) The aims of this supplemental application are to expand the scope of the training and research outlined in the original K-07 proposal. The original application proposed training and research focused on describing psychosocial sequelae to genetic testing for breast and ovarian cancer risk. Training included a series of courses focused on genetics, psychosocial sequelae to genetic testing and instrument development. The general aim of the research was to develop a psychosocial screening tool that could be used to screen for excessive psychosocial distress in women at excess risk for developing breast and ovarian cancer. Training and research aspects of the proposal are progressing well and according to plan. A limitation of study to date relates to the homogeneity of the sample (white, well educated, high socioeconomic status) and thus the fact that the sample may not represent the population of candidates for genetic risk assessment. This limitation raises concerns about access to genetic risk assessment services. This supplement is designed to describe barriers to access so that genetic risk assessment for susceptibility to breast and ovarian cancer does not become a service fashioned for a privileged few. The training will consist of mentored experiences and coursework related to psychosocial aspects of risk, cultural issues in healthcare utilization, sampling, use of data from a state tumor registry, bias in data collection, and data analysis as well as refining knowledge about characteristics that prompt referral of women at increased breast cancer risk to psychological services. The investigator will meet regularly with 2 investigators from the STAR trial, designed to compare the efficacy of tamoxifen and raloxifene as preventive breast cancer agents in women at increased risk. Exposure to the issues encountered in recruiting women for this trial, strategies for recruiting minorities and the psychosocial aspects of risk will provide invaluable opportunities for learning. Proposed supplemental research will test the psychosocial screening instrument under development on a diverse sample of women accessed from a state tumor registry determined to be at excess breast and ovarian cancer risk and one of their first degree relatives. Findings will permit identification of factors that prevent or promote use of genetic risk assessment services and characteristics associated with significant psychosocial problems. This study has the potential to promote optimal use of genetic risk assessment technology by understanding demographic, and psychosocial factors that may inhibit use especially by women who may benefit from them.
