Women with a strong family history of breast cancer who have inherited a mutation in genes known as BRCA1 and BRCA2 have an 85-90% risk of developing breast cancer, often at ages younger than expected. However, the vast majority of women who have a family history of breast cancer have a risk much lower than 90%. In fact, most women with a family history of breast cancer who have only a single affected first-degree relative are unlikely to carry a BRCA1 or BRCA2 mutation. Consequently, these women are not appropriate candidates for genetic testing or counseling. Despite the fact that most women with a family history of breast cancer are not likely to carry a BRCA1 or BRCA2 mutation, studies show that this group is extremely interested in obtaining genetic testing. Of particular concern is the possibility that high demand for testing may exceed available counseling resources. Evidence suggests that demand for testing may be driven by lack of knowledge and misconceptions about the benefits, risks, and limitations of testing. Because of the anticipated high demand and limited counseling resources, there is a need for an educational tool to facilitate informed decision making. We propose to test the application of an Internet-based educational tool as an intervention for helping women with a family history of breast cancer make informed decisions about presymptomatic genetic testing. The expected outcome is improved risk comprehension and reduced psychological distress relative to hereditary breast cancer. In order to understand the exaggerated risk perception among these women, we need to understand how women process and interpret risk information. Thus the experimental plan includes a study of the cognitive informational (coping) styles of program users based on the Monitoring Process Model. We will consider not only attentional style, but also the ways in which women process and interpret risk information as we develop our intervention in an effort to make effective use of the Internet as an educational tool. This will allow us to ultimately tailor information based on an individual's attentional style in Phase II.
