Hereditary breast cancer. Psychosocial issues and family physicians' role.
OBJECTIVE
To outline the psychosocial issues in hereditary breast cancer (HBC) assessment and discuss the role of family physicians.


METHODS
A literature search using MEDLINE, CINAHL, CancerLit, and HealthStar databases was conducted from January 1990 to April 1998, using the key words breast cancer or neoplasm and familial or hereditary, genetic testing or screening, primary care or family physician or counseling, genetic counseling, psychosocial or psychological. We found only a few studies focusing on a small number of well-studied "research families."


RESULTS
Women with a family history of breast cancer were likely to be highly interested in genetic testing for cancer risk. The benefit of testing for those with negative results is reassurance. Those found to be carriers of genetic mutations might benefit from increased surveillance and prophylactic therapy. Risks of testing include anxiety, depression, guilt, altered self-image, and insurance and employment discrimination. A family physician's role is to assess risk, to provide information and support so women can make informed choices about referral to familial cancer clinics, to offer cancer surveillance, and to provide support once genetic test results are available.


CONCLUSIONS
Genetic testing is rapidly moving from research to clinical applications. Family physicians play an integral role in educating and managing women at risk for HBC. Physicians must prepare themselves with knowledge and counseling skills to meet the challenges of this new technology.
Carroll
J C
JC
Department of Family and Community Medicine, University of Toronto. june.carroll@utoronto.ca
Heisey
R E
RE
Warner
E
E
Goel
V
V
McCready
D R
DR
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000235:genetics* / Q000517:prevention & control; D003657:Decision Making; D005194:Family Practice; D005260:Female; D005817:Genetic Counseling; D020022:Genetic Predisposition to Disease / Q000523:psychology*; D005820:Genetic Testing / Q000523:psychology*; D006801:Humans; D008875:Middle Aged