This project will evaluate different strategies for counseling female
relatives of women with breast cancer. Potential subjects will be
identified during a follow-up study of a population-based cohort of women
diagnosed with breast cancer at age 45 or younger. Relatives of these
probands will be offered the opportunity to participate in the counseling
study. Based on an initial pedigree analysis, women from high-risk
families (meeting criteria for autosomal dominant predisposition to
breast cancer) will be offered genetic counseling and information
regarding options for DNA testing to further evaluate inherited risk for
breast cancer. We anticipate that we will identify 10-15 high-risk
families in this study. Subjects not meeting the high-risk criteria will
be randomized to one of four arms: (1) Genetic counseling: (2) Group
education and counseling: (3) Counseling by their primary care provider,
based on risk information provided by the study; and (4) A comparison
group who will be provided only with informational materials about breast
cancer risk and prevention. A total of 100 subjects will be enrolled in
each arm. Counseling provided will include information on genetic and
non-genetic risk factors for breast cancer, current recommendations for
prevention and screening, and information on the potential role in the
future of DNA-based testing for mutations associated with breast cancer
risk. Subjects randomized to the primary care counseling and comparison
groups will be offered the opportunity for genetic counseling after a 1-
year follow-up period and data collection have been completed. Subjects
will be surveyed before, immediately after and one year following
counseling, to assess risk perception, degree of psychological distress
related to breast cancer. breast cancer screening practices,
understanding of genetic risks for breast cancer and interest in genetic
testing, and interest in genetic testing. Follow-up of subjects from the
high-risk families will include use of genetic testing and the
psychological effects and preventive behaviors occurring after testing.
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