Abstract
Simple SummaryIdentifying breast cancer patients with pathogenic mutations that run in their families may improve the follow-up care they receive and breast cancer screening of their close relatives. In this study we identified breast cancer patients with high chances of having a pathogenic mutation and their close female relatives. We developed and tested two different kinds of letters and booklets that presented either personalized or generic information about screening and breast cancer that runs in families, and we encouraged participants to seek genetic evaluation. We found that both types of letters worked equally well for breast cancer patients and for relatives, regardless of their racial background. The personalized letters had slightly better outcomes. Some breast cancer patients and their relatives used genetic services and improved their screening practices. Black patients and their relatives were more satisfied with the booklets than other participants.We compared a tailored and a targeted intervention designed to increase genetic testing, clinical breast exam (CBE), and mammography in young breast cancer survivors (YBCS) (diagnosed <45 years old) and their blood relatives. A two-arm cluster randomized trial recruited a random sample of YBCS from the Michigan cancer registry and up to two of their blood relatives. Participants were stratified according to race and randomly assigned as family units to the tailored (n = 637) or the targeted (n = 595) intervention. Approximately 40% of participants were Black. Based on intention-to-treat analyses, YBCS in the tailored arm reported higher self-efficacy for genetic services (p = 0.0205) at 8-months follow-up. Genetic testing increased approximately 5% for YBCS in the tailored and the targeted arm (p ≤ 0.001; p < 0.001) and for Black and White/Other YBCS (p < 0.001; p < 0.001). CBEs and mammograms increased significantly in both arms, 5% for YBCS and 10% for relatives and were similar for Blacks and White/Others. YBCS and relatives needing less support from providers reported significantly higher self-efficacy and intention for genetic testing and surveillance. Black participants reported significantly higher satisfaction and acceptability. Effects of these two low-resource interventions were comparable to previous studies. Materials are suitable for Black women at risk for hereditary breast/ovarian cancer (HBOC).
Highlights
Women diagnosed with breast cancer younger than 45 years old constitute approximately 25% of new breast cancer cases in the US, and are more likely to carry germline pathogenic variants associated with hereditary breast and ovarian cancer (HBOC)syndrome [1,2]
Uptake of genetic testing in both arms of our randomized controlled trials (RCTs) increased approximately 5%, which is similar to a previous RCT reporting the efficacy of a booklet on rates of genetic testing [28]
The lower uptake of genetic testing among young breast cancer survivors (YBCS) may be related to other factors, including the short-term follow-up, the recruitment strategy precluding a referral from a healthcare provider, and the fact that YBCS were on average 11 years post diagnosis and genetic testing may not have been perceived as relevant or urgent [35]
Summary
Women diagnosed with breast cancer younger than 45 years old (young breast cancer survivors-YBCS) constitute approximately 25% of new breast cancer cases in the US, and are more likely to carry germline pathogenic variants associated with hereditary breast and ovarian cancer (HBOC)syndrome [1,2]. Women diagnosed with breast cancer younger than 45 years old (young breast cancer survivors-YBCS) constitute approximately 25% of new breast cancer cases in the US, and are more likely to carry germline pathogenic variants associated with hereditary breast and ovarian cancer (HBOC). National guidelines recommend periodic screening for changes in family history and genetic evaluation (counseling and testing) of YBCS to determine HBOC status, and physical exams including clinical breast exams (CBE) and mammograms to screen for local recurrence or a new primary tumor [3,4]. Earlier if indicated based on family history [3,4]. They may not always manage this risk effectively due to lack of information and inaccurate understanding of cancer risk inheritance patterns [16,17,18]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
