, the association was not significant.

Conclusions

Educational background may predict awareness knowledge of breast cancer genetic testing only for those with higher tolerance for ambiguity. These findings could inform future intervention research concerning education about cancer genetic testing.

Keywords

Genetic screening Breast neoplasm Personality Uncertainty Educational status 

References

  1. 1.
    Guttmacher AE, Collins FS (2003) Welcome to the genomic era. N Engl J Med 349:996–998. doi:10.1056/NEJMe038132 PubMedCrossRefGoogle Scholar
  2. 2.
    Botkin JR, Smith KR, Croyle RT et al (2003) Genetic testing for a BRCA1 mutation: prophylactic surgery and screening behavior in women 2 years post testing. Am J Med Genet A 118:201–209. doi:10.1002/ajmg.a.10102 CrossRefGoogle Scholar
  3. 3.
    Claes E, Evers-Kiebooms G, Decruyenaere M et al (2005) Surveillance behavior and prophylactic surgery after predictive testing for hereditary breast/ovarian cancer. Behav Med 31:93–105. doi:10.3200/BMED.31.3.93-106 PubMedCrossRefGoogle Scholar
  4. 4.
    Collins V, Meiser B, Gaff C, St John DJ, Halliday J (2005) Screening and preventive behaviors one year after predictive genetic testing for hereditary nonpolyposis colorectal carcinoma. Cancer 104:273–281. doi:10.1002/cncr.21183 PubMedCrossRefGoogle Scholar
  5. 5.
    Hadley DW, Jenkins JF, Dimond E, de Carvalho M, Kirsch I, Palmer CG (2004) Colon cancer screening practices after genetic counseling and testing for hereditary nonpolyposis colorectal cancer. J Clin Oncol 22:39–44. doi:10.1200/JCO.2004.06.128 PubMedCrossRefGoogle Scholar
  6. 6.
    Halbert CH, Lynch H, Lynch J et al (2004) Colon cancer screening practices following genetic testing for hereditary nonpolyposis colon cancer (HNPCC) mutations. Arch Intern Med 164:1881–1887. doi:10.1001/archinte.164.17.1881 PubMedCrossRefGoogle Scholar
  7. 7.
    Kinney AY, Simonsen SE, Baty BJ et al (2006) Risk reduction behaviors and provider communication following genetic counseling and BRCA1 mutation testing in an African American kindred. J Genet Couns 15:293–305. doi:10.1007/s10897-006-9026-7 PubMedCrossRefGoogle Scholar
  8. 8.
    Pylvanainen K, Kairaluoma M, Mecklin JP (2006) Compliance and satisfaction with long-term surveillance in Finnish HNPCC families. Fam Cancer 5:175–178. doi:10.1007/s10689-005-5442-3 PubMedCrossRefGoogle Scholar
  9. 9.
    Wagner A, van Kessel I, Kriege MG et al (2005) Long term follow-up of HNPCC gene mutation carriers: compliance with screening and satisfaction with counseling and screening procedures. Fam Cancer 4:295–300. doi:10.1007/s10689-005-0658-9 PubMedCrossRefGoogle Scholar
  10. 10.
    Watson M, Kash KM, Homewood J, Ebbs S, Murday V, Eeles R (2005) Does genetic counseling have any impact on management of breast cancer risk? Genet Test 9:167–174. doi:10.1089/gte.2005.9.167 PubMedCrossRefGoogle Scholar
  11. 11.
    Hall MJ, Olopade OI (2006) Disparities in genetic testing: thinking outside the BRCA box. J Clin Oncol 24:2197–2203. doi:10.1200/JCO.2006.05.5889 PubMedCrossRefGoogle Scholar
  12. 12.
    Rogers EM (2003) Diffusion of innovations, 5th edn. Free Press, New YorkGoogle Scholar
  13. 13.
    Smerecnik CM, Mesters I, de Vries NK, de Vries H (2008) Educating the general public about multifactorial genetic disease: applying a theory-based framework to understand current public knowledge. Genet Med 10:251–258. doi:10.1097/GIM.0b013e31816b4ffd PubMedGoogle Scholar
  14. 14.
    Bottorff JL, Ratner PA, Balneaves LG et al (2002) Women’s interest in genetic testing for breast cancer risk: the influence of sociodemographics and knowledge. Cancer Epidemiol Biomarkers Prev 11:89–95PubMedGoogle Scholar
