Psychosocial Adjustment and Perceived Risk Among Adolescent Girls From Families With BRCA1/2 or Breast Cancer History

Abstract

Purpose: To evaluate the impact of breast cancer family history and maternal BRCA1/2 mutation on the psychosocial adjustment and perceived risk in girls age 11 to 19 years old.

Materials and methods: Girls age 11 to 19 years old with one or more relatives with breast cancer or a familial BRCA1/2 mutation (breast cancer family history [BCFH] positive, n = 208; n = 69 with BRCA1/2-positive mother), peers (BCFH negative, n = 112), and their mothers completed assessments of psychosocial adjustment, breast cancer-specific distress, and perceived risk of breast cancer.

Results: General psychosocial adjustment did not differ significantly between BCFH-positive and BCFH-negative girls, either by self-report or mother report, except for higher self-esteem among BCFH-positive girls (P = .01). BCFH-positive girls had higher breast cancer-specific distress than BCFH-negative girls (P < .001), but girls from BRCA1/2-positive families did not differ from other BCFH-positive peers. BCFH-positive girls were more likely to report themselves at increased self-risk for breast cancer in adulthood than BCFH-negative peers (74% v 33%, respectively; P ≤ .001). Girls from BRCA1/2-positive families were more likely than other BCFH-positive and BCFH-negative peers to report themselves at increased risk (P < .001). In all groups, perceived risk of breast cancer was associated with older age. Higher breast cancer-specific distress among adolescent girls was associated with higher self-perceived risk of breast cancer and higher maternal breast cancer-specific distress.

Conclusion: Adolescent girls from BRCA1/2-positive and breast cancer families have higher self-esteem and do not have poorer psychosocial adjustment than peers. However, they do experience greater breast cancer-specific distress and perceived risk of breast cancer, particularly among older girls. Understanding the impact is important to optimize responses to growing up in families at familial and genetic risk for breast cancer, particularly given the debate over the genetic testing of children for cancer susceptibility in adulthood.

Conflict of interest statement

Authors’ disclosures of potential conflicts of interest are found in the article online at www.jco.org. Author contributions are found at the end of this article.

© 2016 by American Society of Clinical Oncology.

Figures

Fig 1.

(A) Anxiety by breast cancer family history (BCFH) group and age of girls. The youngest BCFH-positive girls had lower anxiety than BCFH-negative girls (P < .034 comparing two BCFH-positive subgroups to BCFH-negative subgroup). Anxiety was lower among older BCFH-negative girls (P = .002), but there were no significant differences in anxiety by age group among either BCFH-positive subgroup. The difference in the relationship between age and anxiety between BCFH-positive girls (both subgroups) and BCFH-negative girls was statistically significant (P < .009 for interaction terms). (B) Percentage of girls who believe they are at higher risk for breast cancer than peers by age and breast cancer family history (BCFH group). Older age was significantly associated with higher perceived risk (P < .01). Compared with 11- to 13-year-old girls, 14- to 16-year old girls (odds ratio, 2.18; 95% CI, 1.26 to 3.79) and 17- to 19-year-old girls (odds ratio, 4.21; 95% CI, 2.28 to 7.77) were more likely to report themselves at increased risk on a verbal scale. There were significant differences between BCFH-positive and BCFH-negative groups at the youngest ages (P < .01 comparing BCFH-negative with each of the three other risk categories) but no statistically significant differences among the three BCFH-positive groups. The relationship of age with perceived risk was not moderated by the four risk groups (P > .2 for interaction terms).