Colleen Sands

A RANDOMIZED TRIAL OF BREAST CANCER RISK COUNSELING : INTERACTING EFFECTS OF COUNSELING, EDUCATIONAL LEVEL, AND COPING STYLE

The authors evaluated the impact of individualized breast cancer risk counseling (BCRC) on breast-cancer-specific distress and general distress in 239 women with a family history of breast cancer. Following a baseline assessment of demographics, risk factors, coping styles, and distress, participants were assigned randomly to receive either BCRC or general health education (GHE; i.e., control group). After controlling for education level, women who received BCRC had significantly less breast-cancer-specific distress at 3-month follow-up compared with women who received GHE. A significant Education Level x Treatment Group interaction indicated that the psychological benefits of BCRC were greater for women with less formal education. In both the BCRC and GHE groups, participants who had monitoring coping styles exhibited increases in general distress from baseline to follow-up.

Gail model breast cancer risk components are poor predictors of risk perception and screening behavior

SummaryThe Gail model is being used increasingly to determine individual breast cancer risk and to tailor preventive health recommendations accordingly. Although widely known to the medical and biostatistical communities, the risk factors included in the model may not be salient to the women to whom the model is being applied. This study explored the relationship of the individual Gail model risk factors to perceived risk of breast cancer and prior breast cancer screening among women with a family history of breast cancer. Data from baseline interviews with 969 women found a striking disparity between the objective risk factors included in the model and the accuracy of perceived risk and screening behaviors of this population, particularly among women over the age of 50 years.Risk perception accuracy was unrelated to all of the Gail model risk factors for all age groups. Reported mammography adherence was only associated with having had a breast biopsy in both age groups. Breast self examination (BSE) practice was independent of all measured factors for both age groups. These findings support the need for further research to identify additional determinants of risk perception and motivators of screening behavior.

A randomized trial of breast cancer risk counseling: the impact on self-reported mammography use.

OBJECTIVES We evaluated the impact of individualized breast cancer risk counseling on mammography use among women at risk for breast cancer. METHODS Participants (n = 508) were randomized to the breast cancer risk counseling intervention or a general health education control intervention, and 85% completed follow-up. RESULTS In multivariate modeling, a significant group-by-education interaction demonstrated that among less-educated participants, breast cancer risk counseling led to reduced mammography use. There was no intervention effect among the more-educated participants. CONCLUSIONS These results suggest that standard breast cancer risk counseling could have an adverse impact on the health behaviors of less-educated women.

Academic detailing: A model for in‐office CME

The National Cancer Institute (NCI), in its goal to reduce cancer mortality by 50% by the year 2000, has placed a special emphasis on prevention and early detection, especially in underserved populations. Check-Up On Health is a community based health education program being carried out by Fox Chase Cancer Center in three inner city Philadelphia neighborhoods, to improve the provision of appropriate cancer screening and prevention services to older, blue-collar adults by their primary care physicians. Primary care physicians in the chosen neighborhoods were targeted to receive a brief cancer prevention educational message delivered by project staff and patterned on the model of drug detailing developed by the pharmaceutical industry. This study represents an attempt to evaluate the feasibility and acceptability of such an approach aimed at improving cancer prevention promotion in the health care system. Primary care physicians were identified by community residents who attended one of 67 Check-Up On Health education presentations about cancer prevention at churches, social clubs, and senior-citizen centers within the targeted neighborhoods. An attempt was then made by project staff to visit each identified physician in his/her office or clinic, during office hours, both to conduct a brief survey and to deliver an educational message about either cancer screening guidelines or counseling for smoking cessation. The physicians were also provided with educational materials for themselves as well as their patients. Twelve months after the visit, a follow-up phone call to the physicians assessed the impact of the visit and solicited suggestions for future outreach efforts.(ABSTRACT TRUNCATED AT 250 WORDS)

Psychosocial adjustment in school-age girls with a family history of breast cancer

