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Results of an Intervention for Individuals and Families with BRCA Mutations: A Model for Providing Medical Updates and Psychosocial Support Following Genetic Testing

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Journal of Genetic Counseling

Providing medical management updates and long-term support to families with hereditary cancer syndromes in rural areas is a challenge. To address this, we designed a one-day retreat for BRCA1/2 carriers in our region. The retreat included educational updates about medical management, genetic privacy and discrimination, and addressed psychological and family issues. Evaluations completed at the conclusion of the retreat were overwhelmingly positive with requests for a similar event in the future. The impact of this retreat on a variety of health behaviors was assessed. Eligible participants completed questionnaires before and 6 months after the retreat. Questionnaires focused on lifestyle, cancer screening and prevention practices, psychological history and distress, decision-making regarding genetic testing, and family communication issues. For individuals who completed both the pre and post retreat questionnaires, one-half made lifestyle changes and nearly two-thirds increased cancer screening, initiated chemoprevention, completed or planned to complete preventative surgery in the future. We conclude that this type of forum provides a valuable opportunity for BRCA carriers and their families to receive updated medical information, share personal experiences, provide and receive support, as well as change health behaviors.

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REFERENCES

  • Antoniou, A., Pharoah, P. D., Narod, S., Risch, H. A., Eyfjord, J. E., Hopper, J. L., et al. (2003). Average risks of breast and ovarian cancer associated with BRCA1 and BRCA2 mutations detected in case series unselected for family history: A combined analysis of 22 studies. Am J Hum Genet, 72, 1117–1130.

    Article  CAS  Google Scholar 

  • Armstrong, K., Calzone, K., Stopfer, J., Fitzgerald, G., Coyne, J., & Weber, B. (2000). Factors associated with decisions about clinical BRCA1/2 testing. Cancer, Epidem, Bio Prev, 9, 1251–1254.

    CAS  Google Scholar 

  • Breast Cancer Linkage Consortium. (1999). Cancer risks in BRCA2 mutation carriers. J Natl Cancer Inst, 91, 1310–1316.

    Article  Google Scholar 

  • Cella, D. F., Mahon, S. M., & Donovan, M. I. (1990). Cancer recurrence as a traumatic event. Behav Med, 16, 15022.

    Article  Google Scholar 

  • d’Agincourt-Canning, L. (2001). Experience of genetic risk: Disclosure and the gendering of responsibility. Bioethics, 15(3), 231–247.

    Article  Google Scholar 

  • Di Prospero, L. S., Seminsky, M., Honeyford, J., Doan, B., Franssen, E., Mechino, W., Chart, P., & Warner, E. (2001). Psychosocial issues following a positive result of genetic testing for BRCA1 and BRCA2 mutations: findings from a focus group and a needs-assessment survey. CMAJ, 164(7), 1005–1009.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Dorval, M., Maunsell, E., Dugas, M. J., & Simard, J. (2001). Support groups for people carrying a BRCA mutation. JAMC, 165(6), 740.

    CAS  Google Scholar 

  • Dunkel-Schetter, C. (1984). Social support and cancer: findings based on patient interviews and their interpretations. J Soc Issues, 40, 77–98.

    Article  Google Scholar 

  • Easton, D. F., Ford, D., & Bishop, D. T. (1995). Breast and ovarian cancer incidence in BRCA1-mutation carriers. Breast Cancer Linkage Consortium. Am J Hum Genet, 56, 265–271.

    Article  CAS  Google Scholar 

  • Esplen, M. J., Hunter, J., Leszcz, M., Warner, E., Narod, S., Metcalfe, K., et al. (2004). A multicenter study of supportive-expressive group therapy for women with BRCA1/BRCA2 mutations. Cancer, 101, 2327–2340.

    Article  Google Scholar 

  • Ford, D., Easton, D. F., Bishop, D. T., Narod, S.A., & Goldgar, D. E. (1994). Risks of cancer in BRCA1-mutation carriers. Lancet, 343, 692–695.

    Article  CAS  Google Scholar 

  • Forrest, K., Simpson, S. A., Wilson, B. J., van Teijlingen, E. R., McKee, L., Haites, N., & Matthews, E. (2003). To tell or not to tell: barriers and facilitators in family communication about genetic risk. Clin Genet, 64, 317–326.

    Article  CAS  Google Scholar 

  • Friedenson, B. (2005). BRCA1 and BRCA2 pathways and the risk of cancers other than breast or ovarian. Medscape Gen Med, 7(2), 60.

