This project will evaluate a BRCA1 predisposition testing program modeled closely on the Huntington Disease paradigm for members of previously identified families in which cancer susceptibility has been linked to BRCA1 with posterior probability >90%. Although we anticipate the cloning of BRCA1 before or during the project, we will restrict participants to members of linked families because of the limitations of available risk information which has been derived from linked families only (1,2).

In order to gather important data on the psychosocial and behavioral aspects and sequelae of genetic counseling protocols for hereditary cancer, this investigation will study a consecutive series of approximately 1,000 index cases of Colorectal Cancer (CRC), identified at the UTMDACC, who will be offered molecular testing for hereditary nonpolyposis colon cancer (HNPCC) and participation in the study. From this series, approximately 65 carriers of HNPCC mutations, and 225 first degree relatives (FDRs) of those index cases will be enrolled.

This study will examine the efficacy of brief, nurse-delivered counseling intervention, Stress Inoculation Therapy (SIT), on the enhancement of psychological adjustment to the receipt of genetic cancer risk information, on the improvement of comprehension of genetic risk, and on the promotion of adherence to follow-up prevention recommendations. In addition, we will assess how coping style disposition moderates the effects of the intervention. Outcome measures will include both general psychological adjustment as well as risk-specific distress.

The objective of the proposed study is to determine whether computer-based education is as effective as practitioner-based education for increasing understanding of genetic testing for breast cancer. The primary study hypothesis is that comprehension scores on a test of immediate recall of information about genetic screening for breast cancer will be as high for patients informed by computer-based education as by practitioner-based education.

This project builds on an exploratory study of psychosocial and ethnocultural factors related to intentions to obtain genetic testing for heritable colon cancer, and a pilot study of genetic counseling for intermediate-risk colorectal cancer (CRC) family members.

This application proposes three interrelated phases of research. The first phase will extend the prospective descriptive study of psychosocial aspects of molecular testing for HNPCC in colorectal cancer (CRC) cases, the first degree relatives (FDRs) of CRC cases who are found to be carriers of an HNPCC mutation, and spouses/partners (S/Ps) of the FDRs. The second phase will study the psychosocial issues related to participation in a phase II randomized, controlled chemoprevention trial for HNPCC involving adherence to a Cox II inhibitor and periodic check-ups over a 1 year period.

The main goal of this proposal is to develop appropriate comprehensive counseling guidelines for predictive colon cancer gene testing by assessing perceptions and attitudes toward the gene tests, including their social and psychological determinants, and assessing the impact of the test on at-risk persons.

The overall goals of this project are to develop relevant, evidence-based clinical practice guidelines for genetic testing for BRCA1/2 through a consensus process involving community care practitioners and oncologists, and to evaluate the effect of the guidelines on clinical practice. The project will convene a Guidelines Group. Educational materials will be developed based on the guidelines, to aid clinicians in pedigree assessment, interpretation of the risks and benefits of BRCA1/2 testing, and use of cancer surveillance or other individuals with increased cancer risk.

This study will evaluate different methods of counseling for women with a family history of breast cancer. The study will take advantage of an existing breast cancer cohort to identify family members who are candidates for counseling concerning their risk for breast cancer. Subjects from these high-risk families will be offered genetic counseling and DNA-based linkage studies to test for the presence of a BRCA1 mutation accounting for cancer risk within the family. A total of 400 other subjects will be randomized to one of 3 counseling interventions or to a comparison group.

This prospective, longitudinal study will examine decision-making about pre-surgery BRCA1/2 testing and the medical, psychosocial, and economic outcomes of testing among newly-diagnosed breast cancer patients who are at high risk for having a BRCA1/2 mutation. The theoretical framework for this investigation is derived from Expected Utility Theory.