OBJECTIVE: Understanding how young girls respond to growing up with breast cancer family histories is critical given expansion of genetic testing and breast cancer messaging. We examined the impact of breast cancer family history on psychosocial adjustment and health behaviors among >800 girls in the multicenter LEGACY Girls Study. METHODS: Girls aged 6 to 13 years with a family history of breast cancer or familial BRCA1/2 mutation (BCFH+), peers without a family history (BCFH–), and their biological mothers completed assessments of psychosocial adjustment (maternal report for 6- to 13-year-olds, self-report for 10- to 13-year-olds), breast cancer–specific distress, perceived risk of breast cancer, and health behaviors (10- to 13-year-olds). RESULTS: BCFH+ girls had better general psychosocial adjustment than BCFH– peers by maternal report. Psychosocial adjustment and health behaviors did not differ significantly by self-report among 10- to 13-year-old girls. BCFH+ girls reported higher breast cancer–specific distress (P = .001) and were more likely to report themselves at increased breast cancer risk than BCFH– peers (38.4% vs 13.7%, P < .001), although many girls were unsure of their risk. In multivariable analyses, higher daughter anxiety was associated with higher maternal anxiety and poorer family communication. Higher daughter breast cancer–specific distress was associated with higher maternal breast cancer-specific distress. CONCLUSIONS: Although growing up in a family at risk for breast cancer does not negatively affect general psychosocial adjustment among preadolescent girls, those from breast cancer risk families experience greater breast cancer–specific distress. Interventions to address daughter and mother breast cancer concerns and responses to genetic or familial risk might improve psychosocial outcomes of teen daughters.

Psychosocial Adjustment and Perceived Risk Among Adolescent Girls From Families With BRCA1/2 or Breast Cancer History

PURPOSE To evaluate the impact of breast cancer family history and maternal BRCA1/2 mutation on the psychosocial adjustment and perceived risk in girls age 11 to 19 years old. MATERIALS AND METHODS Girls age 11 to 19 years old with one or more relatives with breast cancer or a familial BRCA1/2 mutation (breast cancer family history [BCFH] positive, n = 208; n = 69 with BRCA1/2-positive mother), peers (BCFH negative, n = 112), and their mothers completed assessments of psychosocial adjustment, breast cancer-specific distress, and perceived risk of breast cancer. RESULTS General psychosocial adjustment did not differ significantly between BCFH-positive and BCFH-negative girls, either by self-report or mother report, except for higher self-esteem among BCFH-positive girls (P = .01). BCFH-positive girls had higher breast cancer-specific distress than BCFH-negative girls (P < .001), but girls from BRCA1/2-positive families did not differ from other BCFH-positive peers. BCFH-positive girls were more likely to report themselves at increased self-risk for breast cancer in adulthood than BCFH-negative peers (74% v 33%, respectively; P ≤ .001). Girls from BRCA1/2-positive families were more likely than other BCFH-positive and BCFH-negative peers to report themselves at increased risk (P < .001). In all groups, perceived risk of breast cancer was associated with older age. Higher breast cancer-specific distress among adolescent girls was associated with higher self-perceived risk of breast cancer and higher maternal breast cancer-specific distress. CONCLUSION Adolescent girls from BRCA1/2-positive and breast cancer families have higher self-esteem and do not have poorer psychosocial adjustment than peers. However, they do experience greater breast cancer-specific distress and perceived risk of breast cancer, particularly among older girls. Understanding the impact is important to optimize responses to growing up in families at familial and genetic risk for breast cancer, particularly given the debate over the genetic testing of children for cancer susceptibility in adulthood.

