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The Trajectory of Psychological Impact in BRCA1/2 Genetic Testing: Does Time Heal?

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Most research on adjustment of women undergoing genetic testing for breast cancer susceptibility has not followed women for more than 6 months after result receipt and has not evaluated curvilinear patterns in general and cancer-specific adjustment.

Purpose

This study’s primary goal was to examine the trajectory of psychological status in women at risk for breast and ovarian cancer prior to undergoing genetic testing through 1 year after BRCA1/2 result receipt.

Methods

Women in the UCLA Familial Cancer Registry completed questionnaires assessing psychological status (i.e., depressive symptoms, negative and positive mood, anxiety, and cancer-related distress) prior to testing and at 1, 6, and 12 months after result receipt.

Results

Of 155 women tested, 117 were BRCA1/2− (96 uninformative negative and 21 true negative) and 38 were BRCA1/2+. Linear mixed model analyses revealed a consistent pattern in adjustment indicators, such that the groups did not differ at baseline, but mutation carriers endorsed significantly more depressive symptoms, negative mood, and cancer-specific distress relative to non-mutation carriers at 1 and 6 months after test result receipt (and less positive mood at 6 months only). At 12 months, negative and positive mood returned to baseline levels for mutation carriers, and depressive symptoms approached baseline. At 12 months, the groups differed significantly only on cancer-specific distress, owing to declining distress in non-carriers. Neither having a previous cancer diagnosis nor receiving a true negative versus uninformative negative result predicted reactions to genetic testing.

Conclusions

Genetic testing prompted an increase in general and cancer-specific distress for BRCA1/2+ women, which remitted by 1 year after result receipt.

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References

  1. Miki Y, Swensen J, Shattuck-Eidens D, et al. A strong candidate for the breast and ovarian cancer susceptibility gene BRCA1. Science. 1994; 266: 66–71.

    Article  PubMed  Google Scholar 

  2. Wooster R, Bignell G, Lancaster J, et al. Identification of the breast cancer susceptibility gene BRCA2. Nature. 1995; 378: 789–792.

    Article  PubMed  Google Scholar 

  3. Antoniou A, Pharoah PD, Narod S, et al. Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case series unselected for family history: A combined analysis of 22 studies. Am J Hum Genet. 2003; 72: 1117–1130.

    Article  PubMed  Google Scholar 

  4. Easton DF, Ford D, Bishop DT. Breast and ovarian cancer incidence in BRCA1-mutation carriers. Breast Cancer Linkage Consortium. Am J Hum Genet. 1995; 56: 265–271.

    PubMed  Google Scholar 

  5. Ford D, Easton DF, Bishop DT, Narod SA, Goldgar DE. Risks of cancer in BRCA1-mutation carriers. Breast Cancer Linkage Consortium. Lancet. 1994; 343: 692–695.

    Article  PubMed  Google Scholar 

  6. Struewing JP, Hartge P, Wacholder S, et al. The risk of cancer associated with specific mutations of BRCA1 and BRCA2 among Ashkenazi Jews. N Engl J Med. 1997; 336: 1401–1408.

    Article  PubMed  Google Scholar 

  7. Szabo CI, King MC. Inherited breast and ovarian cancer. Hum Mol Genet. 1995; 4: 1811–1817.

    PubMed  Google Scholar 

  8. Croyle RT, Smith KR, Botkin JR, Baty B, Nash J. Psychological responses to BRCA1 mutation testing: Preliminary findings. Health Psychol. 1997; 16: 63–72.

    Article  PubMed  Google Scholar 

  9. Arver B, Haegermark A, Platten U, Lindblom A, Brandberg Y. Evaluation of psychosocial effects of pre-symptomatic testing for breast/ovarian and colon cancer pre-disposing genes: A 12-month follow-up. Fam Cancer. 2004; 3: 109–116.

    Article  PubMed  Google Scholar 

  10. Claes E, Evers-Kiebooms G, Denayer L, et al. Predictive genetic testing for hereditary breast and ovarian cancer: Psychological distress and illness representations 1 year following disclosure. J Genet Couns. 2005; 14: 349–363.

    Article  PubMed  Google Scholar 

  11. Dorval M, Patenaude AF, Schneider KA, et al. Anticipated versus actual emotional reactions to disclosure of results of genetic tests for cancer susceptibility: Findings from p53 and BRCA1 testing programs. J Clin Oncol. 2000; 18: 2135–2142.

    PubMed  Google Scholar 

  12. Kinney AY, Bloor LE, Mandal D, et al. The impact of receiving genetic test results on general and cancer-specific psychologic distress among members of an African-American kindred with a BRCA1 mutation. Cancer. 2005; 104: 2508–2516.

