An update on DNA-Based BRCA1/BRCA2 genetic counseling in hereditary breastcancer

The identification of BRCA1 and BRCA2 mutations has enabled physicians to i dentify persons at high risk for carcinoma of the breast and ovary in hered itary breast-ovarian cancer (HBOC) families. Many physicians have limited k nowledge about the effective translation of these new discoveries into clin ical practice settings. This problem is further confounded by the limited n umber of genetic counselors who have experience with cancer genetics. Genet ic counseling about DNA test results was provided to 420 patients from 37 H BC/HBOC families. Descriptive data were collected and recorded about their responses to questions posed immediately before and after test results were disclosed. Findings disclosed a significant tendency of patients to overes timate rather than underestimate their risk (P < .001) prior to receiving r esults. The chief reason for declining to receive results was fear of insur ance discrimination. The primary reason that patients sought test results t vas for their children. Most women reported that, if testing identified the m as mutation carriers, they would consider lifetime surveillance and proph ylactic surgery. Responses to DNA test results were varied and often unpred ictable. Counseling by an appropriately educated and skilled professional i s essential to assist people in making decisions regarding testing and heal th management. (C) Elsevier Science Inc., 1999. All rights reserved.