Ackerman Marra G, Shapiro Peter A, Coe Austin, Trivedi Meghna S, Crew Katherine D
New York University Langone Medical Center, New York City, New York.
Columbia University Medical Center, New York City, New York.
Breast J. 2017 Sep;23(5):519-524. doi: 10.1111/tbj.12791. Epub 2017 Mar 21.
We evaluated whether mental illness is a barrier to genetic counseling for hereditary breast and ovarian cancer (HBOC) in multiethnic breast cancer patients. We conducted a retrospective analysis of 308 women with newly diagnosed breast cancer and eligible for HBOC genetic testing seen in the breast clinic of an academic, urban medical center from 2007 to 2015. Uptake of genetic services and history of mental health disorder (MHD), defined as a psychiatric diagnosis or treatment with an antidepressant, mood stabilizer, anxiolytic, or antipsychotic medication, were ascertained by medical chart review. The mean age at breast cancer diagnosis was 56 years, with 44% non-Hispanic whites, 37% Hispanics, and 15% non-Hispanic blacks. Ninety-nine (32%) women met study criteria for MHD, 73% had a genetics referral, 57% had genetic counseling, and 54% completed BRCA testing. Uptake of genetic counseling services did not differ by race/ethnicity or presence of MHD. In multivariable analysis, younger age at diagnosis, Ashkenazi Jewish heritage, and family history of breast cancer were associated with HBOC genetic counseling. A relatively high proportion of breast cancer patients eligible for HBOC genetic testing were referred to a genetic counselor and referral status did not vary by MHD or race/ethnicity.
我们评估了精神疾病是否会成为多种族乳腺癌患者进行遗传性乳腺癌和卵巢癌（HBOC）遗传咨询的障碍。我们对2007年至2015年期间在一家学术性城市医疗中心的乳腺诊所就诊的308名新诊断为乳腺癌且符合HBOC基因检测条件的女性进行了回顾性分析。通过查阅病历确定了遗传服务的接受情况以及精神健康障碍（MHD）史，MHD定义为有精神科诊断或使用抗抑郁药、心境稳定剂、抗焦虑药或抗精神病药进行治疗。乳腺癌诊断时的平均年龄为56岁，其中44%为非西班牙裔白人，37%为西班牙裔，15%为非西班牙裔黑人。99名（32%）女性符合MHD的研究标准，73%的人有遗传学转诊，57%的人接受了遗传咨询，54%的人完成了BRCA检测。遗传咨询服务的接受情况在种族/民族或是否存在MHD方面没有差异。在多变量分析中，诊断时年龄较小、阿什肯纳兹犹太血统以及乳腺癌家族史与HBOC遗传咨询有关。有资格进行HBOC基因检测的乳腺癌患者中，有相对较高比例的人被转诊给了遗传咨询师，转诊状态在MHD或种族/民族方面没有差异。
