To describe and illustrate elements of a group counselling approach designed to enhance the communication of risk information on breast cancer (BC) to women with a family history of this disease. Breast cancer is a leading cause of female cancer death. The most important risk factor for BC is a positive family history in at least 1 first-degree relative, and approximately one-third of women with BC have a family history of the disease. Recent evidence suggests that there is a significant psychological impact associated with having a family history of BC, and this may influence the psychological adjustment and response to being counselled for personal risk. New counselling approaches are required.
Method:
This paper describes a group therapy approach that incorporates principles of supportive-expressive therapy designed to address the emotional impact of being at risk for BC and to promote accuracy of perceived risk. The key elements of the intervention are described along with clinical illustrations from groups that are part of an ongoing study to develop and standardize the group therapy.
Conclusion:
Qualitative data from the groups suggest that this model of therapy is both feasible and effective.
National Cancer Institute of Canada. Canadian cancer statistics. Toronto: Canadian Cancer Society; 1996.
2.
GailMHBrintonLAByarDPCorleDKGreenSBSchairerC, and others. Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst1989;81:1879–86.
3.
SlatterMLKerberRA. A comprehensive evaluation of family history and breast cancer risk. The Utah population database. JAMA1993;270:1563–8.
4.
WeberBLGarberJF. Familial breast cancer. In: Breast disease updates. HarrisJR, editor. JB Lippincott Co; 1995. p 1–23.
5.
ClausEBRischNThompsonWD. Autosomal dominant inheritance of early-onset breast cancer: Implications for risk perception. Cancer1994;73:643–51.
6.
SpiegelDBloomJKraemerHCGottheilE.The beneficial effect of psychosocial treatment on survival of metastatic breast cancer patients: A randomized prospective outcome study. Lancet1989;10:888–91.
7.
SpiegelDSpiraJ.Supportive-expressive group therapy: Treatment of manual of psychosocial intervention for women with recurrent breast cancer. Psychosocial treatment laboratory breast cancer intervention project. Stanford (CA): Stanford University School of Medicine; 1991.
8.
ValdimarsdottirHBBovbjergDHKashKHollandJCOsborneMPMillerDG. Psychological distress in women with a familial risk of breast cancer. Psychooncology1995;4:133–41.
9.
LermanCLustbaderERimerBDalyMMillerSSandsC, and others. Effects of individualized breast cancer risk counselling: A randomized trial. J Natl Cancer Inst1995;87(4):286–92.
10.
LermanCSwartzMMillerSMDalyMSandsCRimerBK. A randomized trial of breast cancer risk counseling: Interacting effects of counseling, educational level, and coping style. Health Psychol1996;15:75–83.
11.
StefanekM.Counselling women at high risk for breast cancer. Oncology1990;4:27–36.
12.
KellyPT. Counseling persons who have family histories of cancer. In: NewellGR, editor. The practice of cancer prevention in clinical medicine. New York: Raven Press; 1983.
13.
KellyPT. Risk counselling for relatives of cancer patients: New information, new approaches. Journal of Psychosocial Oncology1987;5:65–79.
14.
ChampionL.The relationship of selected variables to breast cancer detection behaviors in women 35 and older. Oncol Nurs Forum1991;18:733–9.
15.
LermanCRimerBTrackBBalshemAEngstromP.Factors associated with repeat adherence to breast cancer screening. Prev Med1990;19:279–90.
16.
KellyPT. Counseling persons with family histories of cancer. In: NewellGR, editor. Cancer prevention in clinical medicine. New York: Raven Press; 1983. p 147–65.
17.
SwartzMDLermanCMillerSMDalyMMasnyA.Coping disposition, perceived risk, and psychological distress among women at increased risk for ovarian cancer. Health Psychol1995;14:232–5.
18.
SharpeNF. Informed consent and huntington disease: A model for communication. Am J Med Genet1994;50:239–46.
19.
ThirlawayKFallowfieldLNunnerleyHPowlesT.Anxiety in women “at risk” of developing breast cancer. Br J Cancer1996;73:1422–4.
20.
Royak-SchalerRBenderlyBL. Challenging the breast cancer legacy. New York: Harper Perennial; 1993.
21.
JostenDMEvansAMLoveRS. The cancer prevention clinic: A service program for cancer-prone families. Journal of Psychosocial Oncology1985;3:5–20.
22.
VogelVGGravesDSVernonSWLordJAWinnRJPetersGN. Mammographic screening of women with increased risk of breast cancer. Cancer1990;66:1613–20.
23.
KellyPT. Genetic counseling with the cancer patient's family. Curr Prob Cancer1983;7:15–41.
24.
KashKMHollandJCHalperMSMillerDG. Psychological distress surveillance behaviors of women with a family history of breast cancer. J Nat Cancer Inst1992;84:24–30.
25.
WellischDGritzERSchainWWangHSiauJ.Psychological functioning of daughters of breast cancer patients: Part II. Characterizing the distressed daughter of a breast cancer patient. Psychosomatics1992;33:171–9.
26.
LermanCKashKStefanekM.Younger women at increased risk for breast cancer: Perceived risk, psychological well-being, and surveillance behavior. J Natl Cancer Ins Monogr1994;16:171–6.
27.
MilunskyA, editor. Genetic disorders and the fetus: Diagnosis, prevention, and treatment. 3rd ed.Baltimore: Johns Hopkins University Press; 1992. p 3–10, 22–3.
28.
KesslerSLevineEK. Psychological aspects of genetic counseling IV: Subjective assessment of probability. American Journal of Genetics1987;28:361–70.
29.
KellyPT. Counselling needs of women with a maternal history of breast cancer. Patient Counsel Health Education1980;2:118–24.
30.
LermanCTrockBRimerBJepsonCBrodyDBoyceA.Psychological side effects of breast cancer screening. Health Psychol1991;10:259–67.
31.
LermanCBieseckerBBenkendorfJLKernerJGomez-CamineroAHugesC, and others. Controlled trial of pretest education approaches to enhance informed decision-making for BRCA1 gene testing. J Natl Cancer Inst1997;89:148–57.
32.
ChungJYMagrawMM. A group approach to pychosocial issues faced by HIV-positive women. Hospital and Community Psychiatry1992;43:891–3.
33.
LevineSHBystritskyABaronDJonesLD. Group psychotherapy for HIV-seropositive patients with major depression. Am J Psychother1991;45:413–24.
34.
KollerPMarmarCRKanasN.Psychodynamic group treatment of posttraumatic stress disorder in Vietnam veterans. Int J Group Psychother1992;42:225–46.
35.
YalomID. Theory and practice of group psychotherapy. 3rd ed.New York: Basic Books; 1985.
36.
YalomID. Existential psychotherapy. New York: Basic Books; 1980.
37.
LynchHLermanC.Psychological aspects of familial breast cancer. In: Breast cancer, advances in biology and therapeutics. CalvoFCrepinMMagdelenatH, editors. John Libbey Eurotext; 1996. p 11–8.
38.
SpiegelDBloomJRYalomID. Group support for patients with metastatic cancer. Arch Gen Psychiatry1981;38:527–33.
