Genetic Counseling Before Surgery Can Lower Stress and Help Women Make Decisions

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A small study has found that women diagnosed with breast cancer who are offered genetic counseling before breast cancer surgery have less stress and make more informed decisions about treatment compared to women who don’t get genetic counseling before surgery.

The study was published online by the Annals of Surgical Oncology on July 6, 2012. Read the abstract of “Cognitive and Psychological Impact of BRCA Genetic Counseling in Before and After Definitive Surgery Breast Cancer Patients.”

About 5% to 10% of breast cancers are thought to be hereditary, caused by abnormal genes passed from parent to child.

Genes are particles in cells, contained in chromosomes, and made of DNA (deoxyribonucleic acid). DNA contains the instructions for building proteins. And proteins control the structure and function of all the cells that make up your body.

Most inherited cases of breast cancer are associated with two abnormal genes: BRCA1 (BReast CAncer gene one) and BRCA2 (BReast CAncer gene two).

Everyone has BRCA1 and BRCA2 genes. The function of the BRCA genes is to repair cell damage and keep breast cells growing normally. But when these genes contain abnormalities or mutations that are passed from generation to generation, the genes don’t function normally and breast cancer risk increases.

Women with an abnormal BRCA1 or BRCA2 gene:

  • have up to an 85% lifetime risk of developing breast cancer
  • have a much higher-than-average lifetime risk of developing ovarian cancer; estimates range from 15% to 60%

This small study was done by researchers at the Moffitt Cancer Center in Tampa, Fla. Some doctors don’t offer newly diagnosed women genetic counseling before breast cancer surgery because they don’t want to increase their stress levels. The doctors worry that adding genetic testing decisions to the stress of dealing with diagnosis and making treatment decisions may be overwhelming for some women. So the researchers decided to see if there were any differences in stress levels between women who had genetic counseling before breast cancer surgery and women who had genetic counseling after breast cancer surgery.

A total of 103 women participated in the study:

  • 87 already had breast cancer surgery
  • 16 hadn’t had breast cancer surgery yet

The women were about 49 years old and 81% of them were white. About 38% of the women were diagnosed with stage II or stage III cancer.

All the women received genetic counseling about abnormal BRCA1 and BRCA2 genes.

Both before and after the genetic counseling, the women completed surveys that asked about:

  • the cancer’s characteristics
  • the women’s knowledge of abnormal BRCA genes and cancer risk
  • cancer-related stress levels
  • the women’s knowledge about genetic testing
  • any conflicting feelings about making genetic testing decisions
  • the women’s knowledge of breast cancer treatments

The researchers compared the survey results before and after the genetic counseling and also compared the results between the two groups of women (women who had surgery vs. women who hadn’t).

Both groups of women had lower cancer-related stress after genetic counseling. This difference was statistically significant for women who hadn’t yet had surgery, which means that the difference was likely because of the genetic counseling and not just due to chance.

Both groups of women also had a statistically significant increase in their knowledge about breast cancer and genetic testing after genetic counseling.

Women who had already had breast cancer surgery had fewer conflicting feelings about making genetic testing decisions after genetic counseling and were more knowledgeable about treatment benefits, risks, and side effects.

While this study was small, the results are encouraging. Right now, women are often not getting genetic counseling before breast cancer surgery because doctors are worried that it may be too much for them to handle; the study shows that pre-surgery counseling can be reassuring and give women more medical knowledge. Genetic counseling and/or testing should happen before treatment because it seems to affect the treatments a woman gets. Also, genetic counseling before surgery actually seems to have a positive impact on a woman's experience.

If you and/or some of your family members have been diagnosed with breast cancer, you may be interested in the possibility of genetic testing.

A BRCA mutation is more likely to run in your family if:

  • Many women in your family have had breast and/or ovarian cancer, particularly at a younger age than these cancers typically develop (before age 50).
  • Some women in your family have had cancer involving both breasts.
  • There is both breast and ovarian cancer in your family.
  • Men in your family have had breast cancer.
  • There is breast cancer in your family and either male relatives on the same side of the family have had prostate cancer at a young age, or male or female relatives on the same side of the family have had gastrointestinal cancers, such as cancer of the pancreas, gall bladder, or stomach.
  • Your family is of Ashkenazi (Eastern European) Jewish descent.

If any of these are true for either side of your family, you may be a candidate for genetic testing. If you’ve been diagnosed with breast cancer, you may want to meet with a genetic counselor before breast cancer surgery. To find a genetic counselor who specializes in family-related cancer risk, talk to your doctor or check with the hospitals and cancer centers in your area.

For more information on BRCA1 and BRCA2 testing and counseling, visit the Breastcancer.org Genetic Testing pages.

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