The recent cloning of a breast-ovarian cancer susceptibility gene (BRCA1), and determination of the locus of a related gene (BRCA2), offers potential for clinical genetic testing for breast cancer susceptibility. This study examined interest in and expectations about an impending genetic test among first-degree relatives (FDRs) of breast cancer patients. One hundred five females completed two structured telephone interviews to assess demographics, breast cancer risk factors, psychological factors, and attitudes about genetic testing for breast cancer susceptibility. Overall, 91% of FDRs said that they would want to be tested, 4% said they would not, and 5% were uncertain. The most commonly cited reasons for wanting genetic testing were to learn about one's children's risk, to increase use of cancer screening tests, and to take better care of oneself. Women with less formal education were motivated by childbearing decisions and future planning to a greater degree than were women with education beyond high school. Most women anticipated a negative psychological impact of positive test results, involving increased anxiety (83%), depression (80%), and impaired quality of life (46%). In addition, 72% of women indicated that they would still worry if they tested negative. In multivariate regression analysis, level of baseline depression was the strongest predictor of an anticipated negative impact of genetic testing (Beta = .15; P, .0001). These results suggest that the demand for genetic testing for breast cancer susceptibility may be great, even among women who are not likely to have predisposing mutations.(ABSTRACT TRUNCATED AT 250 WORDS)

InrmdwtonAlthough regular This study assessed whether a brief reminder (step 2) was more effective than no reminder and compared the relative impact of three different interventionstelephone counseling, a second reminder letter, and a letter suggesting a preventive office visit-in motivating still nonadherent women to get mammograms (step 3). Methods ProceduresFor the step 2 and step 3 intervention evaluations, two mutually exclusive samples were used. So that both interventions could be completed within the same time period, thereby minimizing effects of secular events, women for the step 3 evaluation were selected first because of step 3's longer follow-up period (185 daysvs 95 for step 2).Step were eligible for evaluation; of these, 21%could not be contacted during the allotted time interval, 19% had already had their mammograms, and 1% refused.Step 3 evaluation. An annual packet (step 1) was mailed to 2123 women who constituted the initial sample and a step 2 reminder was sent to women without a mammogram report. Ninety days after the packet mailing, we attempted to survey 1265 women without a mammogram report to verify their mammography status. Of these, 25% could not be contacted during the 1-week eligibility evaluation window, 25% had already had mammograms, and 2% refused. Thus, 598 eligible women were randomized to one of three interventions: (1)

Background. This study evaluated the perceptions of patients with breast cancer of their medical interactions with providers. The determinants and psychological consequences of communication problems also were examined. Methods. Ninety‐seven patients with Stage I or II breast cancer completed a set of validated questionnaires before initiating postoperative therapy. Data on psychological distress were collected at baseline and 3‐month follow‐up, and multivariate models were fit to explain the relationship between pretreatment communication problems and subsequent psychological distress. Data on clinical variables were abstracted from medical records. Results. A substantial proportion of patients (84%) reported difficulties communicating with the medical team. Communication problems were more common among patients who were less optimistic about their disease and had less assertive coping styles. Patient‐reported communication problems were associated with increased anxiety, depression, anger, and confusion at the 3‐month follow‐up. The association between communication problems and mood disturbance remained significant, although small, after adjusting for baseline mood disturbance, demographic, clinical, and coping style variables. Conclusion. Interventions that enhance communication between patients with breast cancer and their providers may improve patients' psychological adjustment to treatment. Conversely, interventions that lower distress and modify coping style may enhance communication.

Background. This study evaluated the perceptions of patients with breast cancer of their medical interactions with providers. The determinants and psychological consequences of communication problems also were examined.Methods. Ninety-seven patients with Stage I or I1 breast cancer completed a set of validated questionnaires before initiating postoperative therapy. Data on psychological distress were collected at baseline and 3-month follow-up, and multivariate models were fit to explain the relationship between pretreatment communication problems and subsequent psychological distress. Data on clinical variables were abstracted from medical records.Results. A substantial proportion of patients (84%) reported difficulties communicating with the medical team. Communication problems were more common among patients who were less optimistic about their disease and had less assertive coping styles. Patient-reported communication problems were associated with increased anxiety, depression, anger, and confusion at the %month follow-up. The association between communication problems and mood disturbance remained significant, although small, after adjusting for baseline mood disturbance, demographic, clinical, and coping style variables.Conclusion. Interventions that enhance communication between patients with breast cancer and their pro-From the

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