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Uptake of Offer to Receive Genetic Information about BRCA1 and BRCA2 Mutations in an Australian Population-Based Study

¹ Key Centre for Women's Health in Society, Department of Public Health, ² Genetic Epidemiology Laboratory, Department of Pathology, and ³ Centre for Genetic Epidemiology, University of Melbourne; ⁴ Familial Cancer Centre, Peter MacCallum Cancer Institute, and ⁵ Genetic Health Services Victoria, Royal Children's Hospital, Melbourne, Victoria, Australia; ⁶ Familial Cancer Service, Westmead Hospital, Westmead, New South Wales, Australia; ⁷ Hereditary Cancer Clinic, Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia; ⁸ Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand; and ⁹ Cancer Epidemiology Centre, The Cancer Council Victoria, Carlton, Victoria, Australia

Requests for reprints: John L. Hopper, Centre for Genetic Epidemiology, University of Melbourne, 723 Swanston Street, Carlton, Victoria 3053, Australia. Phone: 61-3-8344-0697; Fax: 61-3-9349-5815. E-mail: j.hopper{at}unimelb.edu.au

Research on the utilization of genetic testing services for mutations in BRCA1 and BRCA2 has focused on women with a strong family history of breast and ovarian cancer. We conducted a population-based case-control-family study of Australian women diagnosed with invasive breast cancer before age 40 years, unselected for family history, and tested for germ line mutations in BRCA1 and BRCA2. Case subjects found to carry a deleterious mutation and their relatives who had given a research blood sample were informed by mail that the study had identified "genetic information" and were offered the opportunity to learn more. Those interested were referred to a government-funded family cancer clinic. Of 94 subjects who received the letter, 3 (3%) did not respond and 38 (40%) declined to learn their result (16 declined the referral, 10 accepted but did not attend a clinic, and 12 attended a clinic but declined testing), and 12 (13%) remain "on hold." The remaining 41 (44%) chose to learn their result (3 of whom already knew their mutation status). There was no evidence that the decision to learn of mutation status depended on age, gender, family history, or having been diagnosed with breast cancer. Of 19 families with more than one participant, in 11 (58%) there was discordance between relatives in receiving genetic results. Although in Australia genetic testing is offered free of charge and insurance issues are not a major consideration, we found considerable reluctance, indecision, and unexplained variability both between and within case families in the desire to know their mutation status.