Abstract
Limited studies have examined the pre-counselling knowledge and attitudes of high-risk women on hereditary breast and ovarian cancer (HBOC) syndromes genetic screening in Asia Pacific regions, particularly among Chinese. After controlling cost, an intrinsic barrier to undertake such screening, comprehensive understanding of the baseline characteristics of this cohort towards HBOC genetic counselling and testing service (GT) could be sought. This study aimed at exploring the baseline knowledge, possible motivators, barriers, and decisional factors of undertaking such service. One hundred and forty-two Southern Hong Kong Chinese high-risk females (89.4% with cancer history; 10.6% were cancer-free at-risk family members) completed a questionnaire right before their pre-testing GT. Results showed that perceived benefits to self and family members with reference to cancer prevention are important decisional motivators. A sponsored cancer genetic testing service in this cohort was crucial as 71.3% would not have opted for self-financed screening. Pre-testing and post-testing counselling were essential, particularly for older and less educated high-risk individuals. More importantly, after thorough pre-counselling with Q&A session, the entire cohort in this study gave written consent to undertake GT. Moreover, those proven to be germline pathogenic variant carriers were willing to share the information with family members and successfully persuaded them to pursue GT.
References
Antoniou A, Pharoah PDP, Narod S, Risch HA, Eyfjord JE, Hopper JL, Loman N, Olsson H, Johannsson O, Borg Å, Pasini B, Radice P, Manoukian S, Eccles DM, Tang N, Olah E, Anton-Culver H, Warner E, Lubinski J, Gronwald J, Gorski B, Tulinius H, Thorlacius S, Eerola H, Nevanlinna H, Syrjäkoski K, Kallioniemi OP, Thompson D, Evans C, Peto J, Lalloo F, Evans DG, Easton DF (2003) 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 72:1117–1130. https://doi.org/10.1086/375033
Armstrong J et al (2015) Utilization and outcomes of BRCA genetic testing and counseling in a national commercially insured population: the ABOUT study. JAMA Oncol 1:1251–1260. https://doi.org/10.1001/jamaoncol.2015.3048
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424. https://doi.org/10.3322/caac.21492
Census and Statistics Department (2018) Hong Kong in figures. Hong Kong
Chieng WS, Lee SC (2006) Establishing a cancer genetics programme in Asia - the Singapore experience. In: Hered Cancer Clin Pract 4(3):126–135. https://doi.org/10.1186/1897-4287-4-3-126
Chin TM, Tan SH, Lim SE, Iau P, Yong WP, Wong SW, Lee SC (2005) Acceptance, motivators, and barriers in attending breast cancer genetic counseling in Asians. Cancer Detect Prev 29:412–418. https://doi.org/10.1016/j.cdp.2005.06.009
Colas C, Golmard L, dePauw A, Caputo S, Stoppa-Lyonnet D (2019) “Decoding hereditary breast cancer” benefits and questions from multigene panel testing. Breast 45:29–35. https://doi.org/10.1016/j.breast.2019.01.002
Coyle YM (2009) Lifestyle, genes, and cancer. Methods Mol Biol 472:25–56. https://doi.org/10.1007/978-1-60327-492-0_2
Cragun D, Bonner D, Kim J, Akbari MR, Narod SA, Gomez-Fuego A, Garcia JD, Vadaparampil ST, Pal T (2015) Factors associated with genetic counseling and BRCA testing in a population-based sample of young Black women with breast cancer. Breast Cancer Res Treat 151:169–176. https://doi.org/10.1007/s10549-015-3374-7
Cragun D, Weidner A, Lewis C, Bonner D, Kim J, Vadaparampil ST, Pal T (2017) Racial disparities in BRCA testing and cancer risk management across a population-based sample of young breast cancer survivors. Cancer 123:2497–2505. https://doi.org/10.1002/cncr.30621
Domchek SM, Aghajanian C, Shapira-Frommer R, Schmutzler RK, Audeh MW, Friedlander M, Balmaña J, Mitchell G, Fried G, Stemmer SM, Hubert A, Rosengarten O, Loman N, Robertson JD, Mann H, Kaufman B (2016) Efficacy and safety of olaparib monotherapy in germline BRCA1/2 mutation carriers with advanced ovarian cancer and three or more lines of prior therapy. Gynecol Oncol 140:199–203. https://doi.org/10.1016/j.ygyno.2015.12.020
Hayden EP, Dougherty LR, Maloney B, Olino TM, Sheikh H, Durbin CE, Nurnberger JI Jr, Lahiri DK, Klein DN (2008) Early-emerging cognitive vulnerability to depression and the serotonin transporter promoter region polymorphism. J Affect Disord 107:227–230. https://doi.org/10.1016/j.jad.2007.07.028
Ho DYF (1974) Relational counseling: an Asian perspective on therapeutic intervention. - PsycNET. Am J Orthopsychiatry 44:620–636. https://doi.org/10.1111/j.1939-0025.1974.tb00917.x
