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Genetic tests deliver better cancer risk management

Friday 11 January, 2008

Fifty percent of women found not to be at high risk for cancer continue to over-use mammography even three years after they learn the good news about their genetic test result, new research shows.

In addition, about ten percent undertake unnecessary ovarian screening. Women with a family history of ovarian cancer are the most likely to continue screening for ovarian cancer even after a negative genetic test result reveals that they are at low risk for the disease.

The research paper  "Cancer Risk Management Practices of Noncarriers Within BRCA1/2 Mutation-Positive Families in the Kathleen Cuningham Foundation Consortium for Research Into Familial Breast Cancer" was published in the Journal of Clinical Oncology on Thursday 10 January 2008.

It was authored by The Cancer Council Victoria, Colebatch Clinical Research Fellow, and Peter MacCallum Cancer Centre Medical Oncologist, Associate Professor of Medicine, Kelly-Anne Phillips MB;BS, MD, FRACP.

"The findings have immediate implications for clinical practice in Australia," Associate Professor Kelly-Anne Phillips said.

Most Australian and New Zealand Family Cancer Clinics do not have a policy of following up women who receive an informative negative test result and who are therefore not at high risk for cancer. However the negative test result and the fact that the woman can revert to just following population screening guidelines is communicated to the woman and her GP.

"This study suggests that perhaps a follow-up call from the Family Cancer Clinic some time after result disclosure might be useful to ensure that women have fully understood the good news of their genetic test result for their cancer risk, and that they have reduced their screening behaviour appropriately," she said. "The information is also important for GPs who are the main health care providers for such women."

Referral for further psychosocial interventions might be appropriate for those who have not reduced their screening appropriately, because excessive anxiety about cancer might be driving such women to have unnecessary tests.

"Overscreening in this population of women is wasteful and may be detrimental for women, particularly due to false positive screening results," Ms Phillips said.

The Cancer Council Victoria, Director, Professor David Hill said  this study reinforced how important it was to regularly remind women who test negative for a family mutation to return to normal screening intervals.

Women in this study were participants in the Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer (kConFab) and came from families where there was a known gene mutation. The results are not relevant to women in families where no gene mutation has been identified. The Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer (kConFab) is a cohort of more than 1,100 multiple-case families with breast cancer (BC), consisting of 9,000 individual participants from Australia and NewZealand. Families are recruited after an initial family member attends a consultation in one of 16 Family Cancer Clinics (FCCs).

Australian guidelines were used to determine the recommended screening practices for the Australian population.

The Council Victoria awarded the inaugural Colebatch Clinical Research Fellowship to Associate Professor Kelly-Anne Phillips at the Peter MacCallum Cancer Centre. This fellowship was established in the memory of Dr John Colebatch (1909-2005). Dr Colebatch pioneered work in the field of paediatric haematology and clinical trial practice in Australia.

The Cancer Council Victoria supports cancer researchers working in Victorian universities, hospitals and medical research institutes and in 2006 over $3.4 million was provided to this external research.