Familial Cancer

, Volume 3, Issue 1, pp 21–28 | Cite as

BRCA1 testing with definitive results: a prospective study of psychological distress in a large clinic-based sample

  • Jon G. Reichelt
  • Ketil Heimdal
  • Pål Møller
  • Alv A. Dahl

Abstract

Aim: To examine the short-term psychological impact of receiving definite results concerning BRCA1 mutation status in a clinical setting. Methods: A test was offered for consecutive sample of 395 women from 53 families with demonstrated BRCA1 mutations. The sample included 50 women with a personal history of cancer, and 345 women without. Of the 287 women who chose to be tested and participated in the study, 79% of those with cancer 33% of those without cancer had a demonstrated BRCA1 mutation. Psychological distress was measured with the hospital anxiety and depression scale (HADS), the general health questionnaire (GHQ-28), the impact of event scale (IES) and Beck's hopelessness scale (BHS) at the time the patients were offered testing and six weeks after receiving the test result. Results: No significant changes were found in psychological distress from baseline to follow-up in any groups. Women with cancer were significantly more distressed than those without both at baseline and at six weeks, while women without cancer had levels of psychological distress comparable to or lower than normative data as measured by HADS. Conclusions: Our sample had a low level of psychological distress at baseline. Receiving a definite positive or negative result on the BRCA1 test had minimal effects on short-term psychological distress. These findings indicate that establishing a special psychological service in relation to predictive BRCA1 testing could be superfluous.

BRCA1 follow-up genetic testing predictive testing psychological consequences psychological distress 

