Evaluation of the needs of male carriers of mutations in BRCA1 or BRCA2 who have undergone genetic counseling

To date, the concerns of men at risk of inheriting a BRCA1 mutation or a BR CA2 mutation have received little attention, It had been anticipated that f ew men would be interested in predictive testing when a BRCA mutation was i dentified in their family. However, these men are often affected emotionall y by diagnoses of breast cancer in their relatives and may themselves harbo r fears that cancer will develop. Male carriers of BRCA1/2 mutations are at increased risk of development of cancers of several types, including those of the breast and prostate. We conducted an evaluation of the needs and ex periences of 59 male carriers of BRCA1/2 mutations followed at either the U niversity of Toronto or Creighton University. We assessed their motivations for seeking genetic counseling and testing, involvement in family discussi ons of breast and ovarian cancer, risk perception, changes in cancer-screen ing practices, and overall satisfaction with the genetic-counseling process . The principal motivation for seeking genetic counseling was concern for t heir daughters. The majority (88%) of men participated in family conversati ons about breast and ovarian cancer, and 47% participated in conversations about prophylactic surgery. Most men believed that they were at increased r isk of development of cancer (prostate, breast, colorectal, and skin cancer s). However, fewer than one-half (43%) of the men with no previous diagnosi s of cancer stated that their prostate cancer-surveillance practices had ch anged after they had received genetic test results. More than one-half (55% ) had intrusive thoughts about their cancer risk. Although levels of satisf action were high, practitioners should be aware of (a) potential pressures influencing men to request predictive testing, (b) the difficulties that me n encounter in establishing surveillance regimens for breast and prostate c ancer, and (c) the general lack of information about men's particular exper iences in the medical community.