Journal of Genetic Counseling

, Volume 18, Issue 4, pp 339–349 | Cite as

Cancer Genetics Service Interest in Women with a Limited Family History of Breast Cancer

  • Tamara J. SomersEmail author
  • Julie C. Michael
  • William M. P. Klein
  • Andrew Baum
Original Research


Women with a limited family history of breast cancer may be interested in cancer genetics information although their objective risk of breast cancer may not indicate routine referral to cancer genetics services. This study examined factors related to interest and use of cancer genetics services in a community sample of women with a limited family history of breast cancer (N = 187) who had no previous contact with cancer genetics services. Participants provided demographic information and ratings of perceived risk, cancer distress, attitudes, and intentions to initiate cancer genetics services. Participants were given information about a cancer genetics clinic that served women having concerns about their breast cancer risk. Women were contacted within 6 weeks and 8 months following their study appointment. Six weeks following their study appointment, 25% of women had initiated cancer genetics services. Eight months following their study appointment, 18% of women reported having completed a cancer genetics service appointment. Baseline intentions independently predicted both initiation at 6 weeks and appointment at 8 months. Cancer distress was positively associated with cancer genetics service initiation and appointment. Results suggest that some women with a limited family history of breast cancer are interested in seeking out cancer genetics information. Women with a limited family history of breast cancer may benefit from the availability of cancer genetics information provided through primary healthcare settings.


Breast cancer Genetics services First-degree relative Health behavior intentions 



Portions of this article were presented at the 2007 Society of Behavioral Medicine Annual Conference in Washington, DC. Author AB is now at the University of Texas-Arlington. We wish to thank Rachel Hess, MD, Department of General Internal Medicine, University of Pittsburgh Medical Center, for her help with study implementation. This work was supported by internal funds from the University of Pittsburgh Cancer Institute.