  15. 15.
    Bruno M, Tommasi S, Stea B et al (2004) Awareness of breast cancer genetics and interest in predictive genetic testing: a survey of a southern Italian population. Ann Oncol 15(Suppl 1):I48–I54. doi:10.1093/annonc/mdh658 PubMedCrossRefGoogle Scholar
  16. 16.
    Tambor ES, Rimer BK, Strigo TS (1997) Genetic testing for breast cancer susceptibility: awareness and interest among women in the general population. Am J Med Genet 68:43–49. doi:10.1002/(SICI)1096-8628(19970110)68:1<43::AID-AJMG8>3.0.CO;2-ZPubMedCrossRefGoogle Scholar
  17. 17.
    Mogilner A, Otten M, Cunningham JD, Brower ST (1998) Awareness and attitudes concerning BRCA gene testing. Ann Surg Oncol 5:607–612. doi:10.1007/BF02303830 PubMedCrossRefGoogle Scholar
  18. 18.
    Welkenhuysen M, Evers-Kiebooms G, Decruyenaere M, Claes E, Denayer L (2001) A community based study on intentions regarding predictive testing for hereditary breast cancer. J Med Genet 38:540–547. doi:10.1136/jmg.38.8.540 PubMedCrossRefGoogle Scholar
  19. 19.
    Wideroff L, Vadaparampil ST, Breen N, Croyle RT, Freedman AN (2003) Awareness of genetic testing for increased cancer risk in the year 2000 National Health Interview Survey. Community Genet 6:147–156. doi:10.1159/000078162 PubMedCrossRefGoogle Scholar
  20. 20.
    Ludman EJ, Curry SJ, Hoffman E, Taplin S (1999) Women’s knowledge and attitudes about genetic testing for breast cancer susceptibility. Eff Clin Pract 2:158–162PubMedGoogle Scholar
  21. 21.
    Gwyn K, Vernon SW, Conoley PM (2003) Intention to pursue genetic testing for breast cancer among women due for screening mammography. Cancer Epidemiol Biomarkers Prev 12:96–102PubMedGoogle Scholar
  22. 22.
    Budner S (1962) Intolerance of ambiguity as a personality variable. J Pers 30:29–50. doi:10.1111/j.1467-6494.1962.tb02303.x PubMedCrossRefGoogle Scholar
  23. 23.
    Frenkel-Brunswik E (1948) Tolerance toward ambiguity as a personality variable. Am Psychol 3:268Google Scholar
  24. 24.
    Prosen SS (1980) Ambiguity intolerance. In: Woody RH (ed) Encyclopedia of clinical assessment. Jossey-Bass, San Francisco, pp 463–472Google Scholar
  25. 25.
    Quillin JM, Lyckholm LJ (2006) A principle-based approach to ethical issues in predictive genetic testing for breast cancer. Breast Dis 27:137–148PubMedGoogle Scholar
  26. 26.
    Murray TH (1997) Genetic exceptionalism and future diaries: is genetic information different from other medical information? In: Rothstein MA (ed) Genetic secrets: protecting privacy and confidentiality in the genetic era. Yale University Press, New Haven, pp 60–73Google Scholar
  27. 27.
    Guttmacher AE, Porteous ME, McInerney JD (2007) Educating health-care professionals about genetics and genomics. Nat Rev Genet 8:151–157. doi:10.1038/nrg2007 PubMedCrossRefGoogle Scholar
  28. 28.
    Schor R, Pilpel D, Benbassat J (2000) Tolerance of uncertainty of medical students and practicing physicians. Med Care 38:272–280. doi:10.1097/00005650-200003000-00004 PubMedCrossRefGoogle Scholar
  29. 29.
    Chase GA, Geller G, Havstad SL, Holtzman NA, Bassett SS (2002) Physicians’ propensity to offer genetic testing for Alzheimer’s disease: results from a survey. Genet Med 4:297–303. doi:10.1097/00125817-200207000-00008 PubMedCrossRefGoogle Scholar
  30. 30.
    Geller G, Tambor ES, Chase GA, Holtzman NA (1993) Measuring physicians’ tolerance for ambiguity and its relationship to their reported practices regarding genetic testing. Med Care 31:989–1001. doi:10.1097/00005650-199311000-00002 PubMedCrossRefGoogle Scholar
  31. 31.
