title: International perspectives on genetic counseling and testing for breast cancer risk.
abstract: Familial cancer services have been developed in many countries in response to a rapidly evolving demand for genetic counseling and testing for breast cancer risk. This article presents a synthesis of the literature on international aspects of genetic counseling and testing and discusses similarities and differences in the provision of genetic counseling and testing, taking seven countries with well established familial cancer services as a case study (Australia, Canada, France, Germany, Netherlands, UK and US). Potential international differences are discussed in terms of: provider and patient attitudes to genetic counseling and genetic testing; utilization rates of genetic testing and prophylactic surgery; and the psychological impact of genetic testing for breast cancer risk. The comparative analyses of utilization rates and the psychological impact of testing indicate a wide range of variability in uptake rates and psychological outcomes, most likely reflecting sample variability and methodological differences in measurement. International comparison studies using controlled designs would be required to ascertain whether international differences exist, and to disentangle the differential role of clinical, individual and family context factors, on the one hand, and the cultural and health system-related factors unique to particular countries, on the other.
authors.affiliation: Psychosocial Research Group, Department of Medical Oncology, Prince of Wales Hospital, Dickinson 3, Randwick, NSW, Australia. b.meiser@unsw.edu.au
authors.forename: Bettina
authors.initials: B
authors.lastname: Meiser
authors.forename: Clara
authors.initials: C
authors.lastname: Gaff
authors.forename: Claire
authors.initials: C
authors.lastname: Julian-Reynier
authors.forename: Barbara B
authors.initials: BB
authors.lastname: Biesecker
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Esplen
authors.forename: Andrea
authors.initials: A
authors.lastname: Vodermaier
authors.forename: Aad
authors.initials: A
authors.lastname: Tibben
mesh_terms: D001290:Attitude; D001943:Breast Neoplasms / Q000235:genetics* / Q000517:prevention & control / Q000523:psychology; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005817:Genetic Counseling; D005820:Genetic Testing; D006801:Humans; D038622:Internationality; D008408:Mastectomy; D010052:Ovariectomy; D013315:Stress, Psychological / Q000209:etiology