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Attitudes toward Colon Cancer Gene Testing: Factors Predicting Test Uptake¹

Departments of Psychiatry and Behavioral Sciences [A-M. C., C. Y.], Oncology [A-M. C., G. M. P., K. J., S. V. B.], and Medicine [J. D. B., J. A. B.], School of Medicine, and Departments of Epidemiology [G. M. P., E. K. L., M. T. B.] and Biostatistics [D. L. M.], School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland 21287-7218

Objectives. Genetic discoveries in hereditary nonpolyposis colorectal cancer (HNPCC) have made possible genetic testing to determine susceptibility to this form of colorectal cancer (CRC). This study measured the uptake of genetic testing for HNPCC among first-degree relatives of CRC patients and conducted a preliminary analysis of the predictors of test uptake.

Materials and Methods. We compared 77 test acceptors and 181 decliners on demographic, medical history, and psychological characteristics, controlling for distance from the testing center. The psychological factors studied were risk perception for CRC, frequency of cancer thoughts, and perceived ability to cope with unfavorable genetic information.

Results. In the final regression model, after accounting for all variables, the significant predictors of test uptake were increased risk perception, greater perceived confidence in ability to cope with unfavorable genetic information, more frequent cancer thoughts, and having had at least one colonoscopy. The association between risk perception and uptake was dependent on frequency of cancer thoughts. Among those who thought about getting CRC more often, the probability of testing increased as perceived risk increased to 50% likelihood of getting CRC and then leveled off. In contrast, among those who never or rarely thought about getting CRC, risk perception was unrelated to testing decision.

Conclusions. Our findings are consistent with the associations reported between psychological factors and other cancer screening behaviors.

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