An estimated 182,000 new cases of breast cancer, and 24,000 new cases of ovarian cancer will occur in the United States in 1994. An unacceptable burden of morbidity and mortality among women is associated with these two cancers. Among other risk factors, family studies have documented a significantly increased risk among first and second degree relatives of women with both breast and ovarian cancer. Advances in molecular genetic technology have led to the identification of genes associated with human cancer, and data from linkage analysis for 214 families with multiple cases of site-specific breast or breast and ovarian cancer strongly suggest that a gene on a region of chromosome 17q termed the BRCA1 gene, accounts for the majority of families in whom both early onset breast and ovarian cancer occur, and in approximately 45% of families with site-specific breast cancer. It is anticipated that the BRCA1 as well as other cancer susceptibility genes will become available for genetic screening, to identify carriers in the population and to target early preventive strategies to the most appropriate risk groups.Although the availability of molecular genetic tools to assess risk for breast and ovarian cancer offers an attractive means of directing cancer control efforts, the medical, psychological and social risks associated with such an approach have not been fully evaluated. We will recruit a cohort of 600 women with one or more first degree relatives with breast and/or ovarian cancer into a genetic cancer risk assessment program modeled on the Family Risk Assessment Program at Fox Chase Cancer Center (FCCC). Participants will be recruited at two sites from an ethnically diverse population. Risk status will initially be based on review of extended family pedigrees and individual risk factors. Blood samples will be collected and stored for BRCA1 (and other gene) testing when available.We propose to study the efficacy of a brief, nurse-delivered counseling intervention, Stress Inoculation Therapy (SIT), on the enhancement of Psychological adjustment to the receipt of genetic cancer risk information, on the improvement of comprehension of genetic risk, and on the promotion of adherence to follow-up prevention recommendations. In addition, we will assess how coping style disposition moderates the effects of the intervention. Outcome measures will include both general psychological adjustment as well as risk-specific distress. The availability of DNA markers for the BRCA1 gene will allow us to compare risk assignment based on clinical parameters with that provided by genetic testing to determine if family history can serve as a tool to select appropriate candidates for genetic screening in the future. The proposed study provides a unique opportunity to develop and test among women of different socioeconomic and ethnic groups a relatively brief psychoeducational counseling intervention which could have a significant public health impact on cancer control.
| Hurley, K E; Miller, S M; Costalas, J W et al. (2001) Anxiety/uncertainty reduction as a motivation for interest in prophylactic oophorectomy in women with a family history of ovarian cancer. J Womens Health Gend Based Med 10:189-99 |
| Daly, M; Farmer, J; Harrop-Stein, C et al. (1999) Exploring family relationships in cancer risk counseling using the genogram. Cancer Epidemiol Biomarkers Prev 8:393-8 |
