Psychological consequences of predictive genetic testing for hereditary non-polyposis colorectal cancer (HNPCC): A prospective follow-up study

Predictive genetic testing for cancer allows identification of those with t he mutation (mutation positive) who should undergo cancer surveillance aimi ng at early detection of cancer and those without the mutation (mutation ne gative), whose unnecessary worry can be alleviated and who need not undergo frequent surveillance, However, there is a risk that predictive testing mi ght have a harmful emotional impact on an individual. In the course of a pr edictive genetic testing protocol, we assessed general anxiety (by the Stat e-Trait Anxiety Inventory [STAI]), fear of cancer and death, satisfaction w ith life and attitude to the future using a questionnaire survey in 271 ind ividuals tested for hereditary nonpolyposis colorectal cancer (HNPCC), Meas urements were made before the first counseling (baseline), at the test disc losure session (STAI only) and I and IZ months after disclosure, Although a t every measurement, the mutation-positive individuals were more afraid of cancer than those who were mutation negative, in both groups fear of cancer decreased significantly from baseline after disclosure, The mutation-posit ive subjects were more anxious than their counterparts immediately after th e test disclosure, but the differences had disappeared at the follow-ups. I n other variables, neither differences between the groups defined by mutati on status nor changes with time were detected. Our findings suggest that co unseling and testing relieve fear of cancer; no harmful emotional impact wa s detectable at the I-year follow-up. To confirm these findings, however, t he impact of testing should be studied after a longer interval, Furthermore , to evaluate the ultimate interpretation of these results, studies are nee ded to investigate the impact of fear of cancer on surveillance behavior am ong the mutation-positive subjects. (C) 2001 Wiley-Liss, Inc.