Sussner Katarina M, Thompson Hayley S, Jandorf Lina, Edwards Tiffany A, Forman Andrea, Brown Karen, Kapil-Pair Nidhi, Bovbjerg Dana H, Schwartz Marc D, Valdimarsdottir Heiddis B
Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY 10029, USA.
Psychooncology. 2009 Sep;18(9):945-55. doi: 10.1002/pon.1492.
Rising health disparities are increasingly evident in relation to use of genetic services (including genetic counseling and testing) for breast cancer risk, with women of African descent less likely to use genetic services compared with Whites. Meanwhile, little is known regarding potential within-group acculturation and psychological differences underlying perceived barriers to genetic testing among women of African descent.
Hypothesized contributions of acculturation factors and breast cancer-specific distress to perceived barriers to genetic testing were examined with a statistical analysis of baseline data from 146 women of African descent (56% US born and 44% foreign born) meeting genetic breast cancer risk criteria and participating in a larger longitudinal study that included the opportunity for free genetic counseling and testing. Perceived barriers assessed included: (1) anticipation of negative emotional reactions, (2) stigma, (3) confidentiality concerns, (4) family-related worry, and (5) family-related guilt associated with genetic testing.
In multivariate analyses, being foreign born was a significant predictor of anticipated negative emotional reactions about genetic testing (beta=0.26; SE=0.11; p=0.01). Breast cancer-specific distress scores (avoidance symptoms) were positively related to anticipated negative emotional reactions (beta=0.02; SE=0.005; p=<0.0001), confidentiality concerns (beta=0.02; SE=0.01; p=0.02), and family-related guilt (beta=0.02; SE=0.01; p=0.0009) associated with genetic testing.
Results suggest an influence of acculturation and breast cancer-specific distress on perceived barriers to genetic testing among women of African descent. The potential utility of culturally tailored genetic counseling services taking into account such influences and addressing emotional and psychological concerns of women considering genetic testing for breast cancer should be investigated.
在利用基因服务（包括遗传咨询和检测）评估乳腺癌风险方面，日益凸显的健康差异愈发明显，非洲裔女性相比白人使用基因服务的可能性更低。与此同时，对于非洲裔女性中潜在的文化适应以及基因检测认知障碍背后的心理差异，我们知之甚少。
通过对146名符合遗传性乳腺癌风险标准且参与一项更大规模纵向研究（该研究提供免费遗传咨询和检测机会）的非洲裔女性（56%在美国出生，44%在国外出生）的基线数据进行统计分析，检验文化适应因素和乳腺癌特异性困扰对基因检测认知障碍的假设影响。评估的认知障碍包括：（1）预期负面情绪反应，（2）耻辱感，（3）保密性担忧，（4）与家庭相关的担忧，以及（5）与基因检测相关的家庭内疚感。
在多变量分析中，国外出生是基因检测预期负面情绪反应的显著预测因素（β = 0.26；标准误 = 0.11；p = 0.01）。乳腺癌特异性困扰得分（回避症状）与基因检测预期负面情绪反应（β = 0.02；标准误 = 0.005；p < 0.0001）、保密性担忧（β = 0.02；标准误 = 0.01；p = 0.02）以及与基因检测相关的家庭内疚感（β = 0.02；标准误 = 0.01；p = 0.0009）呈正相关。
结果表明文化适应和乳腺癌特异性困扰对非洲裔女性基因检测认知障碍有影响。应研究考虑此类影响并解决考虑乳腺癌基因检测女性的情绪和心理问题的文化定制遗传咨询服务的潜在效用。
