Familial Cancer Risk Knowledge Doesn’t Spur Healthier Choices in Young PeopleJuly 22, 2022
Disclosing a mother’s BRCA status had no effect on cancer risk-associated behaviors in her adolescent and young adult children, a study found.
Behaviors such as tobacco and alcohol use or physical activity were unchanged whether young people were informed of their mother’s cancer history or pathogenic variant status on genetic testing, a mixed-method study in Pediatrics found.
“Children who had learned of their family’s high genetic risk for breast/ovarian cancer were no more or less likely to act in ways that could prevent cancer (or protect their overall health) compared to those without a BRCA pathogenic variant,” explained Kenneth Tercyak, PhD, behavioral researcher at Georgetown University in Washington, D.C., and colleagues.
Information about BRCA status also did not affect psychologic distress levels such as self-reported depression, anxiety, and general stress.
However, teenagers and young adults with BRCA-positive mothers were more aware of and interested in genetic risk information. Those with cancer-surviving mothers were significantly more likely to believe they were at greater risk of cancer and reported more knowledge about the disease than peers whose mothers had never had cancer.
Maternal BRCA-positive status was also associated with a stronger belief that genes determined cancer risk and the importance of learning about genes.
“However, greater concern over personal cancer risk in the absence of known mutations, even among children of survivors, may be inaccurate,” the authors cautioned. “Thus, it is important to provide AYAs [adolescent and young adults] in such families with clear information about the role of genes in health, both to reduce unnecessary worry and to provide tailored medical management recommendations.”
The authors note that a maternal BRCA-positive status often causes younger family members to receive genetic testing themselves and may have an effect on how families approach cancer risk communication, education, and counseling. They suggest that such families could benefit from support in open communication about genetic testing.
In an accompanying editorial, pediatric hematology-oncology specialist Colin Moore, MD, from Moffitt Cancer Center in Tampa, Florida, and colleagues agreed.
“Although many parents are apprehensive about communicating a positive genetic testing result to their child, the lack of communication can foster misinformation, create an assumption that cancer risk is higher than it is, and suggest to a teenager or young adult that broaching the topic of familial cancer with their parent is taboo,” Moore’s group said.
“Uncertainties regarding the readiness of AYAs to receive this information appear to affect parental disclosure despite growing research suggesting that AYAs welcome and adapt well to this information,” they pointed out.
The cross-sectional, mixed-method study was conducted at four regional cancer centers. Investigators enrolled individuals 12 to 24 years of age, with a mean age of 17.6 years. Two-thirds were female, and 84.6% were non-Hispanic white.
Mother-child dyads were eligible if the mother had undergone genetic counseling and testing that included BRCA status in the past 1 to 5 years, were not currently receiving treatment for cancer, had not had a recurrence, and had disclosed their BRCA status to their AYA children. If a mother was BRCA-positive, her child must not have been tested in order to remain eligible.
Mothers were breast/ovarian cancer survivors in 76.1% of dyads and BRCA-positive in 17.3%.
Data were collected via structured telephone interviews. Investigators assessed lifetime tobacco use, lifetime alcohol use, and physical activity. They also had participants report their beliefs and knowledge regarding cancer, as well as quality of life issues such as depressive and anxious symptoms.
The study’s generalizability may be limited given the predominantly white cohort and the inclusion of only mothers with comprehensive genetic counseling.
Kenneth Tercyak reports no conflicts of interest.
The study was funded by National Cancer Institute and National Human Genome Research Institute.
Colin Moore reports no conflict of interest.