Understanding Decision Making Processes for Undergoing Genetic Testing Among Women With Newly Diagnosed Breast Cancer
Genes are the "blueprints" for our bodies. Some people are born with an abnormal copy ("mutation") of a gene. These people may have a higher chance of getting a disease. Different mutations in different genes cause different diseases. Some women get breast cancer because they are born with an abnormal copy of a gene called BRCA1 or BRCA2. These women also have a higher chance of getting ovary cancer. Women with breast cancer and an abnormal copy of BRCA1 or BRCA2 also have a higher chance of getting a second breast cancer in their other breast. Because of this, women who might have a mutation may have genetic testing soon after their breast cancer diagnosis to learn about their risks of getting another cancer.
Genetic testing may be done right after a woman has been diagnosed with breast cancer. It may also be done later, after surgery is done to treat the cancer. The investigators do not know when it is best to do genetic testing. The investigators are doing this study to try to understand whether women prefer testing before or after surgery. The investigator also want to find out how they feel about their choice later on, when their diagnosis in more in their past.
|Study Design:||Observational Model: Family-Based
Time Perspective: Prospective
|Official Title:||Understanding Decision Making Processes for Undergoing Genetic Testing Among Women With Newly Diagnosed Breast Cancer|
- To determine the relative proportions of women offered genetic testing after a breast cancer diagnosis who decide to have BRCA testing [ Time Frame: 2 years ] [ Designated as safety issue: No ]Either before completing definitive local surgical treatment (pre-surgical testing), after definitive surgical treatment (post-surgical) Women will be evaluated for their levels of general and cancer specific distress, coping style, and stage of decision-making with respect to PM (as this is the primary clinical reason for undergoing immediate testing).
- To determine the relative proportions of women who decide to undergo prophylactic mastectomy (PM) [ Time Frame: 2 years ] [ Designated as safety issue: No ]The decision-making on prophylactic mastectomy (PM) will be obtained from the immediate and delayed BRCA genetic testers at Assessment 3. This will be a binary outcome of PM vs. no PM.
- To assess the factors associated with the decision to choose pre- or post surgical testing. [ Time Frame: 2 years ] [ Designated as safety issue: No ]We will compare the BRCA genetic testers (pooling immediate and delayed to boost the sample size) and the decliners on the summary scores of several psychosocial assessments using independent-sample t-tests for continuous variables (e.g., distress as measured by the BSI and IES) and non-parametric tests for categorical variables such as exact binomial test, Fisher's exact test, or the Chi-square test as appropriate (e.g., the blunters vs. monitors dichotomization) .
- To assess regret experienced by women choosing to undergo either pre- or post-surgical testing. [ Time Frame: 2 years ] [ Designated as safety issue: No ]Regret scores with respect to genetic testing will be summarized (averages and confidence intervals) in women undergoing immediate, delayed, or no BRCA genetic testing (including women in the Decliner groups A, B, and C, who will be analyzed as part of the "no genetic testing" group).
- To delineate factors associated with regret about the timing of genetic testing [ Time Frame: 2 years ] [ Designated as safety issue: No ]particularly the interaction between regret, timing of genetic testing, level of distress at the time of the decision about genetic testing, and choice with respect to PM.
Biospecimen Retention: Samples With DNA
peripheral blood leucocytes and/or mouthwash-collected buccal epithelial cells)
|Study Start Date:||June 2011|
|Estimated Study Completion Date:||June 2014|
|Estimated Primary Completion Date:||June 2014 (Final data collection date for primary outcome measure)|
Women with Breast Cancer
The proposed investigation is a prospective cohort study. Women with newly diagnosed breast cancer will decide whether to undergo BRCA testing either before or after completion of local surgical treatment.
Genetic: BRCA testing and questionnaire assessments
If they consent to enroll, they will complete an instrument evaluating their beliefs regarding the value of genetic testing (Assessment 1). After that, they will decide whether they wish to attend an information session on genetic predisposition. If they do, after completing that information session they will complete a follow-up instrument (Assessment 2), and will then decide to either immediately donate a sample for immediate testing, or to defer the decision until after surgery. Women will be given the results of their genetic testing in the context of a standard results counseling session, after which they will continue with clinical care. They will be followed for clinical decision, especially whether or not they undergo CPM. They will also complete instruments at 6 and 12 months assessing their QoL and decision satisfaction/regret.
|Contact: Mark Robson, MD||646-888-5434|
|Contact: Jennifer Hay, PhD||646-888-0039|
|United States, New York|
|Memorial Sloan-Kettering Cancer Center||Recruiting|
|New York, New York, United States, 10065|
|Contact: Mark Robson, MD 646-888-5434|
|Contact: Jennifer Hay, PhD 646-888-0039|
|Principal Investigator: Mark Robson, MD|
|Principal Investigator:||Mark Robson, MD||Memorial Sloan-Kettering Cancer Center|