Girls from families with a history of breast cancer, or genetic mutations that increase the risk of a breast cancer diagnosis, seem to adjust just as well as other girls when it comes to general anxiety, depression and overall psychosocial adjustment, according to new research from the Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia. However, the study also found that girls from at-risk families tend to worry more about breast cancer, particularly when their mothers have the same worries. The results are published online today in the journal Pediatrics.
"There has been debate over the value of educating teens about breast cancer risk -- and about testing teens for high risk mutations, but what we don't know yet is whether warnings and worries about breast cancer do more harm than good at that age," said lead investigator Angela R. Bradbury, MD, an assistant professor of Hematology/Oncology and Medical Ethics and Health Policy at Penn Medicine. "What the new data suggest is that even with increased awareness of breast cancer among many girls, those in at-risk families show no more signs of anxiety- and depression-related behaviors overall, compared to girls with no breast cancer family history."
In the study -- the largest to date focusing on the subject of psychosocial adjustment in girls who grow up in families with a history of breast cancer -- researchers examined survey data on behaviors and other measures of psychosocial adjustment provided by 869 girls (age 6-13) from six centers in the United States and Canada, and separately their mothers. Some of the girls had first or second-degree relatives with a breast cancer history, or near-relatives with BRCA1/2 gene mutations, which on average bring a strong risk of breast cancer in or even before middle age. Other girls in the study came from families with no breast cancer history and no sign of cancer-predisposing mutations.
The girls with a family history of breast cancer or high-risk mutations did seem more worried specifically about breast cancer than the other girls, but authors suggest a healthy knowledge about risk can be a motivating factor for adopting behaviors proven to lower risk.
"Recent data suggest that breast tissue may be very susceptible to environmental exposures during adolescence. So, we may need to think about talking with girls earlier about what they are exposed to and what diet and exercise behaviors they have at that age," Bradbury said. "To do this, we need to understand how they think and feel about breast cancer. Having a little bit of worry can give someone one more reason to have a healthier diet or increase their amount of exercise."
Additional results of the study determined that daughters with higher anxiety, either in general or over breast cancer, tended to have mothers with higher anxiety--hinting that mothers could help their daughters cope by looking to their own psychological health.
"Mothers come into our clinic and ask what they can do for their daughters, to keep them healthy--I think the message here is that the best thing you can do for your daughter is to try to keep yourself and your family, both physically and psychologically," Bradbury said.
Part of the LEGACY Girls Study
The study was conducted as part of an ongoing National Cancer Institute-sponsored project, the LEGACY Girls Study, which involves multiple investigators at six clinical sites in North America. The LEGACY study's broad aim has been to help scientists better understand the behaviors, environmental exposures, and genetic factors that cause breast cancer, by tracking more than 1,000 women from girlhood through adolescence.
A breast cancer prevention strategy that starts in adolescence would mean educating girls about breast cancer risk factors, and some day possibly even screening them for BRCA1/2 and other cancer-promoting gene mutations.
"Before we start adding conversations about breast cancer in childhood or adolescence, we wanted to better understand how girls think about and respond to an awareness of breast cancer, and so we decided to look at girls in the LEGACY Study who grow up knowing that their mother or some other close relative has had breast cancer," Bradbury said.
The Penn team recently completed another study of LEGACY girls age 11-19 -- a study presented at a scientific conference last year--that came to very similar conclusions as the new results. Moving forward he team will also be able to use follow-up data from the new study to better understand how distress and awareness about breast cancer change in these women as they get older, and the impact on heath and standard risk behaviors, which may be particularly important for at-risk teens.
Bradbury is also an investigator in Penn's Basser Center for BRCA, the first comprehensive BRCA-focused center of its kind with research initiatives ranging from the basic biology of BRCA-related cancers to communication of BRCA test results within families.
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