  1. Amir, E., Evans, D. G., Shenton, A., Lalloo, F., Moran, A., Boggis, C., Wilson, M., et al. (2003). Evaluation of breast cancer risk assessment packages in the family history evaluation and screening programme. Journal of Medical Genetics, 40, 807–814.PubMedPubMedCentralCrossRefGoogle Scholar
  2. American Cancer Society. (2007). Cancer facts and figures. Atlanta: American Cancer Society.Google Scholar
  3. Barlow, W. E., White, E., Ballard-Barbash, R., Vacek, P. M., Titus-Ernstoff, L., Carney, P. A., Tice, J. A., et al. (2006). Prospective breast cancer risk prediction model for women undergoing screening mammography. Journal of the National Cancer Institute, 98, 1204–1214.PubMedCrossRefGoogle Scholar
  4. Bishop, A. J., Marteau, T. M., Hall, S., Kitchener, H., & Hajek, P. (2005). Increasing women’s intentions to stop smoking following an abnormal cervical smear test. Preventive Medicine, 41, 179–185.PubMedCrossRefGoogle Scholar
  5. Bober, S. L., Hoke, L. A., Duda, R. B., Regan, M. M., & Tung, N. M. (2004). Decision-making about tamoxifen in women at high risk for breast cancer: Clinical and psychological factors. Journal of Clinical Oncology, 22, 4951–4957.PubMedCrossRefGoogle Scholar
  6. Bowen, D., McTiernan, A., Burke, W., Powers, D., Pruski, J., Durfy, S., Gralow, J., et al. (1999). Participation in breast cancer risk counseling among women with a family history. Cancer Epidemiology Biomarkers and Prevention, 8, 581–585.Google Scholar
  7. Bowen, D. J., Helms, A., Powers, D., Andersen, R., Burke, W., McTiernan, A., et al. (2003). Predicting breast cancer screening intentions and behavior with emotion and cognition. Journal of Social and Clinical Psychology, 22, 213–232.CrossRefGoogle Scholar
  8. Bowen, D. J., Alfano, C. M., McGregor, B. A., & Andersen, M. R. (2004). The relationship between perceived risk, affect and health behaviors. Cancer Detection and Prevention, 28, 409–417.PubMedCrossRefGoogle Scholar
  9. Burke, W., & Emery, J. (2002). Genetics education for primary-care providers. Nature, 3, 561–566.Google Scholar
  10. Burke, W., Culver, J. O., Bowen, D., Lowry, D., Durfy, S., McTiernan, A., & Andersen, M. R. (2000). Genetic counseling for women with an intermediate family history of breast cancer. American Journal of Medical Genetics, 90, 361–368.PubMedCrossRefGoogle Scholar
  11. Cameron, L. D., & Reeve, J. (2006). Risk perceptions, worry, and attitudes about genetic testing for breast cancer susceptibility. Psychology and Health, 21, 211–230.PubMedCrossRefGoogle Scholar
  12. Cappelli, M., Surh, L., Walker, M., Korneluk, Y., Humphreys, L., Verma, S., et al. (2001). Psychological and social predictors of decisions about genetic testing for breast cancer in high-risk women. Psychology Health and Medicine, 6, 321–333.CrossRefGoogle Scholar
  13. Chaliki, H., Loader, S., Levenkron, J. C., Logan-Young, W., Hall, W. J., & Rowley, P. T. (1995). Women’s receptivity to testing for a genetic susceptibility to breast cancer. American Journal of Public Health, 85, 1133–1135.PubMedPubMedCentralCrossRefGoogle Scholar
  14. Clark, V. A., Lovegrove, H., Williams, A., & Machperson, M. (2000). Unrealistic optimism and the health belief model. Journal of Behavioral Medicine, 23, 367–376.CrossRefGoogle Scholar
  15. Claus, E. B., Risch, N., & Thompson, W. D. (1994). Autosomal dominant inheritance of early-onset breast cancer: Implications for risk prediction. Cancer, 73, 643–651.PubMedCrossRefGoogle Scholar
  16. Colditz, G. A., Willet, W. C., Hunter, D. J., Stampfer, M. J., Manson, J. E., Hennekens, C. H., & Rosner, B. A. (1993). Family history, age, and risk of breast cancer. Prospective data from the Nurses’ Health Study. Journal of the American Medical Association, 270, 338–343.PubMedCrossRefGoogle Scholar
  17. Collaborative Group on Hormonal Factors in Breast Cancer (2001). Familial breast cancer: collaborative reanalysis of individual data from 52 epidemiological studies including 28,209 women with breast cancer and 101,986 women without the disease. Lancet, 358, 1389–1399.CrossRefGoogle Scholar
  18. Culver, J., Burke, W., Yasui, Y., Durfy, S., & Press, N. (2001). Participation in breast cancer genetic counseling: The influence of educational level, ethnic background, and risk perception. Journal of Genetic Counseling, 10, 215–231.CrossRefGoogle Scholar
