Psychological impact and intervention needs in genetic counseling for women with hereditary breast cancer risk

Abstract

The psychological aspects of genetic counseling for breast cancer are reviewed. The principal profits for the genetic counseling participants are: to obtain certainty, be capable of estimating the risk of developing hereditary cancer, to take preventive measures, and to help their relatives. Genetic risk counselling has been shown to improve significantly the accuracy of risk perception, but a significant proportion of women continue to hold misperceptions, which is caused by problems to understand the information and cognitive or emotional biases. The estimations of risk should be a mean to assist in health decision-making and not a mere predictor of cancer. It is preferable to provide the estimations about cancer risk in absolute probabilities, and to avoid terms of relative risk. The values of the participants and the consequences for his well-being in the long term must be incorporated to the process of decision-making. The participants must view their decisions in terms of the advantages/disadvantages and not as correct/wrong.
The participation in CGO does not have negative consequences in mental health for the most people. The open communication among relatives is an important determinant of the adjustment to the process. The psychological intervention is necessary for the following conditions: a) the participants who have problems of familiar communication; b) those who are tested first; c) high levels of distress, anxiety, pessimism, or low self-esteem prior to testing; d) having lost a relative to hereditary cancer during the adolescence (11-20 years); e) the recent death of a relative from cancer and grief; f) recent diagnosis of cancer or recurrence; g) the participants who decline genetic testing; h) carriers who do not expect to be carriers; i) those who consider to undergoing prophylactic surgery.