BRCA1 IN THE FAMILY - A CASE DESCRIPTION OF THE PSYCHOLOGICAL IMPLICATIONS

Our experience with the first family in the Netherlands for whom predi ctive DNA-testing for Hereditary Breast and Ovarian Cancer (HBOC) beca me an option is described. This serves to illustrate the complex emoti onal impact on a family as a whole, and upon the members separately, o f becoming aware that breast and ovarian cancer is hereditary, and the implications of undergoing predictive testing. All family members rec eived genetic counseling and were offered pre- and post-test psycholog ical follow-up. We observed two important roles within the family, One member became ''the messenger of the news'' informing the relatives o f the hereditary character of cancer in the family. Another was ''the first utilizer'' of the new options; namely, the predictive DNA-test a nd preventive surgery. This first utilizer became the example to the r est of the family. Decisions made about preventive treatment (prophyla ctic ovariectomy and/or mastectomy) were based on the experiences with in the family, whether one identified with an affected family member w ith breast or with ovarian cancer. The actions and reactions perceived were illustrative of what kind of support provisions should be provid ed in addition to the genetic and oncological counseling for HBOC. Mor eover HBOC should be considered both as an individual and a family pro blem and be treated as such in genetic counseling. (C) 1997 Wiley-Liss , Inc.