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Editor—An important aim of genetic risk counselling is to confirm a level of cancer risk and offer risk management strategies.1 By giving counsellees accurate information about their risk, in place of ignorance, uncertainty, or a false assumption of the inevitability of breast cancer, it is hoped that some of the associated worry about personal risk may be alleviated.
Earlier work by the authors showed that women frequently overestimate their risk of breast cancer,2 creating the possibility of reassuring women by providing a more realistic risk value. Subsequent research showed that risk counselling significantly improved risk accuracy over a one year follow up period, both for women who overestimated and underestimated risk.3 This improvement was more likely if women were sent a personal letter containing the risk information after their visit.3However, there was concern that accurate risk information may induce or increase anxiety in women referred for genetic counselling, especially in those who initially underestimated their risk.
This was not borne out by a study of first time attendees at the Family History Clinic, who were followed for a one year period after genetic risk counselling. Women were found to adopt a more accurate perception of their risk without an increase in scores on general measures of anxiety at any time point post-counselling.4 There was a suggestion from questionnaire data that women with an accurate appraisal of risk after genetic counselling had the best levels of mental health and psychiatric diagnoses derived by interview were not caused by risk counselling. However, some women with psychiatric morbidity reported that the early loss of a mother was very difficult to resolve,4 a problem also reported in adolescent daughters of breast cancer patients.5 The relationship between early loss and cancer worry in high risk …