    Article  PubMed  Google Scholar 

  13. Lerman C, Narod S, Schulman K, et al. BRCA1 testing in families with hereditary breast-ovarian cancer. A prospective study of patient decision making and outcomes. JAMA. 1996; 275: 1885–1892.

    Article  PubMed  Google Scholar 

  14. Lodder L, Frets PG, Trijsburg RW, et al. Psychological impact of receiving a BRCA1/BRCA2 test result. Am J Med Genet. 2001; 98: 15–24.

    Article  PubMed  Google Scholar 

  15. Lodder L, Frets PG, Trijsburg RW, et al. One year follow-up of women opting for presymptomatic testing for BRCA1 and BRCA2: Emotional impact of the test outcome and decisions on risk management (surveillance or prophylactic surgery). Breast Cancer Res Treat. 2002; 73: 97–112.

    Article  PubMed  Google Scholar 

  16. Reichelt JG, Heimdal K, Møller P, Dahl AA. BRCA1 testing with definitive results: A prospective study of psychological distress in a large clinic-based sample. Fam Cancer. 2004; 3: 21–28.

    Article  PubMed  Google Scholar 

  17. Schwartz M, Peshkin B, Hughes C, Main D, Isaacs C, Lerman C. Impact of BRCA1/BRCA2 mutation testing on psychological distress in a clinic-based sample. J Clin Oncol. 2002; 20: 514–520.

    Article  PubMed  Google Scholar 

  18. Tercyak K, Lerman C, Peshkin B, et al. Effects of coping style and BRCA1 and BRCA2 test results on anxiety among women participating in genetic counseling and testing for breast and ovarian cancer risk. Health Psychol. 2001; 20: 217–222.

    Article  PubMed  Google Scholar 

  19. Cella D, Hughes C, Peterman A, et al. A brief assessment of concerns associated with genetic testing for cancer: The multidimensional impact of cancer risk assessment (MICRA) questionnaire. Health Psychol. 2002; 21: 564–572.

    Article  PubMed  Google Scholar 

  20. Halbert CH, Schwartz MD, Wenzel L, et al. Predictors of cognitive appraisals following genetic testing for BRCA1 and BRCA2 mutations. J Behav Med. 2004; 27: 373–392.

    Article  PubMed  Google Scholar 

  21. Watson M, Foster C, Eeles R, et al. Psychosocial impact of breast/ovarian (BRCA1/2) cancer-predictive genetic testing in a UK multi-centre cohort. Br J Cancer. 2004; 91: 1787–1794.

    Article  PubMed  Google Scholar 

  22. Meiser B, Butow P, Friedlander M, et al. Psychological impact of genetic testing in women from high-risk breast cancer families. Eur J Cancer. 2002; 38: 2025–2031.

    PubMed  Google Scholar 

  23. Fredrickson BL. The role of positive emotions in positive psychology: The broaden-and-build theory of positive emotions. Am Psychol. 2001; 56: 218–226.

    Article  PubMed  Google Scholar 

  24. Becker MH, Maiman LA. Sociobehavioral determinants of compliance with health and medical care recommendations. Med Care. 1975; 13: 10–24.

    Article  PubMed  Google Scholar 

  25. Carver CS, Scheier MF. Principles of self-regulation: Action and emotion. In: Higgins ET, Sorrentino RM, eds. Handbook of Motivation and Cognition: Foundations of Social Behavior. New York: Guilford; 1990: 3–52.

    Google Scholar 

  26. Brickman P, Campbell DT. Hedonic relativism and planning the good society. In: Appley MH, ed. Adaptation Level Theory: A Symposium. New York: Academic; 1971: 287–302.

    Google Scholar 

  27. Suh E, Diener E, Fujita F. Events and subjective well-being: Only recent events matter. J Pers Soc Psychol. 1996; 70: 1091–1102.

    Article  PubMed  Google Scholar 

  28. van Roosmalen MS, Stalmeier PF, Verhoef LC, et al. Impact of BRCA1/2 testing and disclosure of a positive result on women affected and unaffected with breast or ovarian cancer. Am J Med Genet. 2004; 124A: 346–355.

    Article  Google Scholar 

  29. Lerman C, Hughes C, Lemon SJ, et al. What you don’t know can hurt you: Adverse psychologic effects in members of BRCA1-linked and BRCA2-linked families who decline genetic testing. J Clin Oncol. 1998; 16: 1650–1654.

    PubMed  Google Scholar 

  30. Diener E, Lucas RE, Scollon CN. Beyond the hedonic treadmill: Revising the adaptation theory of well-being. Am Psychol. 2006; 61: 305–314.

    Article  PubMed  Google Scholar 

  31. Coyne JC, Kruus L, Racioppo M, Calzone KA, Armstrong K. What do ratings of cancer-specific distress mean among women at high risk of breast and ovarian cancer? Am J Hum Genet. 2003; 116: 222–228.

