Genetics of Colorectal Cancer (PDQ®): Genetics - Health Professional Information [NCI] - Psychosocial Issues in Hereditary Colon Cancer Syndromes
Psychosocial research in cancer genetic counseling and testing focuses on the interest in testing among populations at varying levels of disease risk, psychological outcomes, interpersonal and familial effects, and cultural and community reactions. The research also identifies behavioral factors that encourage or impede surveillance and other health behaviors. Data resulting from psychosocial research can guide clinician interactions with patients and may include:
- Decision-making about risk-reduction interventions, risk assessment, and genetic testing.
- Evaluation of psychosocial interventions to reduce distress and/or other negative sequelae related to risk notification of genetic testing.
- Resolution of ethical concerns.
This section of the summary will focus on psychosocial aspects of genetic counseling and testing for Lynch syndrome (LS), familial adenomatous polyposis (FAP), and Peutz-Jeghers syndrome (PJS), including issues surrounding medical screening, risk-reducing surgery, and chemoprevention for these syndromes.
Participation in Genetic Counseling and Testing for Hereditary CRC
There are an increasing number of studies examining the actual uptake of genetic counseling and testing for LS (see Table 16). Studies have included colorectal cancer (CRC) patients and unaffected, high-risk family members, recruited mainly from clinical settings and familial colon cancer registries. Most studies actively recruited participants for free genetic counseling and testing as part of research protocols.[1,2,3,4,5,6,7,8] Participation or uptake was defined at various points in the process, including genetic counseling before testing; provision of a blood sample for testing; and genetic counseling for disclosure of test results.
Table 16. Summary of Prospective Studies Evaluating Participation in Genetic Counseling and Testing for Hereditary Colorectal Cancer (CRC)a,b,c
|Syndrome||Study Population||Nd||GC and GT Participatione|
|FAP = familial adenomatous polyposis; FDR = first-degree relative; GC = genetic counseling; GT = genetic testing; HCCR = hereditary colon cancer registry; LS = Lynch syndrome.|
|a All studies used a prospective, observational design with the exception of one randomized trial evaluating two recruitment methods.|
|b All studies offered free GC and GT, with the exception of one study.|
|c All studies were conducted in the United States, with the exception of one Finnish study and one German study.[5,8]|
|d Indicates number of participants older than 18 years, unless otherwise specified.|
|e GC = participated in pretest or posttest genetic counseling; GT = participated in genetic testing and received results; GT (blood) = only provided blood sample for genetic testing.|
|f Affected = current or previous CRC diagnosis; Unaffected = no previous diagnosis of CRC.|
|LS||Affectedf and unaffectedf members of four extended families from HCCR with a known LS mutation inkindred ||219||59% pretest GC; posttest GC, GT|
|LS||Unaffected FDRs of CRC patients from HCCR||505||21% pretest GC; 26% pending pretest GC; 15% GT (blood); 4% pending GT (blood)|
|LS||Affected and unaffected members of four extended families from HCCR with a known LS mutation in kindred||208||47% pretest GC; 43% posttest GC, GT|
|LS||CRC patients from an oncology clinic and HCCR||510||89% GT (blood)|
|LS||Unaffected members of 36 Finnish families with a known LS mutation in kindred||446||78% pretest GC; 75% posttest GC, GT|
|LS and familial CRC||Affected and unaffected persons who underwent GC in a high-risk colon cancer clinic||57 (LS); 91 (familial CRC)||LS: 14% posttest GC, GT|
|APCI130K: 85% posttest GC, GT|
|LS||CRC patients diagnosed age <60 y with affected FDR orsecond-degree relativerecruited through physicians||101||47% pretest GC; 36% posttest GC, GT|
|LS||Unaffected FDRs of known LS mutation carriers||111||51% pretest GC; 50% posttest GC, GT|
|LS||CRC patients from HCCR, relatives, and spouses||140||26% pretest GC|
|FAP||Unaffected persons from HCCR age >5 y with FAP-affected parent and knownAPCmutation in family||57 adults; 38 minors||87% pretest GC; posttest GC, GT (82% adults; 95% minors)|