Facilitating preventive behaviors among women undergoing BRCA1/2 Testing

Abstract

1011 Background: Genetic testing for BRCA 1/2 provides complex, probabilistic information that can have far-reaching effects with regard to cancer prevention and screening behaviors. We evaluated an enhanced counseling intervention, designed to promote well-informed decision making for follow-up preventive options, among women at putative hereditary risk for breast/ovarian cancer. Methods: Participants (N=180; 96% Caucasian; mean age 47; 56% college educated; 57% unaffected breast/ovarian cancer) received standard group education, an individual pedigree review, a standard pre-disclosure session, and a disclosure session to receive test results. In addition, immediately following pedigree review, women were randomized to receive either: 1) an Enhanced Counseling session involving structured role-play to allow the participant to anticipate possible test outcomes and plan for post-result consequences; or 2) a General Health Information control session, to control for time and attention. Sociodemographic variables were assessed at baseline. Preventive and screening behaviors were assessed 6 months-post feedback of results. Results: As expected, the majority of women (98%) opted for genetic testing, with 86% receiving inconclusive/indeterminate, 11% positive and 3% negative test results for a BRCA1 or BRCA2 genetic mutation. Results of logistic regression analyses showed that women who received enhanced counseling were more likely to undergo prophylactic oophorectomy than control group women (p = .04). Further, the uptake of preventive surgery was greater for women with positive test results (p = .02) and less education (p = .04). Finally, women who received inconclusive/indeterminate results were less likely to undergo CA 125 testing (p = .04). Conclusions: These results suggest that uptake of preventive surgery is greater when participants are provided with the opportunity to fully process their risk-related options. In addition, specific genetic test result and level of education should be considered when designing BRCA1/2-related counseling interventions. No significant financial relationships to disclose.