Psychological care of women with a family history of breast cancer

In parallel to the development of clinical cancer genetics services for women with a significant history of breast cancer, there has been a growing need to identify the psychological sequelae to risk ascertainment, predictive genetic testing and preventive breast surgery. The organisation and structure of cancer genetics clinics vary widely both nationally and across Europe, as does the level of integration of psychological care: available research shows little variation in psychosocial outcomes but cultural factors affect attitudes to and uptake of predictive testing and preventive surgery. There is general agreement that risk counselling can be beneficial without inducing or increasing psychological morbidity. Health professionals in cancer genetic counselling, testing and risk management services increasingly use clinical protocols and professional guidelines.Routine psychological support is not required for the majority of women with a family history of breast cancer, but access to psychological services should be in place for women with high distress relating to the family history or those undergoing predictive testing or preventive surgery. Genetics staff should be aware of potential adverse psychological consequences of risk assessment and risk management interventions, and be adequately trained to elicit women´s concerns and involve psychosocial colleagues where appropriate

Psychological care of women with a family history of breast cancer

In parallel to the development of clinical cancer genetics services for women with a significant history of breast cancer, there has been a growing need to identify the psychological sequelae to risk ascertainment, predictive genetic testing and preventive breast surgery. The organisation and structure of cancer genetics clinics vary widely both nationally and across Europe, as does the level of integration of psychological care: available research shows little variation in psychosocial outcomes but cultural factors affect attitudes to and uptake of predictive testing and preventive surgery. There is general agreement that risk counselling can be beneficial without inducing or increasing psychological morbidity. Health professionals in cancer genetic counselling, testing and risk management services increasingly use clinical protocols and professional guidelines.Routine psychological support is not required for the majority of women with a family history of breast cancer, but access to psychological services should be in place for women with high distress relating to the family history or those undergoing predictive testing or preventive surgery. Genetics staff should be aware of potential adverse psychological consequences of risk assessment and risk management interventions, and be adequately trained to elicit women´s concerns and involve psychosocial colleagues where appropriate

Breast cancer risk perception: what do we know and understand?

Women's perceptions of breast cancer risk are largely inaccurate and are often associated with high levels of anxiety about cancer. There are interesting cultural differences that are not well researched. Genetic risk counselling significantly improves accuracy of women's perceptions of risk, but not necessarily to the correct level. Reasons for this are unclear, but may relate to personal beliefs about susceptibility and to problems or variations in risk communication. Research into the impact of demographic and psychological factors on risk perception has been inconclusive. An understanding of the process of developing a perception of risk would help to inform risk counselling strategies. This is important, because knowledge of risk is needed both for appropriate health care decision making and to reassure women who are not at increased risk

Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial.

