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A Prospective Study of Patient Decision Making and Outcomes

Caryn Lerman, PhD; Steven Narod, MD, FRCPC; Kevin Schulman, MD; Chanita Hughes, MS; Andres Gomez-Caminero, MPH; George Bonney, PhD; Karen Gold, PhD; Bruce Trock, PhD; David Main, MS; Jane Lynch, RN; Cecil Fulmore, MS; Carrie Snyder, RN; Stephen J. Lemon, MD, MPH; Theresa, RN; Patricia Tonin, PhD; Gilbert Lenoir, DVM; Henry Lynch, MD

JAMA. 1996;275(24):1885-1892.

Abstract
Objectives.
—To identify predictors of utilization of breast-ovarian cancer susceptibility (BRCA1 gene) testing and to evaluate outcomes of participation in a testing program.

Design.
—Prospective cohort study with baseline interview assessment of predictor variables (eg, sociodemographic factors, knowledge about hereditary cancer and genetic testing, perceptions of testing benefits, limitations, and risks). BRCA1 test results were offered after an education and counseling session in a research setting. Outcome variables (including depression, functional health status, and prophylactic surgery plans [follow-up only]) were assessed at baseline and 1-month follow-up interviews.

Participants.
—Adult male and female members (n=279) of families with BRCA 1-linked hereditary breast-ovarian cancer (HBOC).

Results.
—Of subjects who completed a baseline interview (n=192), 60% requested BRCA 1 test results (43% of all study subjects requested results). Requests for results were more frequent for persons with health insurance (odds ratio [OR], 3.74; 95% confidence interval [CI], 2.06-6.80); more first-degree relatives affected with breast cancer (OR, 1.59; 95% CI, 1.16-2.16); more knowledge about BRCA1 testing (OR, 1.85; 95% CI, 1.36-2.50); and indicating that test benefits are important (OR, 1.45; 95% CI, 1.13-1.86). At follow-up, noncarriers of BRCA1 mutations showed statistically significant reductions in depressive symptoms and functional impairment compared with carriers and nontested individuals. Individuals identified as mutation carriers did not exhibit increases in depression and functional impairment. Among unaffected women with no prior prophylactic surgery, 17% of carriers (2/12) intended to have mastectomies and 33% (4/12) to have oophorectomies.

Conclusions.
—Only a subset of HBOC family members are likely to request BRCA 1 testing when available. Rates of test use may be higher in persons of a higher socioeconomic status and those with more relatives affected with breast cancer. For some high-risk individuals who receive test results in a research setting that includes counseling, there may be psychological benefits. More research is needed to assess the generalizability of these results and evaluate the long-term consequences of BRCA1 testing.

(JAMA. 1996;275:1885-1892)

Author Affiliations
From the Department of Medicine, Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC (Drs Lerman, Schulman, Gomez-Caminero, Gold, and Trock, Ms Hughes, and Messrs Main and Fulmore); Department of Medicine, Women's College Hospital, Toronto, Ontario (Dr Narod); Division of Population Science, Fox Chase Cancer Center, Philadelphia, Pa (Dr Bonney); Department of Preventive Medicine and Public Health, Creighton University Medical Center, Omaha, Neb (Mss Lynch, Snyder, and Conway and Drs Lemon and Lynch); Department of Human Genetics, McGill University, Montreal, Quebec (Dr Tonin); and Unit of Mechanisms of Carcinogenesis, International Agency for Research in Cancer, Lyon, France (Dr Lenoir).

Footnotes
Reprints: Caryn Lerman, PhD, Division of Cancer Prevention and Control, Georgetown University Medical Center, 2233 Wisconsin Ave NW, Suite 535, Washington, DC 20007.

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