Prevention and genetic testing for breast cancer: variations in medical decisions

• Published in: Social science & medicine (1982) 2004-03, Vol.58 (6), p.1085-1096
• Main Authors: Bouchard, Louise, Blancquaert, I, Eisinger, F, Foulkes, W.D, Evans, G, Sobol, H, Julian-Reynier, C
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Breast Cancer; Breast cancer Genetic testing Medical decision-making; Breast Neoplasms - genetics; Breast Neoplasms - prevention & control; Breast Self-Examination; Cancer; Chemoprevention; Crossnational studies; Decision Making; Doctors; England; Female; France; Genes, BRCA1; Genes, BRCA2; Genetic Counseling; Genetic Predisposition to Disease; Genetic screening; Genetic Testing; Genetics; Gynecology. Andrology. Obstetrics; Health care; Health services; Human genetics; Humans; Mammary gland diseases; Mammography; Mastectomy; Medical Decision Making; Medical sciences; Middle Aged; Montreal, Quebec; Ovarian Neoplasms - genetics; Ovarian Neoplasms - prevention & control; Ovarian Neoplasms - therapy; Ovariectomy; Physician-Patient Relations; Prevention; Preventive medicine; Primary Prevention - methods; Public health; Quebec; Risk Assessment; Risk Factors; Surveys and Questionnaires; Tumors; United Kingdom; Women's health
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/S0277-9536(03)00263-6

The discovery linking the genes BRCA1&2 to familial breast cancer played an important role in the clinical practice of geneticists and physicians. The availability of genetic tests for BRCA gene mutations prompted cancer geneticists to give information about genetic risk and to assess many women with a personal or family history of breast or ovarian cancer to inform them of preventive measures. These consist mainly of breast self-examination, mammography screening, chemoprevention and prophylactic surgery (mastectomy, oophorectomy). This paper examines clinical practices related to hereditary breast cancer testing and introduces a number of results from a survey carried out, between 1996 and 1998, in three clinics located in Montreal (Quebec, Canada), Marseilles (France) and Manchester (Great Britain). Results show substantial differences in the way cancer geneticists deal with environmental risk factors, breast and ovarian cancer testing, and chemoprevention and prophylactic surgery. Differences across cities persist in the multivariate analysis, suggesting that attitudes towards preventive measures may be partially explained by cultural factors. Different dimensions of culture are discussed including the social representation of health and risk, the interpretation of scientific evidence and the role of innovation leadership.