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British Journal of Cancer (2002) 86, 233-238.
doi:10.1038/sj/bjc/6600051
A randomized trial of specialist genetic assessment: psychological impact on women at different levels of familial breast cancer risk
K Brain1, P Norman2, J Gray3, C Rogers4, R Mansel5 and P Harper1
1Institute of Medical Genetics, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, UK
2Department of Psychology, Sheffield University, Western Bank, Sheffield S10 2TP, UK
3Institute of Medical Genetics, University Hospital of Wales NHS Healthcare Trust, Heath Park, Cardiff CF14 4XN, UK
4Breast Test Wales, 18 Cathedral Road, Cardiff CF1 9LJ, UK
5Department of Surgery, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, UK
Correspondence to: Dr J Gray, E-mail: jonathon.gray@UHW-TR.wales.nhs.uk
Received 28 March 2001; revised 9 August 2001; accepted 31 October 2001
The aim was to compare the psychological impact of a multidisciplinary specialist genetics service with surgical provision in women at high risk and those at lower risk of familial breast cancer. Women (n=735) were randomized to a surgical consultation with (trial group) or without (control group) specialist genetic risk assessment and the possible offer of presymptomatic genetic testing. Participants completed questionnaires before and immediately after the consultation to assess anxiety, cancer worry, perceived risk, interest in genetic testing and satisfaction. Responses of subgroups of women stratified by clinicians as low, moderate, or high risk were analyzed. There were no significant main effects of study intervention on any outcome variable. Regardless of risk information, there was a statistically significant reduction in state anxiety (P<0.001). Reductions in cancer worry and perceived risk were significant for women at low or moderate risk (P<0.001) but not those at high risk, and satisfaction was significantly lower in the high risk group (P<0.001). In high risk women who received specialist genetic input, there was a marginally significant trend towards increased perceived risk. The effect of risk information on interest in genetic testing was not significant. Breast care specialists other than geneticists might provide assessments of breast cancer risk, reassuring women at reduced risk and targeting those at high risk for specialist genetic counselling and testing services. These findings are discussed in relation to the existing UK Calman-Hine model of service delivery in cancer genetics.
Keywords: familial breast cancer; genetic risk assessment; psychological impact; service delivery
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| Print ISSN: 0007-0920 | Online ISSN: 1532-1827 | © 2002 Cancer Research UK | ||
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