The Genetic Legacy of Breast Cancer: Extending the Common Sense Model for Genetics to High-Risk BRCA1/2 Counselees and their Adolescent Daughters

Abstract

Screening, surveillance and preventative medical interventions are being identified as best practices for women at high-risk of developing hereditary breast cancer. Genetic screening for the BRCA1/2 mutations associated with hereditary breast cancer is currently recommended as an appropriate health intervention for younger women who have been affected by breast cancer, as well as for those who have been identified as high-risk due to their family histories of breast cancer. At present, however, little is known about the psychosocial implications of genetic screening for BRCA1/2 mutations on young families. Using the common sense model of self-regulation (Leventhal et al., 1997), adapted for genetics (Cameron, 2003; Marteau & Weinman, 2006) as a guiding framework, the goals of this dissertation were to: (a) examine the relationships between threat representation and psychosocial functioning in BRCA1/2 counselees, (b) explore the impact of fear representation on women’s psychosocial functioning, and (c) assess how BRCA1/2 counselees’ threat representations and fear representations impact family functioning and the psychosocial adaptation of their adolescent daughters. Results indicated that total threat representation, including risk representation, illness representation and fear representation, was found to add to the prediction of mothers’ self-reported levels of anxiety, depressive symptoms and intrusive ideation regarding genetic counseling. Additionally, when the cognitive processes of the threat representation were controlled (i.e., risk representation and illness representation), the subjective-emotional processes (i.e., the fear representation) continued to emerge as a significant predictor of mothers’ self-reported anxiety, depressive and intrusive ideation symptoms. Additionally, support for the association between mothers’ threat representations and adolescent daughters’ reports of depressive symptoms and self-concept were noted. Cumulatively, these results provide support for the role of fear representation within the CSM framework and suggest that fear representation plays an important role in BRCA1/2 counselees’ psychosocial adaptation following genetic counseling.