    Bodurtha JN, Quillin JM, Borzelleca JB et al (2007) Recruiting diverse representative women to a randomized controlled trial as a practice model for cancer risk communication. J Natl Med Assoc 99(8):917–922PubMedGoogle Scholar
  32. 32.
    Tambor ES, Bernhardt BA, Chase GA et al (1994) Offering cystic fibrosis carrier screening to an HMO population: factors associated with utilization. Am J Hum Genet 55:626–637PubMedGoogle Scholar
  33. 33.
    Meischke H, Bowen D, Kuniyuki A (2001) Awareness of genetic testing for breast cancer risk among women with a family history of breast cancer: effect of women’s information sources on their awareness. Cancer Detect Prev 25:319–327PubMedGoogle Scholar
  34. 34.
    Dugas MJ, Buhr K, Ladouceur R (2004) The role of intolerance of uncertainty in etiology and maintenance. In: Heimberg RG, Turk CL, Mennin DS (eds) Generalized anxiety disorder: advances in research and practice. Guilford Press, New York, pp 143–163Google Scholar
  35. 35.
    Buhr K, Dugas MJ (2002) The intolerance of uncertainty scale: psychometric properties of the English version. Behav Res Ther 40:931–945. doi:10.1016/S0005-7967(01)00092-4 PubMedCrossRefGoogle Scholar
  36. 36.
    O’Neill SC, DeMarco T, Peshkin BN et al (2006) Tolerance for uncertainty and perceived risk among women receiving uninformative BRCA1/2 test results. Am J Med Genet C Semin Med Genet 142:251–259. doi:10.1002/ajmg.c.30104 Google Scholar
  37. 37.
    Buhr K, Dugas MJ (2006) Investigating the construct validity of intolerance of uncertainty and its unique relationship with worry. J Anxiety Disord 20:222–236. doi:10.1016/j.janxdis.2004.12.004 PubMedCrossRefGoogle Scholar
  38. 38.
    Sorrentino RM, Roney CJR (2000) The uncertain mind: individual differences in facing the unknown. Psychology Press, PhiladelphiaGoogle Scholar
  39. 39.
    Skirton H (2001) The client’s perspective of genetic counseling—a grounded theory study. J Genet Couns 10:311–329. doi:10.1023/A:1016677110500 CrossRefGoogle Scholar
  40. 40.
    Webster DM, Kruglanski AW (1994) Individual differences in need for cognitive disclosure. J Pers Soc Psychol 67:1049–1062. doi:10.1037/0022-3514.67.6.1049 PubMedCrossRefGoogle Scholar
  41. 41.
    Mishel MH (1981) The measurement of uncertainty in illness. Nurs Res 30:258–263. doi:10.1097/00006199-198109000-00002 PubMedCrossRefGoogle Scholar
  42. 42.
    Mishel MH, Padilla G, Grant M, Sorenson DS (1991) Uncertainty in Illness theory: a replication of the mediating effects of mastery and coping. Nurs Res 40:236–240PubMedGoogle Scholar
  43. 43.
    Lipkus IM, Hollands JG (1999) The visual communication of risk. J Natl Cancer Inst Monogr (25):149–163Google Scholar
  44. 44.
    Latimer AE, Katulak NA, Mowad L, Salovey P (2005) Motivating cancer prevention and early detection behaviors using psychologically tailored messages. J Health Commun 10(Suppl 1):137–155. doi:10.1080/10810730500263364 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • John M. Quillin
    • 1
    • 2
  • Judy Silberg
    • 1
  • Resa M. Jones
    • 1
    • 2
    • 3
  • Diane Baer Wilson
    • 2
    • 4
    • 5
  • Hermine Maes
    • 1
    • 2
  • Deborah Bowen
    • 6
  • Joann Bodurtha
    • 1
    • 2
  1. 1.Department of Human and Molecular GeneticsVirginia Commonwealth UniversityRichmondUSA
  2. 2.Massey Cancer CenterVirginia Commonwealth UniversityRichmondUSA
  3. 3.Department of Epidemiology and Community HealthVirginia Commonwealth UniversityRichmondUSA
  4. 4.Division of Quality Medicine, Department of Internal MedicineVirginia Commonwealth UniversityRichmondUSA
  5. 5.RichmondUSA
  6. 6.Department of Social & Behavioral SciencesBoston UniversityBostonUSA

Personalised recommendations