BACKGROUND: We aimed to identify a five-fraction schedule of adjuvant radiotherapy (radiation therapy) delivered in 1 week that is non-inferior in terms of local cancer control and is as safe as an international standard 15-fraction regimen after primary surgery for early breast cancer. Here, we present 5-year results of the FAST-Forward trial. METHODS: FAST-Forward is a multicentre, phase 3, randomised, non-inferiority trial done at 97 hospitals (47 radiotherapy centres and 50 referring hospitals) in the UK. Patients aged at least 18 years with invasive carcinoma of the breast (pT1-3, pN0-1, M0) after breast conservation surgery or mastectomy were eligible. We randomly allocated patients to either 40 Gy in 15 fractions (over 3 weeks), 27 Gy in five fractions (over 1 week), or 26 Gy in five fractions (over 1 week) to the whole breast or chest wall. Allocation was not masked because of the nature of the intervention. The primary endpoint was ipsilateral breast tumour relapse; assuming a 2% 5-year incidence for 40 Gy, non-inferiority was predefined as ≤1·6% excess for five-fraction schedules (critical hazard ratio [HR] of 1·81). Normal tissue effects were assessed by clinicians, patients, and from photographs. This trial is registered at isrctn.com, ISRCTN19906132. FINDINGS: Between Nov 24, 2011, and June 19, 2014, we recruited and obtained consent from 4096 patients from 97 UK centres, of whom 1361 were assigned to the 40 Gy schedule, 1367 to the 27 Gy schedule, and 1368 to the 26 Gy schedule. At a median follow-up of 71·5 months (IQR 71·3 to 71·7), the primary endpoint event occurred in 79 patients (31 in the 40 Gy group, 27 in the 27 Gy group, and 21 in the 26 Gy group); HRs versus 40 Gy in 15 fractions were 0·86 (95% CI 0·51 to 1·44) for 27 Gy in five fractions and 0·67 (0·38 to 1·16) for 26 Gy in five fractions. 5-year incidence of ipsilateral breast tumour relapse after 40 Gy was 2·1% (1·4 to 3·1); estimated absolute differences versus 40 Gy in 15 fractions were -0·3% (-1·0 to 0·9) for 27 Gy in five fractions (probability of incorrectly accepting an inferior five-fraction schedule: p=0·0022 vs 40 Gy in 15 fractions) and -0·7% (-1·3 to 0·3) for 26 Gy in five fractions (p=0·00019 vs 40 Gy in 15 fractions). At 5 years, any moderate or marked clinician-assessed normal tissue effects in the breast or chest wall was reported for 98 of 986 (9·9%) 40 Gy patients, 155 (15·4%) of 1005 27 Gy patients, and 121 of 1020 (11·9%) 26 Gy patients. Across all clinician assessments from 1-5 years, odds ratios versus 40 Gy in 15 fractions were 1·55 (95% CI 1·32 to 1·83, p<0·0001) for 27 Gy in five fractions and 1·12 (0·94 to 1·34, p=0·20) for 26 Gy in five fractions. Patient and photographic assessments showed higher normal tissue effect risk for 27 Gy versus 40 Gy but not for 26 Gy versus 40 Gy. INTERPRETATION: 26 Gy in five fractions over 1 week is non-inferior to the standard of 40 Gy in 15 fractions over 3 weeks for local tumour control, and is as safe in terms of normal tissue effects up to 5 years for patients prescribed adjuvant local radiotherapy after primary surgery for early-stage breast cancer. FUNDING: National Institute for Health Research Health Technology Assessment Programme

Psychological care of women cith a family history of breast cancer

In parallel to the development of clinical cancer genetics services for women with a significant history of breast cancer, there has been a growing need to identify the psychological sequelae to risk ascertainment, predictive genetic testing and preventive breast surgery. The organisation and structure of cancer genetics clinics vary widely both nationally and across Europe, as does the level of integration of psychological care: available research shows little variation in psychosocial outcomes but cultural factors affect attitudes to and uptake of predictive testing and preventive surgery. There is general agreement that risk counselling can be beneficial without inducing or increasing psychological morbidity. Health professionals in cancer genetic counselling, testing and risk management services increasingly use clinical protocols and professional guidelines.Routine psychological support is not required for the majority of women with a family history of breast cancer, but access to psychological services should be in place for women with high distress relating to the family history or those undergoing predictive testing or preventive surgery. Genetics staff should be aware of potential adverse psychological consequences of risk assessment and risk management interventions, and be adequately trained to elicit women¿s concerns and involve psychosocial colleagues where appropriate.De forma paralela al desarrollo de los aspectos clínicos del asesoramiento en mujeres con historia familiar de cáncer de mama, ha habido una creciente necesidad de identificar las secuelas psicológicas de averiguar el riesgo, el examen genético y la cirugía profiláctica mamaria. La organización y la estructura de las unidades de consejo genético varían ampliamente dentro del ámbito nacional y alrededor de Europa, así como la integración en ellas de la atención psicológica. La investigación disponible muestra poca variación en resultados psicosociales pero factores culturales afectan a las actitudes, la realización del test genético y la cirugía preventiva. Existe un acuerdo general en que el consejo acerca del riesgo puede ser beneficioso, sin que induzca o aumente la morbilidad psicológica. Los profesionales de la Salud de los servicios de manejo de riesgo y test en consejo genético oncológico usan cada vez más protocolos clínicos y pautas profesionales. El apoyo psicológico habitual no es necesario para la mayoría de mujeres con una historia familiar de cáncer de mama, pero el acceso a los servicios psicológicos debe estar disponible para aquellas mujeres que presenten un malestar elevado debido a su historia familiar, o para aquellas que van a llevar a cabo un test genético o cirugía preventiva. El personal de la unidad de consejo genético debe ser consciente de las consecuencias psicológicas adversas potenciales de la evaluación del riesgo y de las intervenciones para manejar el riesgo, y estar adecuadamente entrenado para elicitar las preocupaciones de las mujeres e implicar a los colegas psicosociales cuando sea apropiado