  19. DiMatteo, M. R., Sherbourne, C. D., Hays, R. D., Ordway, L., Kravitz, R. L., McGlynn, E. A., Kaplan, S., et al. (1993). Physicians’ characteristics influence patients’ adherence to medical treatment: results from the Medical Outcomes Study. Health Psychology, 12, 91–92.CrossRefGoogle Scholar
  20. Doukas, D. J., & Localio, A. R. (2004). Attitudes and beliefs concerning prostate cancer genetic screeing. Clinical Genetics, 66, 445–451.PubMedCrossRefGoogle Scholar
  21. Erblich, J., Bovbjerg, D. H., & Valdimarsdottir, H. B. (2000). Looking forward and back: Distress among women at familial risk for breast cancer. Annals of Behavioral Medicine, 22, 53–59.PubMedCrossRefGoogle Scholar
  22. Euhus, D. M. (2001). Understanding mathematical models for breast cancer risk assessment and counseling. Breast Journal, 7, 224–232.PubMedCrossRefGoogle Scholar
  23. Euhus, D. M., Leitch, A. M., Huth, J. F., & Peters, G. N. (2002). Limitations of the gail model in the specialized breast cancer risk assessment clinic. Breast Journal, 8, 23–27.PubMedCrossRefGoogle Scholar
  24. Fisher, B., Costantino, J. P., Wickerham, L., Redman, C. K., Kavanah, M., Cronin, W. M., Vogel, V., et al. (1998). Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. Journal of the National Cancer Institute, 90, 1371–1388.PubMedCrossRefGoogle Scholar
  25. Fisher, B., Costantino, J. P., Wickerham, L., Cecchini, R. S., Cronin, W. M., Robidoux, A., Beyers, T. B., et al. (2005). Tamoxifen for the prevention of breast cancer: current status of the national surgical breast and bowel project P-1 study. Journal of the National Cancer Institute, 97, 1652–1662.PubMedCrossRefGoogle Scholar
  26. Fraser, F. C. (1974). Genetic counseling. American Journal of Human Genetics, 26, 636–661.PubMedPubMedCentralGoogle Scholar
  27. Gail, M. H., Brinton, L. A., Byar, D. P., Corle, D. K., Green, S. B., Schairer, C., & Mulvihill, J. J. (1989). Projecting individualized probabilities of developing breast cancer for white females who are examined annually. Journal of the National Cancer Institute, 81, 1879–1886.PubMedCrossRefGoogle Scholar
  28. Green, M. J., Peterson, S. K., Baker, M. W., Harper, G. R., Friedman, L. C., Rubinstein, W. S., & Mauger, D. T. (2004). Journal of the American Medical Association, 292, 442–452.PubMedCrossRefGoogle Scholar
  29. Kaplan, C. P., Hass, J. S., Perez-Stable, E. J., Gregorich, S. E., Somkin, C., Des Jarlais, G., & Kerlikowske, K. (2006). Breast cancer risk reduction options: Awareness, discussion, and use among women from four ethnic groups. Cancer Epidemiology Biomarkers and Prevention, 15, 162–166.CrossRefGoogle Scholar
  30. Kerlikowske, K., Carney, P. A., Geller, B., Mandelson, M. T., Taplin, S. H., Malvin, K., Ernster, V., et al. (2000). Performance of screening mammography among women with and without a first-degree relative with breast cancer. Annals of Internal Medicine, 133, 855–863.PubMedCrossRefGoogle Scholar
  31. Lee, S. C., Bernhardt, B. A., & Helzlsouer, K. J. (2002). Utilization of BRCA1/2 genetic testing in the clinical setting: report from a single institution. Cancer, 94, 1876–1885.PubMedCrossRefGoogle Scholar
  32. Lerman, C., Kash, K., & Stefanek, M. (1994). Younger women at increased risk for breast cancer: perceived risk, psychological well-being, and surveillance behavior. Journal of the National Cancer Institute Monographs, 16, 171–176.Google Scholar
  33. Lerman, C., Lustbader, E., Rimer, B., Daly, M., Miller, S., Sands, C., & Balshem, A. (1995). Effects of individualized breast cancer risk counseling: a randomized trial. Journal of the National Cancer Institute, 87, 286–292.PubMedCrossRefGoogle Scholar
  34. Leventhal, H., & Cameron, L. (1987). Behavioral theories and the problem of compliance. Patient Education and Counseling, 10, 117–138.CrossRefGoogle Scholar
  35. Lipkus, I. M., Klein, W. M. P., Skinner, C. S., & Rimer, B. (2005). Breast cancer risk perceptions and breast cancer worry: What predicts what? Journal of Risk Research, 8, 439–452.CrossRefGoogle Scholar
  36. McAuley, E., Motl, R. W., Morris, K. S., Hu, L., Doerksen, S. E., Elavsky, S., et al. (2007). Enhancing physical activity adherence and well-being in multiple sclerosis: a randomized controlled trial. Multiple Sclerosis, 13, 652–659.PubMedCrossRefGoogle Scholar