Abstract P6-10-17: Psychosocial adjustment, cancer worry and perceived risk in 6-13 year old girls from breast cancer families

Background: Many parents discuss familial and genetic risk of breast cancer (BC) with offspring. What girls know and perceive of BC risk and its psychosocial impact is unknown. Methods: In the multisite LEGACY Girls Study, 6-13 YO daughters and their parents/guardians from BC families (FH+) and families without BC (FH-) were recruited to examine early determinants of, and responses to BC risk. Parents/guardians completed surveys reporting on their daughters’ psychosocial adjustment (PSA). Mothers and daughters 10-13 YO completed surveys reporting their PSA and perceptions of breast cancer risk. We used linear and logistic regressions with variable selection. Results: 731 parents/guardians reported on their own and the PSA of 898 daughters (450 FH+, 448 FH-), and 447 girls (10-13 YO) completed surveys (227 FH+, 220 FH-). FH+ girls have lower somatization and internalizing behaviors by parent/guardian report than FH- girls (Table 1). Intrusive BC (IBC) worry, and avoidant BC (ABC) worry were significantly higher in FH+ girls. IBC worry (coef=0.8, p=0.04) and ABC worry (coef 1.8, p=0.007) were higher in daughters whose mother had BC. Daughter perceived stress (PS), anxiety, depression, somatization, and internalizing did not differ by mother BC history. In multivariable models, daughter-anxiety was associated with mother-anxiety (Coef 1.4, p Conclusions: Pre-adolescent girls from BC families have lower somatization and internalizing behaviors by parent report, but higher self-reported BC worry. Daughter general anxiety, depression and BC worry are associated with corresponding mother affect. Some girls from BC families are aware of their increased risk and related research suggests this may increase with age. Understanding how PSA and BC worry changes over time and the impact on health and risk behaviors can inform interventions to optimize responses to growing up in families at familial and genetic risk for breast cancer. Citation Format: Angela R Bradbury, Linda Patrick-Miller, Brian Egleston, Lisa Schwartz, Colleen B Sands, Wendy Chung, Gord Glendon, Lisa Tuchman, Cindy Moore, Paula Rauch, Irene Andrulis, Saundra Buys, Caren J Frost, Esther M John, Theresa Keegan, Julia Knight, Mary Beth Terry, Mary Daly. Psychosocial adjustment, cancer worry and perceived risk in 6-13 year old girls from breast cancer families [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-10-17.

Should Minors Be Offered BRCA1/2 Testing for Hereditary Breast Cancer? Opinions of Parents Who Have Undergone BRCA1/2 Testing.

Background: Professional societies recommend against the genetic testing of minors for hereditary cancer syndromes that present in adulthood. Yet, many adolescent specialists indicate that they would consider BRCA1/2 testing of minor children. We conducted interviews with parents who have had BRCA1/2 testing, to evaluate their opinions regarding the genetic testing of minors for BRCA1/2 . Methods: 244 parents, including 67 BRCA1/2 mutation carriers (MCs), 140 parents with uninformative negative results (UN), 14 with true negative results (TN) & 23 with a variant of uncertain significance (VUS), from two cancer risk assessment programs completed semi-structured interviews. We used multiple logistic regressions to evaluate the associations among biomedical factors, demographic factors and support of testing minors. Wald tests and likelihood ratio tests were used to assess statistical significance for binary covariates and nominal covariates. Results : 38% of parents supported testing minors for BRCA1/ 2 in response to a dichotomous (Y/N) question . Support was greatest among parents with TN (64%) and UN (40%) results and lower among MCs (31%) and parents with a VUS (26%). In a multivariable analysis, support was greatest among parents who tested negative (p=0.02), were of minority race (p=0.06) and among fathers ( Conclusions: Up to 52% of parents who have undergone BRCA1/2 testing support pediatric testing for BRCA1/2 . Given willingness among general and pediatric practitioners and interest among parents, further research is necessary to formally evaluate the risks and benefits of providing genetic testing to minors for adult-onset hereditary cancer syndromes in order to inform clinical practice and public policy that will ensure optimal psychosocial and medical outcomes for all members of families at risk for hereditary cancer. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4071.