A DESCRIPTIVE STUDY OF BRCA1 TESTING AND REACTIONS TO DISCLOSURE OF TEST-RESULTS

BACKGROUND. The identification of the BRCA1 gene is a powerful tool fo r predicting a patient's lifetime risk for carcinoma of the breast and ovary when she has hereditary breast/ovarian carcinoma (HBOC) syndrom e. The process of BRCA1 testing and genetic counseling, and participan ts' reactions to test results, are described. METHODS. Education about the natural history of HBOC syndrome and the pros and cons of genetic testing was provided to 14 HBOC families comprised of 2549 bloodline relatives. Of these, 388 underwent DNA testing. After informed consent was given by participants, formal linkage analysis and gene mutation studies were performed on the families. Qualitative data on intentions and emotional reactions were collected by physicians/counselors durin g the genetic counseling sessions. RESULTS. Of those tested, 181 recei ved their results after further genetic counseling. Seventy-eight of t hem were positive and 100 were negative for BRCA1 gene mutation. Three had ambiguous findings. The most common reasons given for seeking DNA testing were concern about risk to children and concern about surveil lance and prevention. Prophylactic mastectomy was considered by 35% of women who tested positive, whereas prophylactic oophorectomy was cons idered an important option by 76%. Twenty-five percent of both BRCA1 p ositive and negative individuals were concerned about discrimination b y insurance companies. Eighty percent of those who tested negative rep orted emotional relief, whereas over one-third of those who tested pos itive reported sadness, anger, or guilt. CONCLUSIONS. DNA testing of p atients with HBOC syndrome must be performed in the context of genetic counseling. The authors' results demonstrate the many complex clinica l and nonclinical issues that are important in this process. [See edit orial counterpoint on pages 2063-5 and reply to counterpoint on pages 2066, this issue.] (C) 1997 American Cancer Society.