Basic science investigations have identified an increasingly large number of genetic factors important in cancer. By communicating this genetic information to high risk individuals, we can facilitate informed decision- making about participation in cancer prevention and early detection programs. The purpose of the proposed program is to improve adherence to cancer control regimens among persons with a genetic susceptibility to develop cancer. Subjects for the primary project will be 750 women aged 40-65 who have a positive family history of breast cancer in at least one first-degree relative. A randomized factorial design will be used to evaluate the impact of Breast Cancer Risk Counseling (BCRC), a form of genetic counseling for women at high risk for breast cancer. In addition, two different styles of presenting cancer control recommendations in BCRC will be tested. The BCRC intervention will be based on the traditional medical genetics counseling model, but will concentrate on breast cancer surveillance, rather than on reproductive decisions. Telephone interviews will be conducted prior to the interventions to collect familial and medical data to calculate individualized breast cancer risks and to assess baseline risk perceptions, psychosocial functioning, and breast screening patterns. Post-intervention and follow-up surveys will be used to assess the short- and long-term impact of the interventions on these outcomes. Also, subgroups of women who are most and least likely to benefit from the different BCRC interventions will be identified, based on their precounseling psychosocial characteristics and demographic backgrounds. The information obtained from this primary project will lay the foundation for other studies to improve adherence to cancer control practices in diverse high-risk populations. The interventions proposed for these studies are replicable, and, if effective, can be administered by nurses and physicians in medical practice.
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