BRCA1/2 Genetic Testing: Some Psychological Implications ALESSANDRA BABORE, SONIA MONIQUE BRAMANTI, ALESSANDRA CAVALLO, LUCIA LOMBARDI

Anxiety and depression after genetic test individuals undergoing genetic testing have been observed to experience heightened anxiety, depression, and worry about cancer, immediately after the test, 1 month later and 6 months later [Hamilton et al., 2016; Lodder et al., 2018] at 12 months after genetic test, levels of anxiety and depression tend to decrease [Beran et al., 2008; Bosch et al., 2012; Metcalfe et al., 2012] there is a psychological adjustment period after discovering that one carries a BRCA1/2 mutation

Is anxiety always negative? For mutation carriers, the immediate months after test receipt often involve decisions about: prophylactic options communication of results to family and friends. These activities, accompanied by one’s own emotional and cognitive processing of the result, may explain the heightened distress observed during this period. Increased levels of cancer-related anxiety/worry seem to predict greater likelihood of screening; therefore, it is possible that this kind of anxiety may serve a positive function [Beran et al., 2008]

Causes of distress overall, the most powerful predictor of mid and long term pathological anxiety level is the level of anxiety at baseline. In fact, the higher the levels of anxiety are at the genetic evaluation, the higher the anxiety appears to be after one year [Bosch et al., 2012] an adequate diagnosis of psychological personality might be needed before undergoing genetic testing

Some key points BRCA genetic testing process affects the whole family: although not at genetic risk themselves, spouses can also experience concerns and distress; thus, the BRCA genetic testing process also affects the well-being of untested family members [Hamilton et al., 2016]. Several factors may play a role in the preventive strategy choice of BRCA carriers: some depend on the information process; others rely on psychosocial variables such as risk perception, cancer worry, anxiety and depression levels, family history and having young children.

In brief… What about long-term psychological outcomes (> 18/24 months)? The dark side of the moon… what about men? [in research on BRCA genetic test: men vs. women = 10% vs. 90%] In order to detect distress, general well-being scales are used. Are they adequate? What about individuals who choose not to participate in the screening process?

…and what about clinical psychology? my personal experience in the clinical oncology ward listening, observation and information communication of mutation within the family continuity from the genetic lab to the oncology ward