Randomized trial of a specialist genetic assessment service for familial breast cancer

Background: Because of the growing demand for genetic assessment, there is an urgent need for information about what services are appropriate for wome n with a family history of breast cancer. Our purpose was to compare the ps ychologic impact and costs of a multidisciplinary genetic and surgical asse ssment service with those of current service provisions. Methods: We carrie d out a prospective randomized trial of surgical consultation with (the tri al group) and without (the control group) genetic assessment in 1000 women with a family history of breast cancer. All P values are from two-sided tes ts, Results: Although statistically significantly greater improvement in kn owledge about breast cancer was found in the trial group (P = .05), differe nces between groups in other psychologic outcomes were not statistically si gnificant, Women in both groups experienced statistically significant reduc tions in anxiety and found attending the clinics to be highly satisfying. A n initial specialist genetic assessment cost pound 14.27 (U.S. $22.55) more than a consultation with a breast surgeon. Counseling and genetic testing of affected relatives, plus subsequent testing of family members of affecte d relatives identified as mutation carriers, raised the total extra direct and indirect costs per woman in the trial group to pound 60.98 (U.S. $96.35 ) over costs for the control subjects. Conclusions: There may be little ben efit in providing specialist genetics services to all women with a family h istory of breast cancer. Further investigation of factors that may mediate the impact of genetic assessment is in progress and may reveal subgroups of women who would benefit from specialist genetics services.