Researchers at Moffitt Cancer Center have found that when breast cancer patients are offered pre-test genetic counseling before definitive breast cancer surgery, patients exhibited decreases in distress. Those offered pre-test genetic counseling after surgery improved their informed decision-making. Patients in both groups showed increases in their cancer knowledge with pre-test genetic counseling.

The study, funded by the American Cancer Society, appeared in a recent issue of the Annals of Surgical Oncology.

Given the role of breast cancer gene status in treatment and risk management, breast cancer patients with certain risk factors may benefit from pre-test genetic counseling and genetic testing at or near the time of initial diagnosis, suggested the researchers.

"However, health care providers may be concerned that women with cancer may be at increased risk for distress, particularly if genetic counseling and genetic testing occur at a time near cancer diagnosis and treatment," said study lead co-author Susan T. Vadaparampil, Ph.D., an associate member of Health Outcomes & Behavior at Moffitt. "Yet, few studies have examined whether this is the case, and little is known about the specific impact of pre-test genetic counseling on cancer knowledge, psychosocial adjustment and decision-making about genetic testing for breast cancer patients before or during treatment."

To address this question, Vadaparampil and colleagues recently completed a study of 103 patients, 87 who had undergone surgery and 16 who had not. They ranged in age from 24 to 69. Patients enrolled in this study met with a master's degree-level, trained genetic health professional to obtain a risk assessment based on personal and family genetic history. Patients also received education about hereditary breast and ovarian cancer and discussed the limitations of genetic testing.

"Before surgery, patients may feel overwhelmed by additional risk information and surgical treatment implications presented during genetic counseling," explained study lead co-author Juliette Christie, Ph.D., a post-doctoral fellow in Moffitt's Behavioral Oncology Training Program. "After surgery, patients may be concerned about their personal and family member's genetic vulnerability."

"When speaking with a before-surgery patient, genetic counselors may need to focus on addressing perceived risks associated with genetic testing and how those align with patient values," Vadaparampil said. "Protocols may need to be adapted to meet the specific needs and perspectives of before-surgery breast cancer patients to ensure timely and effective decision-making after pre-test genetic counseling."

The researchers reported that "trends suggest pre-test genetic counseling decreases overall decisional conflict for after-surgery patients … and it is possible that (these) patients gain increased understanding of the benefits and risks of previous and potential treatment and surgical options."

In this study, both before- and after-surgery patient groups reported increases in cancer knowledge after pre-test genetic counseling. Before-surgery patients reported decreases in cancer-related distress and intrusive thoughts.

"Our data suggest that in the weeks following pre-test genetic counseling, cancer-related knowledge in both before- and after-surgery groups increased, distress in before-surgery patients decreased, and informed decision-making in after-surgery patients improved," concluded the authors.