title: Uptake of offer to receive genetic information about BRCA1 and BRCA2 mutations in an Australian population-based study.
abstract: Research on the utilization of genetic testing services for mutations in BRCA1 and BRCA2 has focused on women with a strong family history of breast and ovarian cancer. We conducted a population-based case-control-family study of Australian women diagnosed with invasive breast cancer before age 40 years, unselected for family history, and tested for germ line mutations in BRCA1 and BRCA2. Case subjects found to carry a deleterious mutation and their relatives who had given a research blood sample were informed by mail that the study had identified "genetic information" and were offered the opportunity to learn more. Those interested were referred to a government-funded family cancer clinic. Of 94 subjects who received the letter, 3 (3%) did not respond and 38 (40%) declined to learn their result (16 declined the referral, 10 accepted but did not attend a clinic, and 12 attended a clinic but declined testing), and 12 (13%) remain "on hold." The remaining 41 (44%) chose to learn their result (3 of whom already knew their mutation status). There was no evidence that the decision to learn of mutation status depended on age, gender, family history, or having been diagnosed with breast cancer. Of 19 families with more than one participant, in 11 (58%) there was discordance between relatives in receiving genetic results. Although in Australia genetic testing is offered free of charge and insurance issues are not a major consideration, we found considerable reluctance, indecision, and unexplained variability both between and within case families in the desire to know their mutation status.
authors.affiliation: Centre for Genetic Epidemiology, University of Melbourne, 723 Swanston Street, Carlton, Victoria 3053, Australia. j.hopper@unimelb.edu.au.
authors.forename: Louise A
authors.initials: LA
authors.lastname: Keogh
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Southey
authors.forename: Judi
authors.initials: J
authors.lastname: Maskiell
authors.forename: Mary-Anne
authors.initials: MA
authors.lastname: Young
authors.forename: Clara L
authors.initials: CL
authors.lastname: Gaff
authors.forename: Judy
authors.initials: J
authors.lastname: Kirk
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Tucker
authors.forename: Doreen
authors.initials: D
authors.lastname: Rosenthal
authors.forename: Margaret R E
authors.initials: MR
authors.lastname: McCredie
authors.forename: Graham G
authors.initials: GG
authors.lastname: Giles
authors.forename: John L
authors.initials: JL
authors.lastname: Hopper
mesh_terms: D000328:Adult; D017668:Age of Onset; D001294:Attitude to Health; D001315:Australia; D001943:Breast Neoplasms / Q000235:genetics* / Q000473:pathology; D016022:Case-Control Studies; D004252:DNA Mutational Analysis; D003657:Decision Making; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D006801:Humans; D009361:Neoplasm Invasiveness; D010349:Patient Compliance; D010375:Pedigree; D014342:Truth Disclosure