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References 0

  1. 1.
    Grann VR, Jacobson JS. Population screening for cancer-related germline gene mutations. Lancet Oncol 2002; 3: 341–8. 0PubMedCrossRefGoogle Scholar
  2. 2.
    Lerman C, Narod S, Schulman K et al. BRCA1 testing in families with hereditary breast-ovarian cancer: a prospective study of patient decision and outcomes. JAMA 1996; 275: 1885–92. 0PubMedCrossRefGoogle Scholar
  3. 3.
    Croyle RT, Smith KR, Botkin JR et al. Psychological responses to BRCA1 mutation testing: preliminary findings. Health Psychol 1997; 16: 63–72. 0PubMedCrossRefGoogle Scholar
  4. 4.
    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 declined genetic testing. J Clin Oncol 1998; 16: 1650–4. 0PubMedGoogle Scholar
  5. 5.
    Lodder L, Frets PG, Trijsburg W et al. Psychological impact of receiving a BRCA1/BRCA2 Test result. Am J Med Genet 2001; 98: 15–24. 0PubMedCrossRefGoogle Scholar
  6. 6.
    Schwartz MD, Peshkin BN, Hughes C et al. Impact of BRCA1/BRCA2 mutation testing on psychologic distress in a clinic-based sample. J Clin Oncol 2002; 20: 514–20. 0PubMedCrossRefGoogle Scholar
  7. 7.
    Lerman C, Croyle RT, Tercyak KP et al. Genetic testing: psychological aspects and implications. J Consult Clin Psychol 2002; 70: 784–97. 0PubMedCrossRefGoogle Scholar
  8. 8.
    Meiser B, Butow P, Friedlander M et al. Psychological impact of genetic testing in women from high-risk beast cancer families. Eur J Cancer 2002; 38: 2025–31. 0PubMedGoogle Scholar
  9. 9.
    Butow PN, Lobb EA, Meiser B et al. Psychological outcomes and risk perception after genetic testing and counselling in breast cancer: a systematic review. MJA 2003; 178: 77–81.PubMedGoogle Scholar
  10. 10.
    Broadstock M, Michie S, Marteau T. Psychological consequences of predictive genetic testing a systematic review. Eur J Hum Genet 2000; 8: 731–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Horowitz M, Sundin E, Zanko A et al. Coping with grim news from genetic tests. Psychosomatics 2001; 42: 100–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Gurevich M, Devins GM, Rodin GM. Stress response syndromes and cancer: Conceptual and assessment issues. Psychosomatics 2002; 43: 259–81.PubMedCrossRefGoogle Scholar
  13. 13.
    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Washington, DC: American Psychiatric Association, 1994.Google Scholar
  14. 14.
    World Health Organization. The ICD-10 classification of mental and behavioural disorders. Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization, 1992.Google Scholar
  15. 15.
    Heimdal K, Mæhle L, Apold J et al. The Norwegian founder mutations in BRCA1: High penetrance confirmed in incident cancer series and differences in risk of ovarian cancer. Eur J Cancer 2003; 39: 2205–13.PubMedCrossRefGoogle Scholar
  16. 16.
    Møller P, Heimdal K, Apold J et al.: Genetic epidemiology of BRCA1 mutations in Norway. Eur J Cancer 2001; 37: 2428–34.PubMedCrossRefGoogle Scholar
  17. 17.
    Møller P, Evans G, Haites N et al. Guidelines for follow-up of women at high risk for inherited breast cancer: consensus statement from the Biomed 2 demonstration program on inherited breast cancer. Dis Markers 1999: 15: 207–11.PubMedGoogle Scholar
  18. 18.
    Reichelt JG, Dahl AA, Heimdal K et al. Uptake of genetic testing and pre-test levels of mental distress in Norwegian families with known BRCA1 mutations. Dis Markers 1999; 15: 139–43.PubMedGoogle Scholar
  19. 19.
    Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361–70.PubMedGoogle Scholar
  20. 20.
    Bjelland I, Dahl AA, Tangen Haug T et al. The validity of The Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 2002; 52: 69–77.PubMedCrossRefGoogle Scholar
  21. 21.
    Mykletun A, Stordal E, Dahl AA. The Hospital Anxiety and Depression Scale (HAD): Factor structure, item analyses, and internal consistency in a large population. Br J Psychiatr 2001; 179: 540–4.CrossRefGoogle Scholar
  22. 22.
    Goldberg DP, Williams P. A User's Guide to the General Health Questionnaire. Windsor, UK: NFR-Nelson, 1988.Google Scholar
  23. 23.
    Beck AT, Weismann A, Lester D, Trexler L. The measurement of pessimism: The hopelessness scale. J Cons Clin Psychol 1974; 42: 861–5.CrossRefGoogle Scholar
  24. 24.
    Horowitz MJ, Winer N, Alvarez W. Impact of Event Scale: A measure of subjective stress. Psychosom Med 1979; 41: 209–18.PubMedGoogle Scholar
  25. 25.
    Sundin EC, Horowitz MJ. Impact of event scale: psychometric properties. Br J Psychiatr 2002; 180: 205–9.CrossRefGoogle Scholar
  26. 26.
    Thewes B, Meiser B, Hickie IB. Psychometric properties of the Impact of Event scale amongst women at increased risk for hereditary breast cancer. Psycho-oncology 2001; 10: 459–68.PubMedCrossRefGoogle Scholar
  27. 27.
    Stordal E, Bjartveit Kr¸ger M, Dahl NH et al. Depression in relation to age and gender in the general population: the Nord-Trøndelag Health Study (HUNT). Acta Psychiatr Scand 2001; 104: 210–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Tjemsland L, Søreide JA, Malt UF. Traumatic distress symptoms in early breast cancer. II: Outcome six weeks post surgery. Psycho-oncology 1996; 5: 295–303.CrossRefGoogle Scholar
  29. 29.
    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: 2135–42.PubMedGoogle Scholar
  30. 30.
    Coyne JC, Kruus L, Racioppo M, et al. What do ratings of cancer-specific distress mean among women at high risk of breast and ovarian cancer? Am J Med Genet 2003; 116A: 222–8.CrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 2004

Authors and Affiliations

  • Jon G. Reichelt
    • 1
  • Ketil Heimdal
  • Pål Møller
  • Alv A. Dahl
  1. 1.Department of PsychiatryAker University Hospital, University of OsloOsloNorway

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