¹Department of Medical Psychology and Psychotherapy, Erasmus University Rotterdam/Netherlands Institute for Health Sciences, Rotterdam, The Netherlands

²Department of Clinical Genetics, University Hospital Dijkzigt/Erasmus University Rotterdam, Rotterdam, The Netherlands

³Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands

⁴Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands

⁵Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands

Correspondence to: L N Lodder, Erasmus University Rotterdam, Department of Medical Psychology and Psychotherapy, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.Tel: +31 10 408 7988/408 7812; Fax: +31 10 408 9420; E-mail: l.n.lodder@freeler.nl

Males with a BRCA1/BRCA2 mutation are not at greatly increased risk for cancer, whereas their (grand)daughters, and other female relatives who carry the mutation, are. Males from BRCA1/BRCA2 families may opt for genetic testing to confirm whether or not they may have transmitted the mutation to their children and, if so, to inform them at an appropriate age about the genetic risk and its implications. The psychological implications of genetic testing for men at risk of being a BRCA1/BRCA2 mutation carrier have received little attention. We report on 28 men requesting BRCA1 or BRCA2 testing, and their partners. Men were at 25% (n =4) or 50% risk (n =24) of being a mutation carrier, the majority with daughters and half of them with daughters aged over 20 years. Levels of psychological distress were assessed several weeks before and after disclosure of the test result. In addition, we investigated the level of intrusive thoughts and feelings about breast and ovarian cancer and the tendency to avoid these. By means of interviews and questionnaires, participants could report on (expected) emotional implications of genetic testing for themselves and their children, on experiences with cancer in the family and on personality trait optimism. Distress levels prior to the result in tested men and their partners were low. Many men and partners expected the test result to affect their children's, but not their own level of problems. Men without daughters and those with an optimistic personality had especially low distress prior to disclosure. Most men reported that they did not actively avoid the issue. Only four of the 28 men were identified as mutation carriers. High distress after disclosure of the result was reported by one mutation carrier and by three non-mutation carriers. Verbatim transcripts from interviews showed a large variation of psychological reactions in male mutation carriers (eg regarding guilt feelings). Low pre-test distress in males does not necessarily indicate avoidance of the issue. Future studies may indicate which psychological reactions occur in male mutation carriers when the problem becomes more acute, eg when a daughter is found to carry the mutation and/or is diagnosed with breast or ovarian cancer. European Journal of Human Genetics (2001) 9, 492-500.

genetic testing; cancer; males; BRCA1/BRCA2; psychological distress