Presymptomatic testing for BRCA1 andBRCA2: how distressing are the pre-test weeks?
- L N Loddera,
- P G Fretsa,b,
- R W Trijsburga,
- E J Meijers-Heijboerb,
- J G M Klijnc,
- H J Duivenvoordena,
- A Tibbena,b,d,
- A Wagnerb,
- C A van der Meerb,
- P Devileed,
- C J Cornelissed,
- M F Niermeijerb,
- other members of the Rotterdam/Leiden Genetics Working Group*
- aDepartment of Medical Psychology and Psychotherapy, Erasmus University Rotterdam/Netherlands Institute for Health Sciences, Rotterdam, The Netherlands, bDepartment of Clinical Genetics, University Hospital Dijkzigt/Erasmus University Rotterdam, The Netherlands, cDaniel den Hoed Cancer Institute/University Hospital Rotterdam, The Netherlands, dDepartment of Clinical Genetics, University Hospital Leiden, The Netherlands, e*A M W van den Ouweland, D J J Halley, Department of Clinical Genetics, Rotterdam; C Seynaeve, M M A Tilanus, C C M Bartels, L C Verhoog, C T M Brekelmans, A N van Geel, L Dukel, Daniel den Hoed Cancer Institute, Rotterdam; A C DudokdeWit, Department of Clinical Genetics, Leiden.
- Dr Lodder, Erasmus University Rotterdam, Department of Medical Psychology and Psychotherapy, PO Box 1738, 3000 DR Rotterdam, The Netherlands
- Revised 9 July 1999
- Accepted 5 August 1999
Abstract
Presymptomatic DNA testing for autosomal dominant hereditary breast/ovarian cancer (HBOC) became an option after the identification of the BRCA1 andBRCA2 genes in 1994-1995. Healthy female mutation carriers have a high lifetime risk for breast cancer (56-87%) or ovarian cancer (10-60%) and may opt for intensive breast and ovary surveillance or prophylactic surgery (mastectomy/oophorectomy).
We studied general and cancer related distress in 85 healthy women with a 25% or 50% risk of being carrier of aBRCA1/BRCA2 gene mutation and 66 partners in the six to eight week period between genetic counselling/blood sampling and disclosure of the test result. Questionnaire and interview data are analysed. Associations are explored between levels of distress and (1) expected consequences of being identified as a mutation carrier, (2) personality traits, (3) sociodemographic variables, and (4) experiences related to HBOC.
Mean pre-test anxiety and depression levels in women at risk of being a carrier and partners were similar to those of a normal Dutch population. In about 25% of those at risk of being a carrier and 10% of the partners, increased to high levels of general and cancer related distress were found. Increased levels of distress were reported by women who (1) anticipated an increase in problems after an unfavourable test outcome, (2) considered prophylactic mastectomy if found to be mutation carrier, (3) had an unoptimistic personality, (4) tended to suppress their emotions, (5) were younger than 40 years, and (6) were more familiar with the serious consequences of HBOC. Recently obtained awareness of the genetic nature of cancer in the family was not predictive of distress.
The majority of the women and their partners experienced a relatively calm period before the disclosure of the test result and seemed to postpone distressing thoughts until the week of disclosure of the result. The low distress levels may partly be explained by the use of strategies to minimise the emotional impact of a possibly unfavourable test outcome. However, a minority reported feeling very distressed. Several factors were found to be predictive for increased distress levels.
