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Hereditary breast cancer. Psychosocial issues and family physicians' role
J C Carroll1, R E Heisey, E Warner
1Department of Family and Community Medicine, University of Toronto. june.carroll@utoronto.ca
Insights
Genetic testing for hereditary breast cancer (HBC) offers benefits like reassurance or increased surveillance but carries risks such as anxiety and discrimination. Family physicians are key in guiding women through this process.
Area of Science:
- Oncology
- Genetics
- Family Medicine
Background:
- Hereditary breast cancer (HBC) involves genetic predispositions to breast cancer.
- Psychosocial aspects are critical in assessing and managing HBC risk.
Purpose of the Study:
- To outline psychosocial issues in hereditary breast cancer assessment.
- To discuss the role of family physicians in managing women at risk for HBC.
Main Methods:
- Literature search of medical databases (MEDLINE, CINAHL, CancerLit, HealthStar) from 1990-1998.
- Keywords included breast cancer, hereditary, genetic testing, primary care, and psychosocial factors.
- Analysis of limited studies focusing on well-characterized "research families."
Main Results:
- Women with a family history of breast cancer show high interest in genetic testing.
- Negative results provide reassurance; positive results may lead to increased surveillance and prophylactic options.
- Potential risks of genetic testing include anxiety, depression, guilt, altered self-image, and discrimination.
Conclusions:
- Genetic testing is transitioning from research to clinical practice.
- Family physicians are integral to educating and managing women at risk for HBC.
- Physicians need enhanced knowledge and counseling skills to address the challenges of genetic testing for HBC.
Objectives:
To outline the psychosocial issues in hereditary breast cancer (HBC) assessment and discuss the role of family physicians.
Quality Of Evidence:
A literature search using MEDLINE, CINAHL, CancerLit, and HealthStar databases was conducted from January 1990 to April 1998, using the key words breast cancer or neoplasm and familial or hereditary, genetic testing or screening, primary care or family physician or counseling, genetic counseling, psychosocial or psychological. We found only a few studies focusing on a small number of well-studied "research families."
Main Findings:
Women with a family history of breast cancer were likely to be highly interested in genetic testing for cancer risk. The benefit of testing for those with negative results is reassurance. Those found to be carriers of genetic mutations might benefit from increased surveillance and prophylactic therapy. Risks of testing include anxiety, depression, guilt, altered self-image, and insurance and employment discrimination. A family physician's role is to assess risk, to provide information and support so women can make informed choices about referral to familial cancer clinics, to offer cancer surveillance, and to provide support once genetic test results are available.
Conclusion:
Genetic testing is rapidly moving from research to clinical applications. Family physicians play an integral role in educating and managing women at risk for HBC. Physicians must prepare themselves with knowledge and counseling skills to meet the challenges of this new technology.