When patients with breast cancer received pretest genetic counseling before undergoing definitive surgery for breast cancer, they showed fewer signs of distress. At the same time, patients who were offered counseling after surgery improved their informed decision-making, while both groups were better informed, according to a study by researchers at the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida. The study, funded by the American Cancer Society, was published in the Annals of Surgical Oncology.1
The researchers note that patients with breast cancer with certain risk factors likely would benefit from pretest genetic counseling and genetic testing at or near the time of their initial diagnosis. Although some health care providers may fear that these efforts could increase distress for patients at this time, few studies to date have actually examined the impact of such pretest genetic counseling, according to lead coauthor Susan Vadaparampil, PhD, MPH, an associate member of the Health Outcomes and Behavior Program at H. Lee Moffitt.
She and her colleagues developed a study to determine how pretest counseling impacts cancer knowledge, psychosocial development, and decision-making about genetic testing for patients with breast cancer. They analyzed 103 patients, 87 of whom had undergone surgery and 16 of whom had not. The patients ranged in age from 24 years to 69 years. They met with master's degree-level, trained genetic health professionals to obtain a risk assessment based on their personal and family genetic history. At the same time, they received information about hereditary breast and ovarian cancer as well as the limitations of genetic testing.
The study found that both the before-surgery and aftersurgery groups experienced increases in cancer knowledge after pretest genetic counseling. At the same time, the before-surgery group reported decreases in cancer-related distress and intrusive thoughts. Furthermore, informed decision-making in the after-surgery group improved.
Dr. Vadaparampil stresses that before-surgery genetic counselors may need to focus on perceived risks of genetic testing and how they might align with patients' values.