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BMC Cancer. 2012; 12: 320.
Published online Jul 28, 2012. doi:  10.1186/1471-2407-12-320
PMCID: PMC3472271
How should we discuss genetic testing with women newly diagnosed with breast cancer? Design and implementation of a randomized controlled trial of two models of delivering education about treatment-focused genetic testing to younger women newly diagnosed with breast cancer
Kaaren J Watts,corresponding author1,2 Bettina Meiser,1,2 Gillian Mitchell,3 Judy Kirk,4,5 Christobel Saunders,6 Michelle Peate,1,2 Jessica Duffy,1 Patrick J Kelly,7 Margaret Gleeson,1,8 Kristine Barlow-Stewart,9 Belinda Rahman,1 Michael Friedlander,1,2 and Kathy Tucker1, for the TFGT Collaborative Group
1Department of Medical Oncology, Prince of Wales Hospital, High Street, Randwick, NSW, 2031, Australia
2Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Kensington, NSW, 2052, Australia
3Peter MacCallum Cancer Centre, Familial Cancer Service, Locked Bag 1, A'Beckett Street, East Melbourne, VIC, 8006, Australia
4Familial Cancer Service, Westmead Hospital, Hawkesbury Road, Westmead, NSW, 2145, Australia
5Westmead Millennium Institute for Medical Research at the University of Sydney, PO Box 412, Westmead, NSW, 2145, Australia
6Department of Surgery, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
7School of Public Health, The University of Sydney, Edward Ford Building, Sydney, NSW, 2006, Australia
8Hunter Family Cancer Service, PO Box 84, Waratah, NSW, 2298, Australia
9Centre for Genetics Education, PO Box 317, St Leonards, NSW, 1590, Australia
corresponding authorCorresponding author.
Kaaren J Watts: k.watts/at/unsw.edu.au; Bettina Meiser: b.meiser/at/unsw.edu.au; Gillian Mitchell: gillian.mitchell/at/petermac.org; Judy Kirk: judy.kirk/at/sydney.edu.au; Christobel Saunders: christobel.saunders/at/uwa.edu.au; Michelle Peate: michelle.peate/at/sydney.edu.au; Jessica Duffy: jessica.duffy/at/sesiahs.health.nsw.gov.au; Patrick J Kelly: pkelly/at/health.usyd.edu.au; Margaret Gleeson: Margaret.Gleeson/at/hnehealth.nsw.gov.au; Kristine Barlow-Stewart: kristine.barlowstewart/at/sydney.edu.au; Belinda Rahman: belinda.rahman/at/unsw.edu.au; Michael Friedlander: m.friedlander/at/unsw.edu.au; Kathy Tucker: kathy.tucker/at/sesiahs.health.nsw.gov.au
Received July 4, 2012; Accepted July 13, 2012.
Abstract
Background
Germline BRCA1 and BRCA2 mutation testing offered shortly after a breast cancer diagnosis to inform women’s treatment choices - treatment-focused genetic testing ‘TFGT’ - has entered clinical practice in specialist centers and is likely to be soon commonplace in acute breast cancer management, especially for younger women. Yet the optimal way to deliver information about TFGT to younger women newly diagnosed with breast cancer is not known, particularly for those who were not suspected of having a hereditary breast cancer syndrome prior to their cancer diagnosis. Also, little is known about the behavioral and psychosocial impact or cost effectiveness of educating patients about TFGT. This trial aims to examine the impact and efficiency of two models of educating younger women newly diagnosed with breast cancer about genetic testing in order to provide evidence for a safe and effective future clinical pathway for this service.
Design/methods
In this non-inferiority randomized controlled trial, 140 women newly diagnosed with breast cancer (aged less than 50 years) are being recruited from nine cancer centers in Australia. Eligible women with either a significant family history of breast and/or ovarian cancer or with other high risk features suggestive of a mutation detection rate of > 10% are invited by their surgeon prior to mastectomy or radiotherapy. After completing the first questionnaire, participants are randomized to receive either: (a) an educational pamphlet about genetic testing (intervention) or (b) a genetic counseling appointment at a family cancer center (standard care). Each participant is offered genetic testing for germline BRCA mutations. Decision-related and psychosocial outcomes are assessed over 12 months and include decisional conflict (primary outcome);uptake of bilateral mastectomy and/or risk-reducing salpingo-oophorectomy; cancer-specific- and general distress; family involvement in decision making; and decision regret. A process-oriented retrospective online survey will examine health professionals’ attitudes toward TFGT; a health economic analysis will determine the cost effectiveness of the intervention.
Discussion
This trial will provide crucial information about the impact, efficiency and cost effectiveness of an educational pamphlet designed to inform younger women newly diagnosed with breast cancer about genetic testing. Issues regarding implementation of the trial are discussed.
Trial registration
The study is registered with the Australian and New Zealand Clinical Trials Group (Registration no: ACTRN12610000502033)
Keywords: Breast cancer, Genetic testing, BRCA1, BRCA2, Treatment, Clinical practice
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