The aim of this study was to document how breast cancer patients perceive their prognosis and a tailored treatment based on tumour gene expression analysis, and to identify the features of this approach that may impact its clinical application. In-depth interviews were conducted at three French cancer centres with 37 women (35-69 years of age) with node-positive breast cancer undergoing an adjuvant chemotherapy regimen defined on the basis of the genomic signature predicting the outcome after chemotherapy. Several concerns were identified. First, some misconceptions about these methods were identified due to semantic confusions between the terms 'genomic' and 'genetic', which generated anxiety and uncertainty about the future. Second, the 'not done' and 'not interpretable' signatures were misinterpreted by the women and associated with highly negative connotations. However, the use of tumour genomic analysis to adapt the treatment to each patient received most of the patients' approval because it was perceived as an approach facilitating personalised medicine. In conclusion, improving the quality of provider/patient communications should enable patients to play a more active part in the decision making about their treatment. This will ensure that those who agree to have tumour gene analysis have realistic expectations and sound deductions about the final result disclosure process.
To assess the impact of BRCA1/2 genetic test results on cancer-free women's breast-self-examination (BSE) practices and to prospectively determine their influence on psychological functioning. A prospective longitudinal study on French women's BSE practices and frequencies in BRCA1/2 carriers (N = 217) and non-carriers (N = 313) 1 and 2 years following disclosure of the test results, along with psychological factors predicting BSE practices. Before disclosure, BSE was practised by 47.2% of the women, and increased to 57.3% 1 year later. No change in the women's practices was noted between 12 and 24 months after the test. Carriers and non-carriers practicing regularly BSE at baseline were, respectively 8 to 6 times more likely to be practising BSE regularly at 12 months after being tested. Among the carriers, having fewer depressive symptoms at baseline and believing in the ability of BSE to detect breast cancer were found to be the most decisive factors associated with BSE practices 1 year after disclosure, following adjustment for BSE baseline practices. Among the non-carriers, believing in the ability of BSE to detect breast cancer, greater post-test anxiety, and a higher perceived risk of breast cancer were found to be predictors of post-test BSE practices after adjusting for BSE baseline practices. In France, where performing BSE is neither mandatory nor recommended, an increase in BSE practices was found to occur after disclosure of women's genetic test results, regardless of their carrier status.
> Cette revue de la littérature a pour objectif de présenter le point de vue de patientes atteintes d'un cancer du sein vis-à-vis de l'utilisation des profils d'expression génique de la tumeur pour définir une stratégie thérapeutique. Nous identifions les idées, les attentes ou les craintes qui pourraient constituer une entrave, ou une facilitation, à la mise en oeuvre et à la diffusion de ces méthodes en pratique clinique. Globalement, les patientes s'avèrent très favorables à l'utilisation d'un test génomique pour sélectionner le traitement le plus approprié, dans la logique du concept de médecine personnalisée. Un certain nombre de confusions et d'inquiétudes sont néanmoins observées. Leur connaissance et leur clarification ultérieure par les cliniciens devraient permettre aux patientes de prendre une part plus active et plus éclairée aux prises de décision thérapeutique, de mieux vivre la période d'annonce des traitements et d'améliorer leur vécu ultérieur. < génomiques permettaient d'identifier les patientes les plus susceptibles de bénéficier d'une chimiothérapie adjuvante [10,11]. Bien que la validité clinique des signatures génomiques soit maintenant bien établie, on commence seulement à en explorer l'utilité clinique, c'est-à-dire la façon dont elles influencent effectivement les décisions médicales et bénéficient au patient [12][13][14]. La majorité des médecins oncologues se déclarent très favorables à l'utilisation de ces tests comme aide à la décision thérapeutique [13,15] . Dans un contexte où les stratégies thé-rapeutiques visent à s'adapter au plus juste à chaque patient, la démarche actuelle consiste à essayer de mieux individualiser les traitements en se basant sur l'analyse des profils d'expression génétique (GEP) de la tumeur [2]. Plusieurs études ont suggéré que les GEP pouvaient être utilisés pour définir le risque de récidive après un traitement incluant ou non une chimiothérapie adjuvante, et prédire la réponse à la chimiothérapie néo-adjuvante (administrée avant la chirurgie) [3][4][5][6][7][8][9]. Il a également été rapporté que certaines signatures
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