  37. McTiernan, A., Kuniyuki, A., Yasuim, Y., Bowen, D., Burke, W., Culver, J. B., Anderson, R., et al. (2001). Comparisons of two breast cancer risk estimates in women with a family history of breast cancer. Epidemiology Biomarkers Prevevention, 10, 333–338.Google Scholar
  38. O’Neill, S. M., Peters, J. A., Vogel, V. G., Feingold, E., & Rubinstein, W. S. (2006). Referral to cancer genetic counseling: Are there stages of readiness? American Journal of Medical Genetics Part C, Seminars in Medical Genetics, 142, 221–231.CrossRefGoogle Scholar
  39. Palmero, E. I., Kalakun, L., Schuler-Faccini, L., Giugliani, R., Regla Vargas, F., Rocha, J. C. & Ashton-Prolla, P. (2007). Cancer genetic counseling in public health care hospitals: The experience of three Brazilian services. Community Genetics, 10, 110–119.PubMedGoogle Scholar
  40. Press, N. A., Yasui, Y., Reynolds, S., Durfy, S. J. & Burke, W. (2001). Women’s interest in genetic testing for breast cancer susceptibility may be based on unrealistic expectations. American Journal of Medical Genetics, 10, 99–110.CrossRefGoogle Scholar
  41. Rahm, A. K., Sukhanova, A., Ellis, J., & Mouchawar, J. (2007). Increasing utilization of cancer genetic counseling services using a patient navigator model. Journal of Genetic Counseling, 16, 171–177.PubMedCrossRefGoogle Scholar
  42. Robinson, J. K., Turrisi, R., & Stapleton, J. (2007). Examination of mediating variables in a partner assistance intervention designed to increase performance of skin self-examination. Journal of the American Academy of Dertmatology, 56, 391–397.CrossRefGoogle Scholar
  43. Thompson, H. S., Valdimarsdottir, H. B., Duteau-Buck, C., Guevarra, J., Bovbjerg, D. H., Richmond-Avellaneda, , Godfrey, A., et al. (2002). Psychosocial predictors of BRCA counseling and testing decisions among urban African-American women. Cancer Epidemiology, Biomarkers & Prevention, 11, 1579–1585.Google Scholar
  44. Tice, J. A., Miike, R., Adduci, K., Petrakis, N. L., King, E., & Wrensch, M. R. (2005). Nipple aspirate fluid cytology and the gail model for breast cancer risk assessment in a screening population. Cancer Epidemiology, Biomarkers and Prevention, 14, 324–328.PubMedCrossRefGoogle Scholar
  45. Tyrer, J., Duffy, S. W., & Cuzick, J. (2004). A breast cancer prediction model incorporating familial and personal risk factors. Statistics in Medicine, 23, 1111–1130.PubMedCrossRefGoogle Scholar
  46. U.S. Preventive Services Task Force. (2005). Genetic risk assessment and BRCA mutation testing for breast and ovarian cancer susceptibility: Recommendation statement. Annals of Internal Medicine, 143, 355–361.CrossRefGoogle Scholar
  47. Watson, E. K., Shickle, D., Qureshi, N., Emery, J., & Austoker, J. (1999). The ‘new genetics’ and primary care: GPs’ views on their role and their educational needs. Family Practice, 16, 420–425.PubMedCrossRefGoogle Scholar
  48. Weinstein, N. D., & Klein, W. M. (1995). Resistance of personal risk perceptions to debiasing interventions. Health Psychology, 2, 132–140.CrossRefGoogle Scholar
  49. Weinstein, N. D., Kwitel, A., McCaul, K. D., Magnan, R. E., Gerrard, M., & Gibbons, F. X. (2007). Risk perceptions: assessment and relationship to influenza vaccination. Health Psychology, 26, 146–151.PubMedCrossRefGoogle Scholar
  50. Weiss, D., & Marmar, C. (1997). The Impact of Event Scale-Revised. In J. Wilson, & T. Keane (Eds.), Assessing psychological trauma and PTSD. Guildford: New York.Google Scholar
  51. Zajac, L. E., Klein, W. M., & McCaul, K. D. (2006). Absolute and comparative risk perceptions as predictors of cancer worry: Moderating effects of gender and psychological distress. Journal of Health Communication, 11, S37–S49.CrossRefGoogle Scholar

Copyright information

© National Society of Genetic Counselors, Inc. 2009

Authors and Affiliations

  • Tamara J. Somers
    • 1
    • 5
    Email author
  • Julie C. Michael
    • 2
  • William M. P. Klein
    • 2
  • Andrew Baum
    • 2
    • 3
    • 4
  1. 1.Department of Psychiatry and Behavioral ScienceDuke University Medical CenterDurhamUSA
  2. 2.Department of PsychologyUniversity of PittsburghPittsburghUSA
  3. 3.University of Pittsburgh Cancer InstitutePittsburghUSA
  4. 4.Department of PsychiatryUniversity of Pittsburgh Medical CenterPittsburghUSA
  5. 5.Pain Prevention and Treatment Research ProgramDuke UniversityDurhamUSA

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