Psychosocial Adjustment in School-age Girls With a Family History of Breast Cancer

Abstract

OBJECTIVE Understanding how young girls respond to growing up with breast cancer family histories is critical given expansion of genetic testing and breast cancer messaging. We examined the impact of breast cancer family history on psychosocial adjustment and health behaviors among >800 girls in the multicenter LEGACY Girls Study. METHODS Girls aged 6 to 13 years with a family history of breast cancer or familial BRCA1/2 mutation (BCFH+), peers without a family history (BCFH−), and their biological mothers completed assessments of psychosocial adjustment (maternal report for 6- to 13-year-olds, self-report for 10- to 13-year-olds), breast cancer–specific distress, perceived risk of breast cancer, and health behaviors (10- to 13-year-olds). RESULTS BCFH+ girls had better general psychosocial adjustment than BCFH− peers by maternal report. Psychosocial adjustment and health behaviors did not differ significantly by self-report among 10- to 13-year-old girls. BCFH+ girls reported higher breast cancer–specific distress (P = .001) and were more likely to report themselves at increased breast cancer risk than BCFH− peers (38.4% vs 13.7%, P < .001), although many girls were unsure of their risk. In multivariable analyses, higher daughter anxiety was associated with higher maternal anxiety and poorer family communication. Higher daughter breast cancer–specific distress was associated with higher maternal breast cancer-specific distress. CONCLUSIONS Although growing up in a family at risk for breast cancer does not negatively affect general psychosocial adjustment among preadolescent girls, those from breast cancer risk families experience greater breast cancer–specific distress. Interventions to address daughter and mother breast cancer concerns and responses to genetic or familial risk might improve psychosocial outcomes of teen daughters.

Family-based Breast Cancer Prevention Efforts in Adolescence

“…Research has revealed that most adolescent girls growing up in breast cancer families are aware of their risk for breast cancer in adulthood and there are things that they can do at their age to prevent cancer. 9 Thus, as many health and risk behaviors begin (eg, tobacco and alcohol intake, sexual activity, oral contraceptive use) or become established (eg, diet, exercise) in adolescence early communication about risk for adult cancer has the opportunity to provide a teachable moment. 10 Health and risk behaviors in preadolescence relate to the adoption and maintenance of health and risk behaviors throughout life.…”

Association of Prepubertal and Adolescent Androgen Concentrations With Timing of Breast Development and Family History of Breast Cancer

“…In an earlier study, BCFH-positive mothers and daughters reported greater breast cancer–specific distress compared with BCFH-negative mothers and daughters. 22 If replicated, it is plausible that early-life stress associated with a mother diagnosed with breast cancer may activate the HPA axis prematurely, thereby producing DHEA-S, which would explain our finding that breast cancer–specific distress was specific to DHEA-S and not the other androgens. Dehydroepiandrosterone sulfate is metabolized into androstenedione and testosterone; when puberty begins, the hypothalamic-pituitary-ovarian axis is activated and the ovary starts to contribute 25% to 50% of androstenedione and testosterone in circulation.…”

Please Test My Child for a Cancer Gene, but Don’t Tell Her

“…Such anxiety can be relieved by better communication, not by keeping secrets. 16,17 The medical team should thus discuss with the mother options for evaluating Karen’s mental state either in-person, by a pediatrician-mental health professional, or through a consultation with Karen’s primary pediatrician and treating psychologist, without her presence. Such a consultation might alleviate the mother’s concerns and persuade her to rethink her preferred approach to testing Karen.…”