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Adolescents with BRCA–positive relatives have greater perceived breast cancer risk, distress
Adolescent girls with a family history of breast cancer or a relative with a BRCA mutation had greater breast cancer–specific distress and perceived risk for breast cancer, according to study results published in Journal of Clinical Oncology.
However, girls from these families also reported higher self-esteem and did not have poorer psychosocial functioning than their peers, results showed.
“Our results are not what many would have expected, but they are perhaps not surprising, given that exposure to illness within a family can build resilience, or lead to the development of coping strategies and early maturity,” Angela R. Bradbury, MD, assistant professor of medicine at Perelman School of Medicine at University of Pennsylvania, told HemOnc Today. “This likely varies by family and by specific experience.”
BRCA testing is not recommended in children, and its use among adolescents remains controversial.
“Studies have investigated the psychosocial effects of testing for mutations in adults, but there are no studies in children,” Bradbury said.
Bradbury and colleagues recruited 320 girls aged 11 years to 19 years and their mothers — representing 247 families — who completed surveys designed to ascertain psychosocial adjustment, breast cancer–specific distress and perceived breast cancer risk.
A total of 208 girls came from families with a history of breast cancer (BCFH positive), of whom 69 had a BRCA1/2–positive mother. Sixty-five percent of BRCA1/2–positive mothers reported undergoing mastectomy; 81% reported undergoing oophorectomy.
The other 112 girls were from families without a history of breast cancer (BCFH negative) and were classified as peers.
Girls with BRCA1/2–positive mothers tended to be younger (mean, 14.9 years vs. 15.7 years; P = .03); no other statistically significant differences occurred between the groups.
Among mothers, a higher percentage of those who were BRCA1/2 positive met the criteria for clinically significant distress (25% vs. 12%; P = .043).
All girls had accurate knowledge of their mothers' breast cancer history, and 55% of girls with BRCA1/2–positive mothers reported knowledge of their mother’s testing.
Girls in the BCFH–positive cohort reported higher self-esteem than their peers (P = .01); no other significant differences in general psychosocial adjustment occurred by the girls’ self-reports or by their mothers’ reports.
However, mean breast cancer–specific distress scores were higher among girls in the BCFH–positive cohort (P < .001), and more BCFH–positive vs. –negative girls met criteria for having clinically significant breast cancer–specific distress (11% vs. 1%; P = .01) Levels of distress appeared comparable between girls with BRCA1/2–positive mothers and their BCFH–positive peers.
A greater proportion of girls in the BCFH–positive cohort than BCFH–negative girls reported that they had an increased lifetime risk for breast cancer (74% vs. 33%; P .001).
Additionally, a significantly greater proportion of girls with a BRCA1/2–positive mother reported they had a greater lifetime risk for breast cancer (81%) than girls in the BCFH–positive (68%; P = .006) or BCFH–negative cohorts (32%; P < .001).
The researchers observed a correlation between higher general anxiety and poor family communication (P = .02), as well as depression and poor family functioning (P < .001).
Having a higher perceived risk for breast cancer was more common among older girls (P < .001).
Further, girls with higher breast cancer–specific distress tended to have a higher perceived breast cancer risk (P = .047) and mothers with greater distress (P = .001).
The researchers acknowledged study limitations, including the potential for bias in the study sample. Also, the study population included a small number of ethnic minorities, which may limit the generalizability of the findings.
Because the study focused on mother-daughter pairs, the impact of genetic predispositions passed through paternal lineage — as well as data from women with deceased mothers — could not be captured.
“We encourage parents from ‘breast cancer families,’ or those with genetic risks, to care for themselves, as parental adjustment or family functioning can predict how a daughter will adjust,” Bradbury said. “There is an unmet need for more education and interventions to optimize adaptive and positive responses to genetic and familial risk assessments — even if the testing only occurs in adults — given that genetic testing is expanding in many areas of medicine.” – by Cameron Kelsall
For more information:
Angela R. Bradbury, MD, can be reached at angela.bradbury@uphs.upenn.edu.
Disclosure: Bradbury reports that an immediate family member has received research funding and travel expenses from Hill-Rom and Myriad Genetics. Please see the full study for a list of all other researchers’ relevant financial disclosures.