Advertisement

Journal of Genetic Counseling

, Volume 22, Issue 1, pp 101–107 | Cite as

Factors Associated with Psychological Distress among Women of African Descent at High Risk for BRCA Mutations

  • Yael R. CukierEmail author
  • Hayley S. Thompson
  • Katarina Sussner
  • Andrea Forman
  • Lina Jandorf
  • Tiffany Edwards
  • Dana H. Bovbjerg
  • Marc D. Schwartz
  • Heiddis B. Valdimarsdottir
Original Research

Abstract

Little is known about psychological distress among women of African descent who are at high risk for a BRCA mutation. This is a group for whom breast cancer risk reduction is critical due to the group’s high rates of breast cancer mortality. Distress is important to consider as it may reduce the potential benefit of genetic counseling and negatively affect decision making related to risk reduction. The goals of the current study were to examine breast cancer-specific distress and depressive symptoms in women of African descent at who are at high risk for a BRCA mutation and to identify background factors associated with these outcomes. Participants were 148 high-risk African American and Caribbean women who were part of a larger study that offered participants BRCA counseling at no cost. Participants completed the Impact of Events Scale, which assessed breast cancer-specific distress, and the Center of Epidemiological Studies-Depression Scale, which assessed depressive symptoms. Results of analyses revealed that almost half of the sample achieved scores indicating high and clinically significant breast cancer-specific distress, while almost one-third had clinically significant depression scores. Results further showed that low income was significantly associated with cancer-specific distress, while having a cancer diagnosis was significantly associated with depressive symptoms. These results underscore the need for targeted psychological support throughout the genetic risk assessment process for this particular high-risk group.

Keywords

Genetic risk assessment BRCA1/2 African American Psychological distress Hereditary breast cancer risk 

