A study has found that genetic counseling over the telephone is equal to in-person genetic counseling for women at high risk of a genetic mutation that would raise their risk for breast or ovarian cancer.
The research was published online on June 20, 2016 by the Journal of Clinical Oncology. Read the abstract of “Randomized Noninferiority Trial of Telephone Delivery of BRCA1/2 Genetic Counseling Compared With In-Person Counseling: 1-Year Follow-Up.”
Up to 10% of breast cancers are thought to be hereditary, caused by gene mutations -- a harmful change in the gene -- 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.
Three of the most well-known genes that can mutate and raise the risk of breast and/or ovarian cancer are BRCA1, BRCA2, and PALB2. Women who inherit a mutation in any of these genes -- from their mothers or their fathers -- have a much higher-than-average risk of developing breast cancer and/or ovarian cancer. Men with these mutations have an increased risk of breast cancer, especially if the BRCA2 gene is affected, and possibly of prostate cancer. Many inherited cases of breast cancer have been associated with mutations in these three genes.
The function of the BRCA and PALB2 genes is to keep breast cells growing normally and prevent any cancer cell growth. But when these genes contain the mutations that are passed from generation to generation, they do not function normally and breast cancer risk increases.
Because people are more aware of the genetic mutations linked to breast cancer, the demand for genetic counseling and testing has increased. It’s been difficult for genetic counselors to keep up with this demand, especially in areas with few counselors, so researchers wondered if offering genetic counseling over the telephone, instead of in-person as it’s usually done, could offer the same quality and information. If so, it would allow many more people to talk to a genetic counselor.
In the study, the researchers randomly assigned a representative sample of 988 women at high risk for inherited breast and/or ovarian cancer to one of two types of genetic counseling:
- in person (495 women)
- over the phone (493 women)
Women who had in-person counseling received counseling from a licensed cancer genetic counselor according to national guidelines as well as printed hereditary breast and ovarian cancer information. Women who decided to have genetic testing could provide a sample at their appointment or take a cheek swab test home with them. Women who were tested were offered post-test counseling with the same genetic counselor.
Women who had telephone counseling received counseling from a licensed cancer genetic counselor according to national guidelines. These women were mailed the printed hereditary breast and ovarian cancer information before their telephone counseling session so they could look at the materials during the session. Women who decided to have genetic testing were mailed a cheek swab test. Women who were tested were offered post-test counseling with the same genetic counselor.
Women in both groups were mailed a letter that summarized their personalized risk assessment based on family history and/or genetic test results. The letter also included recommendations on how to best manage their risk.
The researchers measured the women’s:
- anxiety levels
- cancer-specific stress
- mental and physical health-related quality of life
before the women had genetic counseling, 1 week after genetic counseling, and 6 months and 1 year after their last genetic counseling session.
The researchers also measured the women’s:
- perceived control of their risk of hereditary breast and/or ovarian cancer
- difficulty making decisions about managing genetic risk
- follow through on recommendations
1 year after their last genetic counseling session.
The results showed that 1 year after their last counseling session, the women had about the same levels of anxiety, cancer-specific stress, quality of life, perceived control of risk, difficulty making decisions, and follow-through on recommendations no matter which type of genetic counseling they received.
“This trial provides important evidence that telephone genetic counseling for hereditary breast and/or ovarian cancer is noninferior to in-person counseling and can be delivered as safely as in-person counseling without an adverse effect on long-term psychologic, quality-of-life, and decision-making outcomes,” the researchers wrote.
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 mutation linked to a higher risk of breast cancer 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, either in person or on the phone, 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 genetic testing and counseling, visit the Breastcancer.org Genetic Testing pages.