Ho SM, Ho JW, Chan CL, Kwan K, Tsui YK (2003) Decisional consideration of hereditary colon cancer genetic test results among Hong Kong chinese adults. Cancer Epidemiol Biomark Prev 12:426–432
Hong Kong Cancer Registry, Hospital Authority (2019) Female breast cancer in 2016. Hong Kong
Kaufman B et al (2015) Olaparib monotherapy in patients with advanced cancer and a germline BRCA1/2 mutation. J Clin Oncol 33:244–250. https://doi.org/10.1200/jco.2014.56.2728
King M-C, Marks JH, Mandell JB, Group TNYBCS (2003) Breast and ovarian cancer risks due to inherited mutations in BRCA1 and BRCA2. Science 302:643–646. https://doi.org/10.1126/science.1088759
Kwong A, Wong CH, Shea C, Suen DT, Choi CL (2010) Choice of management of southern Chinese BRCA mutation carriers. World J Surg 34:1416–1426
Kwong A, Chu AT, Wu CT, Tse DM (2014) Attitudes and compliance of clinical management after genetic testing for hereditary breast and ovarian cancer among high-risk Southern Chinese females with breast cancer history. Familial Cancer 13:423–430. https://doi.org/10.1007/s10689-014-9706-7
Kwong A, Shin VY, Au CH, Law FBF, Ho DN, Ip BK, Wong ATC, Lau SS, To RMY, Choy G, Ford JM, Ma ESK, Chan TL (2016a) Detection of germline mutation in hereditary breast and/or ovarian cancers by next-generation sequencing on a four-gene panel. J Mol Diagn 18:580–594. https://doi.org/10.1016/j.jmoldx.2016.03.005
Kwong A et al (2016b) Comprehensive spectrum of BRCA1 and BRCA2 deleterious mutations in breast cancer in Asian countries. J Med Genet 53:15–23. https://doi.org/10.1136/jmedgenet-2015-103132
Lee SC, Bernhardt BA, Helzlsouer KJ (2002) Utilization of BRCA1/2 genetic testing in the clinical setting: report from a single institution. Cancer 94:1876–1885
Lipkus IM, Iden D, Terrenoire J, Feaganes JR (1999) Relationships among breast cancer concern, risk perceptions, and interest in genetic testing for breast cancer susceptibility among African-American women with and without a family history of breast cancer. Cancer Epidemiol Biomark Prev 8:533–539
Litton JK et al (2018) Talazoparib in patients with advanced breast cancer and a germline BRCA mutation New England. J Med 379:753–763. https://doi.org/10.1056/NEJMoa1802905
Markus HR, Kitayama S (1991) Culture and the self: implications for cognition, emotion, and motivation. - PsycNET. Psychol Rev 98:224–253. https://doi.org/10.1037/0033-295X.98.2.224
Nakagomi H et al (2016) Willingness of Japanese patients with breast cancer to have genetic testing of BRCA without burden of expenses. Breast Cancer 23:649–653. https://doi.org/10.1007/s12282-015-0618-7
Rajpal N, Munoz J, Peshkin BN, Graves KD (2017) Insights into BRCA1/2 genetic counseling from ethnically diverse Latina breast cancer survivors. J Genet Couns 26:1221–1237. https://doi.org/10.1007/s10897-017-0096-5
Robson M et al (2017) Olaparib for metastatic breast cancer in patients with a germline BRCA mutation N. Engl J Med 377:523–533. https://doi.org/10.1056/NEJMoa1706450
Sussner KM, Jandorf L, Thompson HS, Valdimarsdottir HB (2013) Barriers and facilitators to BRCA genetic counseling among at-risk Latinas in New York City. Psychooncology 22:1594–1604. https://doi.org/10.1002/pon.3187
Thompson D, Easton DF (2002) Breast Cancer Linkage C Cancer incidence in BRCA1 mutation carriers J Natl Cancer Inst 94 1358-1365 doi:https://doi.org/10.1093/jnci/94.18.1358
Zhang L et al (2018) Breast and ovarian cancer penetrance of BRCA1/2 mutations among Hong Kong women. In: Oncotarget 9(38):25025–25033. https://doi.org/10.18632/oncotarget.24382
Acknowledgements
The authors would like to thank Miss Alcina Kong, Miss Angela Li, and Mr Leo Ng for their contributions in literature review and data collection; Hong Kong Hereditary Breast Cancer Family Registry, The Hong Kong Sanatorium and Hospital and Dr. Ellen Li Charitable Foundation for their support in genetic testing; and the participants who took part in this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
The current study is not a clinical trial and ethical approval (UW09-210) had been obtained from the Institutional Review Board (IRB) of The University of Hong Kong.
Conflict of interest
The authors declare no competing interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Chu, A.TW., Tse, D.MS., Suen, D.T.K. et al. Baseline knowledge and receptiveness to genetic testing for hereditary breast and ovarian cancer syndromes in Chinese high-risk females. J Community Genet 12, 431–438 (2021). https://doi.org/10.1007/s12687-021-00518-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12687-021-00518-3