Is It Time to Reconsider Testing Adolescents for Familial BRCA Mutations?

TON - January 2017, Vol 10, No 1 - Genetic Counseling
Courtney Lewis, MS, CGC
Cristi Radford, MS, CGC

Parents with inherited cancer mutations often wonder when to disclose results to their children and what affect it will have on them. A recent study examined the impact of a family history of breast cancer or a familial BRCA1/2 mutation on girls aged 11 to 19 years.1 The study included 208 adolescent females who had ≥1 family members with breast cancer and 69 who had a mother with a BRCA1/2 mutation. For comparison, it also enrolled 112 adolescent girls who did not have a family history of breast cancer. All individuals completed assessments on psychosocial adjustment, breast cancer–specific distress, and perceived risk for breast cancer.

Data from the study suggested that adolescents with a breast cancer family history, including those whose mothers were BRCA1/2 positive, had higher self-esteem and did not have poorer psychosocial adjustment than their peers with no family history of breast cancer. In addition, depression seemed to decrease as the number of individuals in the family with breast cancer increased. The reason for this is unclear; however, it is suggested that exposure to several individuals in a family with breast cancer may trigger adaptive responses.

Adolescents who were aware of their mother’s BRCA1/2-positive status were more likely to report themselves at higher risk for breast cancer than their peers. The same was true to a lesser extent for individuals with a familial risk for breast cancer but without a mother with a BRCA1/2 mutation. The perceived breast cancer risk also increased with adolescent age. These findings are important because they suggest that genetic testing in adolescents may provide relief from uncertainty, reduce cancer-specific distress for those testing negative, and allow for earlier incorporation of genetic test results into an individual’s genetic identity.

This is one of the first studies to examine psychosocial adjustment and perceived risk among adolescent girls from families with BRCA1/2 or breast cancer history. Although current professional guidelines recommend against the testing of children for adult-onset inherited cancer syndromes in the majority of situations, the results of this study suggest there is a need to better understand the impact, both good and bad, of offering genetic testing to adolescents for adult-onset inherited cancer syndromes.

Furthermore, studies are needed because children sometimes receive incidental results when undergoing a test, such as exome analysis, for an unrelated condition. As advances in genetic sequencing continue to take place and cost continues to decrease, children are more likely to receive an incidental finding report that includes a positive result for a gene indicating susceptibility to an adult-onset inherited cancer. Information on how these children and adolescents process the information at different stages of development may allow for interventions to optimize psychosocial and behavior adaptation, as well as health outcomes. In addition, researchers may discover that genetic testing in adolescents who have a parent with a familial mutation is more helpful than harmful.

Source: Bradbury AR, Patrick-Miller L, Schwartz LA, et al. Psychosocial adjustment and perceived risk among adolescent girls from families with BRCA1/2 or breast cancer history. J Clin Oncol. 2016;34:3409-3416.

Related Items
Is It Time to Reevaluate Universal Screening Strategies for Lynch Syndrome in Patients Newly Diagnosed with Colorectal Cancer?
Cristi Radford, MS, CGC, Nicole Centers, BSN, RN, OCN, CBCN, CN-BN
TON - September 2017, Vol 10, No 5 published on September 10, 2017 in Genetic Counseling
Survivorship Clinics—A Second Opportunity for Genetic Risk Stratification
Cristi Radford, MS, CGC, Nicole Centers, BSN, RN, OCN, CBCN, CN-BN
TON - July 2017, Vol 10, No 4 published on July 6, 2017 in Genetic Counseling
Therapeutic Implications—The Next Era of Genetic Diagnosis
Cristi Radford, MS, CGC
TON - May 2017, Vol 10, No 3 published on May 17, 2017 in Genetic Counseling
New Data Suggest the Benefit of Multigene Panel Testing for Patients with Early-Onset Colorectal Cancer
Cristi Radford, MS, CGC
TON - March 2017, Vol 10, No 2 published on March 7, 2017 in Genetic Counseling
Risk and Management Updates for Inherited Colorectal Cancer
Courtney Lewis, MS, CGC , Cristi Radford, MS, CGC
TON - November 2016, Vol 9, No 6 published on November 15, 2016 in Genetic Counseling
Increased Risk for Serous/Serous-like Endometrial Cancer Found in BRCA1 Carriers
Cristi Radford, MS, CGC
TON - September 2016, Vol 9, No 5 published on September 4, 2016 in Genetic Counseling
“Newer” Ovarian Cancer Genes, Option of Risk-Reducing Salpingo-Oophorectomy
Cristi Radford, MS, CGC
TON July 2016 Vol 9 No 4 published on July 18, 2016 in Genetic Counseling
The Evolving Phenotype of Li-Fraumeni Syndrome
Cristi Radford, MS, CGC
TON May 2016 Vol 9 No 3 published on May 16, 2016 in Genetic Counseling
“Newer” Ovarian Cancer Genes and Option of Risk-Reducing Salpingo-Oophorectomy
Cristi Radford, MS, CGC
Online First published on May 12, 2016 in Genetic Counseling, Online First
Counseling, Multiplex Testing May Lower Anxiety in At-Risk Patients with Cancer
Wayne Kuznar
TON March 2016 Vol 9 No 2 published on March 22, 2016 in Genetic Counseling
Last modified: February 2, 2017