Psychological Aspects of High Risk of Breast Cancer

Abstract

In this chapter, we present the spectrum of psychological issues related to familiar/genetic predisposition to breast cancer (BC) in order to help the definition of communication strategies with the woman and members of her family and also to consider the possibility that psychotherapy be necessary in particular conditions, as it may be in the case of emotional crises. From this viewpoint, we discuss the different burdens of communicating the result of a genetic test in two scenarios of search for underlying mutations either in a family with a strong history of BC and/or ovarian cancer or in a woman belonging to a family in which the presence of a deleterious mutation has already been identified. We illustrate the possible reasons for refusing genetic testing and reactions to the test result, including those to an uncertain result: being informed to be a BRCA mutation carrier is an answer that creates a number of further questions. The medical team has to understand what the woman thinks and wants, and what has to be taken into account when communicating the risk, knowing that a positive test may prompt thoughts like “I’m no longer the same woman I was before the genetic test.” The woman’s age and personality, her previous or current cancer experiences, her coping style, and also the physicians’ psychological profile should be considered. Protocols for conducting interviews with women as CLASS and SPIKES are proposed: setting and listening skills, patient perception of situation, invitation from patient to give information, knowledge giving medical fact, explore emotion and empathize as patient responds, strategy and summery, and others are proposed. They provide useful suggestions regarding a number of issues, from the physical context of the meeting to its conclusion, underlying the relevance of the key message “before you tell, ask.” Finally, six true stories of patients are presented.