    Google Scholar 

  • Galinsky, M. J., & Schopler, J. H. (1994). Negative experiences in support groups. Social Work Health Care Special Issue, 20, 77–95.

    Article  CAS  Google Scholar 

  • Gray, R. E., James, P., Manthorne, B. A., Gould, J., & Fitch, M. I. (2004). A consultation with Canadian rural women with breast cancer. Health Exp, 7, 40–50.

    Article  Google Scholar 

  • Hallowell, N., & Murton, F. (1998). The value of written summaries of genetic consultations. Patient Edu Couns, 35(1), 27–34.

    Article  CAS  Google Scholar 

  • Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of event scale: A measure of subjective stress. Psychosom Med, 41, 209–218.

    Article  CAS  Google Scholar 

  • Horowitz, M. (1982). Stress response syndromes and their treatment. In: Goldberg, L., and Breznitz, S. (Eds.), Handbook of stress: Theoretical and clinical aspects. Free Press: New York, pp. 711–732.

    Google Scholar 

  • Hughes, C., Lerman, C., Schwartz, M., Peshkin, B., Wenzel, L., Narod, S., Corio, C., Tercyak, K., Hanna, D., Isaacs, C., & Main, D. (2002). All in the family: Evaluation of the process and content of sisters’ communication about BRCA1 and BRCA2 genetic test results. Am J Med Genet, 107, 143–150.

    Article  Google Scholar 

  • Karp, J., Brown, K. L., Sullivan, M. D., & Massie, M. J. (1999). The prophylactic mastectomy dilemma: A support group for women at high genetic risk for breast cancer. J Genet Couns, 8(3), 163–173.

    Article  CAS  Google Scholar 

  • Kelly, K., Leventhal, H., Andrykowksi, M., Toppmeyer, D., Much, J., Dermody, J., Marvin, M., Baran, J., & Schwalb, M. (2004). The decision to test in women receiving genetic counseling for BRCA1 and BRCA2 mutations. J Genet Couns, 13(3), 237–257.

    Article  Google Scholar 

  • King, M. C., Marks, J. H., & Handell, J.B. (2003). Breast and ovarian cancer risks due to inherited mutations in BRCA1 and BRCA2. Science, 302, 643.

    Article  CAS  Google Scholar 

  • Kotsopoulos, J., & Narod, S. A. (2005). Towards a dietary prevention of hereditary breast cancer. Can Causes Contr, 16, 125–138.

    Article  Google Scholar 

  • Lerman, C., Biesecker, B. B., Benkendorf, J. L., Kerner, J., Gomez-Caminero, A., Hughes, C., et al. (1997). Controlled trial of pretenst education approaches to enhance infored decision-making for BRCA1 gene testing. J Natl Cancer Inst, 89(2), 148–157.

    Article  CAS  Google Scholar 

  • Lerman, C., Hughes, C., Lemon, S. J., Lemon, S. J., Main, D., Snyder, C., et al. (1998). 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, 16, 1639–1641.

    Article  Google Scholar 

  • Liede, A., Karlan, B. Y., & Narod, S. A. (2004). Cancer risks for male carriers of germline mutations in BRCA1 or BRCA2: A review of the literature. J Clin Oncol, 22, 735–742.

    Article  CAS  Google Scholar 

  • Liede, A., Metcalfe, K., Hanna, D., Hoodfar, E., Snyder, C., Durham, C., et al. (2000). Evaluation of the needs of male carries of mutations in BRCA1 or BRCA2 who have undergone genetic counseling. Am J Hum Genet, 67, 1494–1504.

    Article  CAS  Google Scholar 

  • Lodder, L., Frets, P. G., Trijsburg, R. W., Klijn, J. G., Seynaeve, C., Tilanus, M. M., et al. (2003). Attitudes and distress levels in women at risk to carry a BRCA1/BRCA2 gene mutation who decline genetic testing. Am J Med Genet, 119A, 266–272.

    Article  Google Scholar 

  • Lynch, H. T., Watson, P., Tinley, S., Snyder, C., Durham, C., Lynch, J., et al. (1999). An update on DNA-based BRCA1/BRCA2 genetic counseling in hereditary breast cancer. Can Genet Cytogenet, 109, 91–98.

    Article  CAS  Google Scholar 

  • McInerney-Leo, A., Biesecker, B. B., Hadley, D. W., Kase, R. G., Giambarresi, T. R., Johnson, E., Lerman, C., & Struewing, J. P. (2005). BRCA1/2 testing in hereditary breast and ovarian cancer families II: Impact on relationships. Am J Med Genet, 133A, 165–169.

