The new genetics: Psychological responses to genetic testing

This is the second of four articles discussing the broader implications of advances in genetics Predicting disease on the basis of biological markers, such as serum cholesterol concentration or blood pressure, is not new; the ability to predict disease using DNA is. As the scope for genetic testing extends beyond testing for single gene disorders to testing large sections of the population for genes associated with common disorders it is important to consider what effect this will have on individuals and on society as a whole. Research into the psychological impact of genetic testing in Huntington's disease, cystic fibrosis, breast cancer, and ovarian cancer has shown that an individual's decision to undergo testing and his or her response on receiving the results are influenced by many factors. This article discusses the nature of these factors and the implication they have for the introduction of widespread genetic screening. #### Summary points As genetic screening becomes widespread, its psychological impact on individuals, their families, and society as a whole needs to be assessed The psychological impact of predictive genetic testing for Huntington's disease, breast cancer, and ovarian cancer, when offered with expert counselling before and after testing, depends more on pretest expectations, mood, and social support than the results of the test itself Distress associated with screening may be reduced by careful assessment before and after testing, counselling, and support Research is needed to determine the most effective and practical counselling strategies for the increasingly large number of people who will be offered genetic tests for treatable conditions The psychological impact of screening for biological markers associated with increased risk of disease has been well researched.1 Extrapolating from these findings to predict the impact of population based genetic screening of asymptomatic individuals is difficult, though—partly because the predictive value of genetic tests for some …

[1]  N. Holtzman,et al.  The new genetics: Genetic testing and public policy , 1998, BMJ.

[2]  C. Rotimi,et al.  The new genetics in clinical practice , 1998, BMJ.

[3]  D. Craufurd,et al.  Uptake of genetic testing for cancer predisposition. , 1997, Journal of medical genetics.

[4]  W. Klein,et al.  Objective standards are not enough: affective, self-evaluative, and behavioral responses to social comparison information. , 1997, Journal of personality and social psychology.

[5]  S. Michie,et al.  Presentation of Screen Negative Results on Serum Screening for Down's Syndrome: Variations across Britain , 1997, Journal of medical screening.

[6]  J. E. Nash,et al.  Psychological responses to BRCA1 mutation testing: preliminary findings. , 1997, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[7]  H. Duivenvoorden,et al.  Three-year follow-up after presymptomatic testing for Huntington's disease in tested individuals and partners. , 1997, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[8]  B. Wilfond,et al.  Incorporating biomarkers of exposure and genetic susceptibility into smoking cessation treatment: effects on smoking-related cognitions, emotions, and behavior change. , 1997, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[9]  E. Skinner.  A guide to constructs of control. , 1996, Journal of personality and social psychology.

[10]  K. Demyttenaere,et al.  Prediction of psychological functioning one year after the predictive test for Huntington's disease and impact of the test result on reproductive decision making. , 1996, Journal of medical genetics.

[11]  B. Trock,et al.  BRCA1 testing in families with hereditary breast-ovarian cancer. A prospective study of patient decision making and outcomes. , 1996, JAMA.

[12]  J. Struewing,et al.  Anticipated uptake and impact of genetic testing in hereditary breast and ovarian cancer families. , 1995, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[13]  R. Croyle.  Psychosocial effects of screening for disease prevention and detection , 1995 .

[14]  N. Holtzman,et al.  Offering cystic fibrosis carrier screening to an HMO population: factors associated with utilization. , 1994, American journal of human genetics.

[15]  K. Gyr,et al.  Influence of method of reporting study results on decision of physicians to prescribe drugs to lower cholesterol concentration , 1994, BMJ.

[16]  B. Demichelis,et al.  Completeness of reporting trial results: effect on physicians' willingness to prescribe , 1994, The Lancet.

[17]  G. Lenoir,et al.  DNA screening for breast/ovarian cancer susceptibility based on linked markers. A family study. , 1993, Archives of internal medicine.

[18]  M. Morris,et al.  Reluctance to undergo predictive testing: the case of Huntington disease. , 1993, American journal of medical genetics.

[19]  Sandi Wiggins,et al.  The Psychological Consequences of Predictive Testing for Huntington’s Disease , 1992 .

[20]  K. Garver,et al.  Eugenics: past, present, and the future. , 1991, American journal of human genetics.

[21]  S. Michie,et al.  Perceived risk not actual risk predicts uptake of amniocentesis , 1991, British journal of obstetrics and gynaecology.

[22]  D. Craufurd,et al.  UPTAKE OF PRESYMPTOMATIC PREDICTIVE TESTING FOR HUNTINGTON'S DISEASE , 1989, The Lancet.