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Does and should breast cancer genetic counselling include lifestyle advice?

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Abstract

To optimally inform counselees about their and their relatives’ risks, information about lifestyle risk factors, e.g. physical activity and alcohol consumption, might be discussed in breast cancer genetic counselling. This study explored whether lifestyle was discussed, on whose initiative, whether information and/or advice was given, and whether discussion of lifestyle was related to counselees’ characteristics and their causal attributions. First and follow-up consultations with 192 consecutive counselees for breast cancer genetic counselling were videotaped and coded for discussion of lifestyle topics. Counselees completed web-based questionnaires before the initial and after the final consultation. With 52 (27 %) counselees lifestyle was discussed, either in the first, or the final consultation, or both. Counselees mostly raised the topic (60 %). Counsellors provided information about lifestyle risk factors to 19 % and lifestyle advice to 6 % of the counselees. Discussion of lifestyle was not associated with counselees’ characteristics or causal attributions. Post-counselling, more affected counselees considered lifestyle as a cause of their breast cancer (29 %) compared to pre-counselling (15 %; p = 0.003). Information and advice about lifestyle risk factors was infrequently provided, both with breast cancer unaffected and affected counselees and with those who did and did not consider their lifestyle as a cause of their breast cancer. Modifiable lifestyle factors could be discussed more frequently to optimally inform counselees about possible ways to reduce their risk. Counsellors should be educated about effects of lifestyle and research should be conducted on how to best integrate lifestyle information in breast cancer genetic counselling.

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Acknowledgments

We would like to thank Michelle Lenkens, Bianca Wiering and Melissa Gultzow for coding the consultations. Also, we would like to thank all counselees and genetic counsellors, clinical geneticists and residents in clinical genetics who participated in this study. This study was funded by a grant from the Dutch Cancer Society (Nivel 2010-4875).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Medical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands

    Akke Albada & Margreet G. E. M. Ausems

  2. Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands

    Madelèn Vernooij & Sandra van Dulmen

  3. Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, The Netherlands

    Liesbeth van Osch

  4. Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands

    Liesbeth van Osch

  5. Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands

    Anouk Pijpe

  6. Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    Sandra van Dulmen

  7. Department of Health Sciences, Buskerud University College, Drammen, Norway

    Sandra van Dulmen

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  1. Akke Albada
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  2. Madelèn Vernooij
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  3. Liesbeth van Osch
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  4. Anouk Pijpe
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  5. Sandra van Dulmen
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  6. Margreet G. E. M. Ausems
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Correspondence to Akke Albada.

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Albada, A., Vernooij, M., van Osch, L. et al. Does and should breast cancer genetic counselling include lifestyle advice?. Familial Cancer 13, 35–44 (2014). https://doi.org/10.1007/s10689-013-9672-5

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