title: Biopsychological stress factors in BRCA mutation carriers.
abstract: OBJECTIVE
  Cancer risk-related stressors are prominent among BRCA mutation carriers. Loss of one's mother to a BRCA-associated cancer is an additional stressor, which may be related to an enhanced inflammatory response. This study examined the effect of mother's vital status on psychological factors and stress-associated biomarkers among BRCA mutation carriers. The role of bereavement on biopsychological variables was also examined.
  
  
  METHODS
  BRCA-carriers with known maternal transmission enrolled in the Gilda Radner Hereditary Cancer Program were invited to participate. Focus group composition was predetermined based on participants' personal cancer history and mother's vital status. Prior to the focus group, participants completed a Quality of Life (QOL) survey and collected a first morning saliva sample. Inflammatory biomarkers were analyzed from proximal archived serum. One day post focus group, a process survey, and morning saliva were collected.
  
  
  RESULTS
  QOL was significantly lower for those whose mothers are deceased (n = 17) compared to those whose mothers are alive (n = 15) (P = 0.003) after adjusting for age, personal cancer history and prophylactic surgery. Similarly, those whose mothers are deceased reported significantly more perceived stress (P = 0.015), more intrusive thoughts related to cancer risk (P = 0.049), and more anxiety (P = 0.003). Higher bereavement scores were significantly associated with QOL and psychological measures. Biomarker correlates were consistent with and significantly correlated to the patient-reported psychological outcomes for those whose mothers were deceased.
  
  
  CONCLUSIONS
  BRCA mutation carriers with a known maternal transmission whose mother is deceased report higher perceived stress and anxiety, lower QOL, and a stress-associated biomarker profile that is potentially globally immune suppressive.
authors.affiliation: School of Medicine, University of California, Irvine, Irvine, CA, USA. lwenzel@uci.edu
authors.forename: Lari
authors.initials: L
authors.lastname: Wenzel
authors.forename: Kathyrn
authors.initials: K
authors.lastname: Osann
authors.forename: Jenny
authors.initials: J
authors.lastname: Lester
authors.forename: Raluca
authors.initials: R
authors.lastname: Kurz
authors.forename: Susie
authors.initials: S
authors.lastname: Hsieh
authors.forename: Edward L
authors.initials: EL
authors.lastname: Nelson
authors.forename: Beth
authors.initials: B
authors.lastname: Karlan
mesh_terms: D000328:Adult; D019072:Antibiotic Prophylaxis; D001601:Bereavement; D015415:Biomarkers; D005260:Female; D017144:Focus Groups; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease / Q000235:genetics / Q000523:psychology; D061325:Hereditary Breast and Ovarian Cancer Syndrome / Q000235:genetics / Q000378:metabolism / Q000523:psychology*; D006579:Heterozygote; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D016014:Linear Models; D063130:Maternal Death / Q000523:psychology*; D009154:Mutation; D010865:Pilot Projects; D011594:Psychometrics; D011788:Quality of Life; D012463:Saliva / Q000737:chemistry; D013315:Stress, Psychological / Q000378:metabolism / Q000523:psychology*; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; D006854:Hydrocortisone