ESTRELLA DURÁ FERRANDIS (*)

YOLANDA ANDREU (*)

M. JOSÉ GALDÓN (*)

ABSTRACT

A family history of breast cancer is a clear risk for developing the disease. Therefore, when a woman is diagnosed with breast cancer all her female first degree relatives become population at risk. This involve a number of important aspects to be taken into account by psychooncology professionals. (a) First, in addition to the stress associated with the diagnosis and treatment of breast cancer in a close relative, first degree relatives of breast cancer patients have the added stress of learning that they are at risk of this disease. (b)Second, these women become the main target of secondary breast cancer prevention strategies. However, various reports show that a considerable percentage of these women do not follow the recommended screening methods. For this reason, it is necesary to study the possible contribution of psychosocial factors, specially health beliefs, in the practice of preventive behavior aimed at preventing breast cancer in this population, and to design strategies to promote preventive practices. (c) Most of the research on health beliefs among women at risk for breat cancer has focused on risk perception. This research as found that some women with a family history of breast cancer have significantly overestimated their risk, while others have underestimated their risk. The need to provide risk counselling schemes for these women is therefore proposed, in order to estimate and advise them of their real risk. (d) Finally, these women may request genetic testing to determine whether they carry genetic mutations (BRCA1, BRCA2, or others) that cause some types of breast cancer. However, it must be remembered that, although many first degree relatives will have heard of and seek «the cancer gene test», currently testing is appropiate and available only for rare individuals. All these issues are reviewed in the present paper.

RESUMO

Uma história familiar de cancro da mama é um factor de risco para o desenvolvimento da doença. Assim, quando é diagnosticado um cancro da mama a uma mulher, todas as mulheres suas familiares em primeiro grau são uma população em risco. Isto implica aspectos importantes que devem ser tidos em conta pelos profissionais de psico-oncologia. (a) Juntamente com o stress associado ao diagnóstico e tratamento do cancro numa familiar próxima, estas mulheres experimentam também o stress de saberem que também têm risco de desenvolverem a doença. (b) Estas mulheres tornam-se, portanto, um grupo-alvo de estratégias de prevenção secundária do cancro da mama. Por esta razão, é necessário estudar a influência de factores psicossociais, especialmente das crenças de saúde, na prática de comportamentos especificamente direccionados para a prevenção do cancro da mama nessa população e, ao mesmo tempo, também é necessário delinear estratégias que promovam práticas preventivas. (c) A maior parte da investigação sobre as crenças de saúde de mulheres em risco de desenvolverem cancro da mama tem-se centrado na percepção de risco. Este estudo mostra que algumas mulheres com história familiar de cancro da mama sobrestimam significativamente o seu risco, enquanto outras o subestimam. Faz-se uma proposta de aconselhamento de risco, com a finalidade de avaliá-lo e aconselhar essas mulheres sobre o seu risco real. (d) Finalmente, estas mulheres podem necessitar de realizar testes genéticos para averiguar se são portadoras de marcadores relacionados com certos tipos de cancro da mama. Contudo, deve ser lembrado que, embora várias familiares em primeiro grau já tenham ouvido falar e solicitem fazer «o teste do gene do cancro», a sua realização só está indicada para algumas. Todos estes aspectos são revistos neste artigo.

Palavras-chave: Cancro da mama, psicologia, aconselhamento de risco, aconselhamento genético.

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(*)Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, Universidad de Valencia.