    Google Scholar 

  32. Baum A, Friedman AL, Zakowski SG. Stress and genetic testing for disease risk. Health Psychol. 1997; 16: 8–19.

    Article  PubMed  Google Scholar 

  33. Dorval M, Gauthier G, Maunsell E, et al. No evidence of false reassurance among women with an inconclusive BRCA1/2 genetic test result. Cancer Epidemiol Biomarkers Prev. 2005; 14: 2862–2867.

    Article  PubMed  Google Scholar 

  34. van Dijk S, Timmermans DR, Meijers-Heijboer H, Tibben A, van Asperen CJ, Otten W. Clinical characteristics affect the impact of an uninformative DNA test result: The course of worry and distress experienced by women who apply for genetic testing for breast cancer. J Clin Oncol. 2006; 24: 3672–3677.

    Article  PubMed  Google Scholar 

  35. Radloff L. The CES-D Scale: A self-report depression scale for research in the general population. Appl Psychol Meas. 1977; 1: 385–401.

    Article  Google Scholar 

  36. Claus EB, Risch N, Thompson WD. Autosomal dominant inheritance of early-onset breast cancer. Implications for risk prediction. Cancer. 1994; 73: 643–651.

    Article  PubMed  Google Scholar 

  37. Gail MH, Brinton LA, Byar DP, et al. Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst. 1989; 81: 1879–1886.

    Article  PubMed  Google Scholar 

  38. Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: The PANAS scales. J Pers Soc Psychol. 1988; 54: 1063–1070.

    Article  PubMed  Google Scholar 

  39. Spielberger CD, Gorsuch RL, Lushene RE. Manual for the State—Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologist Press; 1970.

    Google Scholar 

  40. Weiss DS, Marmar CR. The impact of event scale-revised. In: Wilson JP, Deane TM, eds. Assessing Psychological Trauma and PTSD. New York, NY: Guilford; 1997: 399–411.

    Google Scholar 

  41. Brain K, Norman P, Gray J, Mansel R. Anxiety and adherence to breast self-examination in women with a family history of breast cancer. Psychosom Med. 1999; 61: 181–187.

    PubMed  Google Scholar 

  42. Diefenbach MA, Miller SM, Daly MB. Specific worry about breast cancer predicts mammography use in women at risk for breast and ovarian cancer. Health Psychol. 1999; 18: 532–536.

    Article  PubMed  Google Scholar 

  43. McCaul KD, Mullens AB. Affect, thought, and self-protective health behavior: The case of worry and cancer screening. In: Suls J, Wallston K, eds. Social Psychological Foundations of Health and Illness. Malden, MA: Blackwell; 2003: 137–168.

    Google Scholar 

  44. Hay JL, McCaul KD, Magnan RE. Does worry about breast cancer predict screening behaviors? A meta-analysis of the prospective evidence. Prev Med. 2006; 42: 401–408.

    Article  PubMed  Google Scholar 

  45. O’Neill SC, DeMarco T, Peshkin BN, et al. Tolerance for uncertainty and perceived risk among women receiving uninformative BRCA1/2 test results. Am J Med Genet. 2006; 142C: 251–259.

    Article  Google Scholar 

  46. Hay JL, Meischke HW, Bowen DJ, et al. Anticipating dissemination of cancer genomics in public health: A theoretical approach to psychosocial and behavioral challenges. Ann Behav Med. 2007; 34: 275–286.

    Article  PubMed  Google Scholar 

  47. McAllister M. Predictive genetic testing and beyond: A theory of engagement. J Health Psychol. 2002; 7: 491–508.

    Article  Google Scholar 

  48. van Oostrom I, Meijers-Heijboer H, Lodder LN, et al. Long-term psychological impact of carrying a BRCA1/2 mutation and prophylactic surgery: A 5-year follow-up study. J Clin Oncol. 2003; 21: 3867–3874.

    Article  PubMed  Google Scholar 

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Acknowledgment

This research was supported by funding from the Breast Cancer Research Foundation to Dr. Stanton. Dr. Ganz was supported through an American Cancer Society Clinical Research Professorship and Dr. Vodermaier by a stipend from the Dr.-Werner-Jackstaedt-Stiftung of the Founder Association of the German Sciences (S134-10.021). The Cancer Center Core Grant (P30 CA 16042) and the Jonsson Cancer Center Foundation provided funding for the UCLA Familial Cancer Registry.

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Correspondence to Annette L. Stanton Ph.D..

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Beran, T.M., Stanton, A.L., Kwan, L. et al. The Trajectory of Psychological Impact in BRCA1/2 Genetic Testing: Does Time Heal?. ann. behav. med. 36, 107–116 (2008). https://doi.org/10.1007/s12160-008-9060-9

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  • DOI: https://doi.org/10.1007/s12160-008-9060-9

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