Genetic counselling for breast cancer gene does not reduce anxiety or distress

Researchers have found that counselling before or after taking a genetic test to assess the risk of developing ovarian or breast cancer does not reduce distress, anxiety or depression.

Dropping the requirement for pre-test counselling increased the number of people who completed the test, the study showed. The research, published in JAMA Oncology and led by scientists at the University of Washington Medicine, compared the rates of distress and anxiety in women who were offered genetic counselling either before, after, before and after their tests or not at all.

'The accepted idea was that you needed genetic counselling before taking a genetic test,' said Dr Elizabeth Swisher, a gynaecologic oncologist at University of Washington school of Medicine. 'But we're finding out that many of these protocols actually represent barriers to testing.'

The study was part of MAGENTA (Making Genetic Testing Accessible) – a three-year project that aimed to assess the impact of eliminating mandatory pre-test counselling for everyone and post-test counselling for everyone with a negative test result.

The randomised clinical trial included 3839 women over the age of 30 and living in the USA. The majority were white, English speaking and college educated. Of these, 3125 participants had a personal or family history or breast or ovarian cancer and 714 reported one biological relative with a pathogenic variant in an actionable cancer susceptibility gene. The genetic testing was conducted via home-delivered saliva kits and the participants were either offered no mandatory genetic counselling, mandatory pre-test counselling, mandatory post-test counselling or mandatory pre- and post-test counselling. Participants then rated their levels of distress and anxiety before the test, as well as three and 12 months after.

Whether women received no counselling, or counselling before, after, or before and after their test also did not affect their level of distress, depression, anxiety or decisional regret at three or 12 months. However, requiring participants to complete genetic counselling pre- and post-test and pre-test counselling only, reduced the number of people that actually completed their genetic testing.

Completion rates for groups that required both pre- and post-test counselling and pre-test counselling only were 69.2 percent and 66.4 percent, respectively. The rate of people completing the test increased to 76.9 percent for no mandatory pre- or post-test counselling and 78.6 percent for mandatory post-test counselling only.

However, in an accompanying editorial Huma Rana and Judy Garber, both from the Dana-Farber Cancer Institute stress that 'the MAGENTA trial results should not be interpreted by clinicians or insurers as demonstrating the lack of value of genetic counselling, especially post-test, in ways not evaluable in the MAGENTA trial.'