    Article  Google Scholar 

  • McKinnon, W., Guttmacher, A., Greenblatt, M., Compas, B., May, S., Cutler, R., & Yandell, D. (1997). The familial cancer program of the vermont cancer center: Development of a cancer genetics program in a rural area. J Genet Coun, 6(2), 131–145.

    Article  CAS  Google Scholar 

  • Meiser, B. (2005). Psychological impact of genetic testing for cancer susceptibility: An update of the literature. Psycho-Oncology, 14, 1060–1074.

    Article  Google Scholar 

  • Metcalfe, K. A., Liede, A., Trinkaus, M., Hanna, D., & Narod, S. A. (2002). Evaluation of the needs of spouses of female carriers of mutations in BRCA1 and BRCA2. Clin Genet, 62, 464–469.

    Article  CAS  Google Scholar 

  • Metcalf, K., Lynch, H. T., Ghadirian, P., Tung, N., Olivotto, I., Warner, E., et al. (2004). Contralateral breast cancer in BRCA1 and BRCA2 mutation carriers. J Clin Oncol, 22, 2328–2335.

    Article  Google Scholar 

  • Miki, Y., Swensen, J., Shattuck-Eidens, D., Futreal, P. A., Harshman, K., Tavtigian, S., et al. (1994). A strong candidate for the breast cancer and ovarian cancer susceptibility gene BRCA1. Science, 226, 66–71.

    Article  Google Scholar 

  • Montazeri, A., Jarvandi, S., Haghighat, S., Vahdani, M., Sajadian, A., Ebrahimi, M., & Haji-Mahmoodi, M. (2001). Anxiety and depression in breast cancer patients before and after participation in a cancer support group. Patient Educ Couns, 45, 195–198.

    Article  CAS  Google Scholar 

  • Narod, S. A., & Offit, K. (2005). Prevention and management of hereditary breast cancer. J Clin Oncol, 23, 1656–1663.

    Article  Google Scholar 

  • Peterson, S. K., Watts, B. G., Koehly, L. M., Vernon, S. W., Baile, W. F., Kohlman, W. K., & Gritz, E. R. (2003). How families communicate about HNPCC testing: Findings from a qualitative study. Am J Med Genet, 119C, 78–86.

    Article  Google Scholar 

  • Speice, J., McDonald, S. H., Rowley, P. T., & Loader, S. (2002). Family issues in a psychoeducation group for women with a BRCA mutation. Clin Genet, 62, 121–127.

    Article  CAS  Google Scholar 

  • Thewes, B., Meiser, B., & Hickie, I. (2001). Psychometric properties of the impact of event scale amongst women at increased risk for hereditary breast cancer. Psycho-Oncology, 10, 459–468.

    Article  CAS  Google Scholar 

  • Von Riper, M., & McKinnon, W. (2004). Genetic testing for breast and ovarian cancer susceptibility: A family experience. J Midwifery Womens Health, 49, 210–219.

    Article  Google Scholar 

  • Wainberg, S., & Husted, J. (2004). Utilization of screening and preventive surgery among unaffected carriers of a BRCA1 or BRCA2 gene mutation. Can Epidemiol Biomarkers Prev, 13(12), 1989–1995.

    CAS  Google Scholar 

  • Wideroff, L., Vadaparampil, S. T., Greene, M. H., Talin, S., Olson, L., & Freedman, A. N. (2005). Hereditary breast/ovarian and colorectal cancer genetics knowledge in a national sample of US physicians. J Med Genet, 42, 749–755.

    Article  CAS  Google Scholar 

  • Wooster, R., Bignell, G., Lancaster, J., Swift, S., Seal, S., Mangion, J., et al. (1995). Identification of the breast cancer susceptibility gene BRCA2. Nature, 378, 789–792.

    Article  CAS  Google Scholar 

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ACKNOWLEDGMENTS

Susan G. Komen Foundation for funding of this event. All the individuals and families who participated in the retreat. The Vermont Cancer Center for their help with the logistical planning of the retreat. All the University of Vermont faculty who devoted their time and energy in being part of the retreat.

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Correspondence to Wendy McKinnon.

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McKinnon, W., Naud, S., Ashikaga, T. et al. Results of an Intervention for Individuals and Families with BRCA Mutations: A Model for Providing Medical Updates and Psychosocial Support Following Genetic Testing. J Genet Counsel 16, 433–456 (2007). https://doi.org/10.1007/s10897-006-9078-8

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  • DOI: https://doi.org/10.1007/s10897-006-9078-8

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