References

  1. American Cancer Society. (2011). Cancer Facts & Figures for African Americans 2011–2012. Atlanta: American Cancer Society.Google Scholar
  2. Armstrong, K., Weber, B., Stopfer, J., Calzone, K., Putt, M., Coyne, J., et al. (2003). Early use of clinical BRCA1/2 testing: Associations with race and breast cancer risk. American Journal of Medical Genetics. Part A, 117A(2), 154–160.PubMedCrossRefGoogle Scholar
  3. Audrain, J., Schwartz, M. D., Lerman, C., Hughes, C., Peshkin, B. N., & Biesecker, B. (1997). Psychological distress in women seeking genetic counseling for breast-ovarian cancer risk: the contributions of personality and appraisal. Annals of Behavioral Medicine, 19(4), 370–377.PubMedCrossRefGoogle Scholar
  4. Belle Doucet, D. J. (2003). Poverty, Inequality, And Discrimination As Sources Of Depression Among U.S. Women. Psychology of Women Quarterly, 27(2), 101–113.CrossRefGoogle 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(24), 4951–4957.PubMedPubMedCentralCrossRefGoogle Scholar
  6. Brown, K. L., Moglia, D. M., & Grumet, S. (2006). Genetic counseling for breast cancer risk: general concepts, challenging themes and future directions. Breast Disease, 27, 69–96.PubMedCrossRefGoogle Scholar
  7. Butow, P., Meiser, B., Price, M., Bennett, B., Tucker, K., Davenport, T., et al. (2005). Psychological morbidity in women at increased risk of developing breast cancer: a controlled study. Psycho-Oncology, 14(3), 196–203.PubMedCrossRefGoogle Scholar
  8. Campeau, P. M., Foulkes, W. D., & Tischkowitz, M. D. (2008). Hereditary breast cancer: new genetic developments, new therapeutic avenues. Human Genetics, 124(1), 31–42.PubMedCrossRefGoogle Scholar
  9. Coiro, M. J. (2001). Depressive Symptoms Among Women Receiving Welfare. Women & Health, 32(1), 1–23.CrossRefGoogle Scholar
  10. Coyne, J. C., Benazon, N. R., Gaba, C. G., Calzone, K., & Weber, B. L. (2000). Distress and psychiatric morbidity among women from high-risk breast and ovarian cancer families. Journal of Consulting and Clinical Psychology, 68(5), 864–874.PubMedCrossRefGoogle Scholar
  11. Cull, A., Anderson, E. D., Campbell, S., Mackay, J., Smyth, E., & Steel, M. (1999). The impact of genetic counselling about breast cancer risk on women’s risk perceptions and levels of distress. British Journal of Cancer, 79(3–4), 501–508.PubMedPubMedCentralCrossRefGoogle Scholar
  12. DiMatteo, M. R., Lepper, H. S., & Croghan, T. W. (2000). Depression Is a Risk Factor for Noncompliance With Medical Treatment: Meta-analysis of the Effects of Anxiety and Depression on Patient Adherence. Archives of Internal Medicine, 160(14), 2101–2107.PubMedCrossRefGoogle Scholar
  13. Duric, V., Butow, P., Sharpe, L., Lobb, E., Meiser, B., Barratt, A., et al. (2003). Reducing Psychological Distress in a Genetic Counseling Consultation for Breast Cancer. Journal of Genetic Counseling, 12(3), 243–264.PubMedCrossRefGoogle Scholar
  14. Easton, D. F., Ford, D., & Bishop, D. T. (1995). Breast and ovarian cancer incidence in BRCA1-mutation carriers. Breast Cancer Linkage Consortium. American Journal of Human Genetics, 56(1), 265–271.PubMedPubMedCentralGoogle Scholar
  15. Force*, U. S. P. S. T. (2005). Genetic Risk Assessment and BRCA Mutation Testing for Breast and Ovarian Cancer Susceptibility: Recommendation Statement. Annals of Internal Medicine, 143(5), 355–361.CrossRefGoogle Scholar
  16. Garssen, B., & Goodkin, K. (1999). On the role of immunological factors as mediators between psychosocial factors and cancer progression. Psychiatry Research, 85(1), 51–61. doi: https://doi.org/10.1016/S0165-1781(99)00008-6.PubMedCrossRefGoogle Scholar
  17. Gronwald, J., Tung, N., Foulkes, W. D., Offit, K., Gershoni, R., Daly, M., et al. (2006). Tamoxifen and contralateral breast cancer in BRCA1 and BRCA2 carriers: an update. International Journal of Cancer, 118(9), 2281–2284.PubMedCrossRefGoogle Scholar
  18. Halbert, C., Kessler, L., Collier, A., Paul Wileyto, E., Brewster, K., & Weathers, B. (2005). Psychological functioning in African American women at an increased risk of hereditary breast and ovarian cancer. Clinical Genetics, 68(3), 222–227.PubMedCrossRefGoogle Scholar
  19. Hall, M. J., & Olopade, O. I. (2006). Disparities in genetic testing: thinking outside the BRCA box. Journal of Clinical Oncology, 24(14), 2197–2203.CrossRefGoogle Scholar
  20. Hasin, D. S., Goodwin, R. D., Stinson, F. S., & Grant, B. F. (2005). Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Archives of General Psychiatry, 62(10), 1097–1106.PubMedCrossRefGoogle Scholar
  21. Helgeson, V. S., Snyder, P., & Seltman, H. (2004). Psychological and physical adjustment to breast cancer over 4 years: identifying distinct trajectories of change. Health Psychology, 23(1), 3–15.PubMedCrossRefGoogle Scholar
  22. Heshka, J. T., Palleschi, C., Howley, H., Wilson, B., & Wells, P. S. (2008). A systematic review of perceived risks, psychological and behavioral impacts of genetic testing. Genetics in Medicine, 10(1), 19–32.CrossRefGoogle Scholar
  23. Hopwood, P., Keeling, F., Long, A., Pool, C., Evans, G., & Howell, A. (1998). Psychological support needs for women at high genetic risk of breast cancer: some preliminary indicators. Psycho-Oncology, 7(5), 402–412.PubMedCrossRefGoogle Scholar
  24. Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of Event Scale: a measure of subjective stress. Psychosomatic Medicine, 41(3), 209–218.PubMedCrossRefGoogle Scholar
