Psychological outcomes and risk perception after genetic testing and counselling in breast cancer: a systematic review.
OBJECTIVE
To conduct a systematic review of the effects of genetic counselling and testing for familial breast cancer on women's perception of risk and psychological morbidity.


METHODS
MEDLINE, PsychLIT and EMBASE were searched for the period 1980-2001.


METHODS
Studies were eligible if published in a peer-reviewed journal in English, included women with a family history of breast cancer who underwent genetic counselling or testing and had either a randomised controlled trial or prospective design, with a pre- and at least one post-counselling assessment.


RESULTS
As there was considerable heterogeneity in populations and measures, results were summarised rather than subjected to meta-analysis.


RESULTS
Overall, genetic counselling and testing appear to produce psychological benefits and to improve accuracy of risk perception. Carriers of mutations in cancer predisposition genes did not experience significant increases in depression and anxiety after disclosure of their mutation status, while non-carriers experienced significant relief. Women who were tested but declined to learn their results seemed to be at greater risk of a worse psychological outcome.


CONCLUSIONS
To date, the data on psychological outcomes after genetic counselling and testing are reassuring. However, few studies used a randomised trial design, limiting the strength of the conclusions. Follow-up to date has been short, and we know little about the long-term impact of testing on patient behaviours, perceptions and psychological state.
Butow
Phyllis N
PN
Medical Psychology Research Unit, Blackburn Building (D06), University of Sydney, NSW 2006, Australia. phyllisb@med.usyd.edu.au
Lobb
Elizabeth A
EA
Meiser
Bettina
B
Barratt
Alexandra
A
Tucker
Katherine M
KM
D000223:Adaptation, Psychological; D001007:Anxiety; D001943:Breast Neoplasms / Q000235:genetics* / Q000517:prevention & control*; D003863:Depression; D037001:Directive Counseling; D005260:Female; D005820:Genetic Testing / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D010465:Perception; D012306:Risk