Genetic counseling for women with an intermediate family history of breastcancer

Women with a family history of breast cancer often over-estimate their pers onal risk for cancer and may view themselves as candidates for genetic test ing even when the likelihood of an informative test result is low. We repor t here on genetic counseling of women with an intermediate family history o f breast cancer, defined as women who have one or more biological relatives with breast cancer but whose pedigree suggests a low likelihood of autosom al dominant transmission. A genetic counseling protocol based on traditiona l genetic counseling strategies was developed with additional components ad ded to address the needs of women with moderately increased breast cancer r isk. These additional components included information about non-genetic ris k factors, comparisons of high and moderate risk pedigrees, and evaluation of personal risk based on both genetic and nongenetic risk factors. Most pa rticipants liked the genetic counseling and found it useful, At baseline, p articipants over-estimated both their personal risk of breast cancer and th at of the average woman. After counseling, estimates of personal and averag e risk of breast cancer were lower, although both remained higher than actu al risk. Most participants reported that they felt less worried about breas t cancer after receiving their personal-Fisk estimate. At baseline, most wo men judged themselves to be candidates for genetic testing and expressed in terest in testing. The number who considered themselves candidates for test ing was reduced after counseling (60% versus 82%) but still constituted a m ajority. Similarly, interest in testing was partially reduced by counseling (60% versus 91%), We conclude that genetic counseling can help women with an intermediate family history of breast cancer to develop more accurate vi ews of their risk, reduce their breast cancer worry, and aid some of them i n developing a more realistic view of genetic testing. (C) 2000 Wiley-Liss, Inc.