This study sought to examine changes in psychological distress following cancer genetic counselling. Women attending a family cancer clinic completed questionnaires before their appointment and at 2 weeks, 6 months and 12 months after their appointment. Twenty-six women were at low risk of developing breast or ovarian cancer, 76 were at moderate risk, 46 were at high risk and 46 women had previously had breast or ovarian cancer. All groups were compared with regard to measures of anxiety, depression, general psychological distress, worry about developing breast and ovarian cancer, and perceived risk of developing breast/ovarian cancer and perceived likelihood of carrying a genetic mutation. General psychological distress did not change over the course of the study and the groups did not differ on these measures. Worry about developing breast cancer and perceptions of the likelihood of carrying a genetic mutation significantly reduced following genetic counselling. On the whole women who had already had breast/ovarian cancer showed more concerns about ovarian cancer and raised perceptions of risk in comparison with the other groups, indicating the need for sensitive counselling of such women.

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Purpose: Many women who have had breast or ovarian cancer who are undergoing tests for the presence of germline mutations in the BRCA1/2 genes will receive a result that is inconclusive. As this continuing uncertainty may have a detrimental effect on their psychological well-being and it is possible that such results will be misinterpreted as indicating that no mutation is present, studying their effect is important. Methods: Sixty-one women undergoing such tests completed questionnaires 2 weeks after their blood was taken and at 1 week and 6 months after receiving a preliminary "inconclusive" result, i.e., indicating that two thirds of the BRCA1 gene had been tested and no mutation had been found so far. Results: Perceived likelihood of having a mutation and perceptions of cancer risk significantly decreased after receipt of the interim result. There were no changes in levels of psychological distress and worry about cancer, in intentions to have mammograms, to carry out breast self-examination, or to have prophylactic surgery. Conclusions: The continuing uncertainty does not seem to have increased distress; however, it is possible that the inconclusive result is being interpreted as a "good news" result, in view of the fact that perceptions of risk decrease after receipt of the result. Genet Med 2002:4(5):353-358. Key Words: BRCA1 results, breast and ovarian cancer genetics, affected women, psychological distress, risk perceptionsThe population risk of developing breast cancer in the UK is 1 in 12, and the risk of ovarian cancer is 1 in 100. A small proportion (approximately 5%-10%) of women who develop breast and ovarian cancers have an inherited susceptibility to these cancers. 1,2 To date, two breast and ovarian cancer predisposing genes have been identified-BRCA1 3-5 and BRCA2. 6 It is possible to detect mutations in these genes in a small number of individuals who have a strong family history of breast or ovarian cancer. Before an unaffected individual can be tested to determine whether or not they have inherited a susceptibility to these cancers, it is first necessary to define the mutation in the family. This involves taking a blood sample from a member of the family who has had breast or ovarian cancer and where there is a high chance of a genetic mutation. The BRCA1 and BRCA2 genes are then analyzed for a mutation. Women undergoing such "mutation search" tests are the focus of the current study. If a mutation is found, a "predictive test" will then be available for close relatives who have not had these types of cancer. Women who have inherited a mutation in the BRCA1 or BRCA2 gene have approximately 80% risk of developing breast cancer over their lifetime, particularly at a young age, and 40%-60% lifetime risk of ovarian cancer. 5 The psychological effect on the first individuals in a family to be tested has tended to be relatively underrepresented in the literature, with research mainly focusing on the effects of predictive testing (which would only occur once a mutation has been found). Affected wo...

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The causes, classification, and prevention of mechanical asphyxial death in children were examined. vomit appear to be cases of the sudden infant death syndrome or background medical conditions. This study suggests the need for advice on maintaining a safe sleeping environment. Only one child choked on a toy and European Standards for Toy Safety appear to have been successful. The prevention of hanging in the group of older boys needs further exploration. (Arch Dis Child 1995; 72: 6-10)