  25. Horowitz, M. J., Wilner, N., Kaltreider, N., & Alvarez, W. (1980). Signs and symptoms of posttraumatic stress disorder. Archives of General Psychiatry, 37(1), 85–92.PubMedCrossRefGoogle Scholar
  26. Hurt, G. J., McQuellon, R. P., & Barrett, R. J. (1994). After treatment ends: neutral time. Cancer Practice, 2(6), 417–420.PubMedGoogle Scholar
  27. King, M. C., Wieand, S., Hale, K., Lee, M., Walsh, T., Owens, K., et al. (2001). Tamoxifen and breast cancer incidence among women with inherited mutations in BRCA1 and BRCA2: National Surgical Adjuvant Breast and Bowel Project (NSABP-P1) Breast Cancer Prevention Trial. JAMA, 286(18), 2251–2256.PubMedCrossRefGoogle Scholar
  28. Kodl, M., Lee, J., Matthews, A., Cummings, S., & Olopade, O. (2006). Correlates of Depressive Symptoms Among Women Seeking Cancer Genetic Counseling and Risk Assessment at a High-Risk Cancer Clinic. Journal of Genetic Counseling, 15(4), 267–276.PubMedCrossRefGoogle Scholar
  29. Kornblith, A. B., & Ligibel, J. (2003). Psychosocial and sexual functioning of survivors of breast cancer. Seminars in Oncology, 30(6), 799–813.PubMedCrossRefGoogle Scholar
  30. Lerman, C., Lustbader, E., Rimer, B., Daly, M., Miller, S., Sands, C., et al. (1995). Effects of individualized breast cancer risk counseling: a randomized trial. Journal of the National Cancer Institute, 87(4), 286–292.PubMedPubMedCentralCrossRefGoogle Scholar
  31. Lindberg, N. M., & Wellisch, D. K. (2004). Identification of Traumatic Stress Reactions in Women at Increased Risk for Breast Cancer. Psychosomatics, 45(1), 7–16.PubMedCrossRefGoogle Scholar
  32. Myers, M. F., Chang, M. H., Jorgensen, C., Whitworth, W., Kassim, S., Litch, J. A., et al. (2006). Genetic testing for susceptibility to breast and ovarian cancer: evaluating the impact of a direct-to-consumer marketing campaign on physicians’ knowledge and practices. Genetics in Medicine, 8(6), 361–370.PubMedCrossRefGoogle Scholar
  33. Narod, S. A., Brunet, J. S., Ghadirian, P., Robson, M., Heimdal, K., Neuhausen, S. L., et al. (2000). Tamoxifen and risk of contralateral breast cancer in BRCA1 and BRCA2 mutation carriers: a case–control study. Hereditary Breast Cancer Clinical Study Group. Lancet, 356(9245), 1876–1881.PubMedCrossRefGoogle Scholar
  34. NCCN practice guidelines for the management of psychosocial distress. National Comprehensive Cancer Network. (1999). Oncology (Williston Park), 13(5A), 113–147.Google Scholar
  35. Palma, M., Ristori, E., Ricevuto, E., Giannini, G., & Gulino, A. (2006). BRCA1 and BRCA2: the genetic testing and the current management options for mutation carriers. Critical Reviews in Oncology/Hematology, 57(1), 1–23.PubMedCrossRefGoogle Scholar
  36. Pratt, L. A., & Brody, D. J. (2008). Depression in the United States household population, 2005–2006. NCHS Data Brief, 7, 1–8.Google Scholar
  37. Radloff, L. S. (1977). The CES-D Scale: A Self-Report Depression Scale for Research in the General Population. Applied Psychological Measurement, 1(3), 385–401.CrossRefGoogle Scholar
  38. Saleeba, A. K., Weitzner, M. A., & Meyers, C. A. (1996). Subclinical Psychological Distress in Long-Term Survivors of Breast Cancer—A Preliminary Communication. Journal of Psychosocial Oncology, 14(1), 83–93.CrossRefGoogle Scholar
  39. Siefert, K., Williams, D. R., Finlayson, T. L., Delva, J., & Ismail, A. I. (2007). Modifiable Risk and Protective Factors for Depressive Symptoms in Low-Income African American Mothers. The American Journal of Orthopsychiatry, 77(1), 113–123.PubMedCrossRefGoogle Scholar
  40. Stefanek, M. E., Helzlsouer, K. J., Wilcox, P. M., & Houn, F. (1995). Predictors of and satisfaction with bilateral prophylactic mastectomy. Preventive Medicine, 24(4), 412–419.PubMedCrossRefGoogle Scholar
  41. Thewes, B., Meiser, B., & Hickie, I. B. (2001). Psychometric properties of the Impact of Event Scale amongst women at increased risk for hereditary breast cancer. Psycho-Oncology, 10(6), 459–468.PubMedCrossRefGoogle Scholar
  42. Thompson, H. S., Valdimarsdottir, H. B., Duteau-Buck, C., Guevarra, J., Bovbjerg, D. H., Richmond-Avellaneda, C., et al. (2002). Psychosocial predictors of BRCA counseling and testing decisions among urban African-American women. Cancer Epidemiology, Biomarkers & Prevention, 11(12), 1579–1585.Google Scholar
  43. Wellisch, D. K., & Lindberg, N. M. (2001). A Psychological Profile of Depressed and Nondepressed Women at High Risk for Breast Cancer. Psychosomatics, 42(4), 330–336.PubMedCrossRefGoogle Scholar

Copyright information

© National Society of Genetic Counselors, Inc. 2012

Authors and Affiliations

  • Yael R. Cukier
    • 1
    Email author
  • Hayley S. Thompson
    • 2
  • Katarina Sussner
    • 3
  • Andrea Forman
    • 4
  • Lina Jandorf
    • 3
  • Tiffany Edwards
    • 5
  • Dana H. Bovbjerg
    • 6
  • Marc D. Schwartz
    • 7
  • Heiddis B. Valdimarsdottir
    • 3
    • 8
  1. 1.Ferkauf Graduate School of PsychologyYeshiva UniversityBronxUSA
  2. 2.Karmanos Cancer Institute, Department of OncologyWayne State University School of MedicineDetroitUSA
  3. 3.Mount Sinai School of Medicine, Department of Oncological SciencesNew YorkUSA
  4. 4.Fox Chase Cancer Center, Cancer Risk Assessment ProgramPhiladelphiaUSA
  5. 5.Fordham University, Center for Community-Engaged ResearchBronxUSA
  6. 6.University of Pittsburgh Cancer Institute, Hillman Cancer CenterPittsburghUSA
  7. 7.Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University Medical CenterWashingtonUSA
  8. 8.Reykjavik UniversityReykjavikIceland

Personalised recommendations