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Women's Interest in Gene Expression Analysis for Breast Cancer Recurrence Risk

Suzanne C. O'Neill, Noel T. Brewer, Sarah E. Lillie, Edward F. Morrill, E. Claire Dees, Lisa A. Carey, Barbara K. Rimer

From the University of North Carolina Lineberger Comprehensive Cancer Center; School of Public Health; and Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC

Address reprint requests to Suzanne C. O'Neill, PhD, Social and Behavioral Research Branch, NHGRI/NIH, Building 31, B1B36B, Bethesda, MD 20892; e-mail: oneills{at}mail.nih.gov

Purpose Genomic and other technologies are improving the accuracy with which clinicians can estimate risk for recurrence (RFR) of breast cancer and make judgments about potential benefits of chemotherapy. Little is known of how patients will respond to genomic RFR testing or interact with their physicians to make informed decisions regarding treatment. We assessed interest in genomic RFR testing and patient preferences for incorporating results into treatment decision making.

Patients and Methods One hundred thirty-nine women previously treated for early-stage breast cancer completed surveys that presented hypothetical scenarios reflecting different test outcomes and potential decisions. We assessed women's attitudes toward RFR testing, how results would affect their choices about adjuvant treatment, and potential concerns about and perceived benefits of testing.

Results The majority of participants said they would "definitely" want to be tested (76%), receive their results (87%), and discuss these results with their physicians. They were willing to pay, on average, $997 for testing. Those who expressed more concerns about testing were less interested in testing and in incorporating results into treatment decision making. Participants were more likely to want chemotherapy when presented with high-risk results and would worry more about those results. They were least likely to trust and most likely to express potential anticipated regret in response to intermediate RFR results.

Conclusion Participants expressed strong interest in testing. Although these decisions were sensitive to RFR, participants’ complex reactions to intermediate RFR suggest care is needed when communicating such results.

Supported by grants from the American Cancer Society (MRSG-06-259-01-CPPB), the National Cancer Institute (R25 CA57726), and the UNC Lineberger Comprehensive Cancer Center.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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