Adolescents' Long-Term Adaptation to Familial Cancer Risks

描述（由申请人提供）：超过25%的乳腺癌幸存妇女同时养育18岁以下的孩子。母亲的癌症扰乱了正常的育儿程序，增加了家庭压力，并导致后代的压力。青春期女孩特别容易患上母亲乳腺癌，随之而来的是焦虑/抑郁情绪的加剧。母亲自己对乳腺癌的痛苦在这些结果中起着核心作用，并延伸到生存率。目前，人们对母亲患乳腺癌“previvorship”对青少年的心理社会影响知之甚少，previvorship是一个通俗术语，描述由于家族史和遗传状况而有患乳腺癌高风险的妇女。超过100，000名女性接受了两种主要乳腺癌风险基因BRCA 1和BRCA 2（BRCA 1/2）的突变检测，根据这些信息做出改变生活的决定。携带BRCA 1/2突变的妇女的生物学子女有50%的机会继承风险赋予突变本身，大大增加了他们一生中患乳腺癌的风险。我们在这一领域的工作表明，即使青少年还没有达到BRCA 1/2癌症基因检测的年龄，超过70%的人被告知他们母亲的基因检测结果和家族癌症风险。关于青少年了解这一消息对他们与癌症相关的行为和认知，生活质量和身份的长期结果的信息非常缺乏。研究表明，遗传信息可能会在家庭成员中培养独特的反应，塑造对疾病风险的看法，并增加与疾病相关的担忧。当关注的焦点是儿童时，这些问题具有重要意义：家庭癌症风险信息的知识可能会影响青少年自我意识的发展，担心癌症，并对自己的癌症风险升高产生误解。这个问题在行为癌症控制文献中被忽视了。鉴于这些问题，本研究的主要目的是加深我们对向青少年披露家族性癌症风险信息的长期结果的理解。我们将通过对与青少年癌症预防和发展相关的公共卫生问题进行混合方法的横断面调查来实现这一目标：癌症相关的行为和认知，生活质量和身份。这些结果将在1-5年前参加BRCA 1/2基因检测的母亲的青少年的大规模分层样本中进行检查，所有这些母亲都将其基因检测结果透露给他们的孩子。将BRCA检测结果纳入研究设计中，使我们有机会发展和有力地评估关于青少年心理社会发展的连贯的、基于家族性癌症风险的假设。假设将在多变量分析中进行测试，这些分析由家庭生态学，家庭系统和压力应对框架指导，这些框架全面解决了基因组条件的公共卫生翻译。预计研究结果将有助于了解青少年的长期心理社会和行为适应，并为对这一不断增长的人口进行干预奠定基础。

DESCRIPTION (provided by applicant): Upwards of 25% of women surviving with breast cancer are simultaneously mothering a child under the age of 18. Maternal cancer disturbs normal parenting routines, increases family stress, and contributes to stress among offspring. Adolescent girls are especially vulnerable to maternal breast cancer occurrence, with attendant elevations in anxiety/depression. Mothers' own distress surrounding their breast cancer plays a central role in these outcomes, extending into survivorship. Presently, little is known about the psychosocial impact on adolescents of maternal breast cancer "previvorship"--a lay term describing women at high risk for developing breast cancer owing to family history and genetic status. Over 100,000 women have been tested for mutations in the 2 major breast cancer risk-conferring genes BRCA1 and BRCA2 (BRCA1/2), making life- altering decisions based upon this information. Biological children of women carrying BRCA1/2 mutations have a 50% chance of inheriting the risk-conferring mutation themselves, dramatically increasing their lifetime risk of developing breast cancer. Our work in this area indicates that even though adolescents are not yet age- eligible for BRCA1/2 cancer genetic testing, >70% are told about their mothers' genetic test result and familial cancer risk. There is a dearth of information on the long-term outcomes of adolescents learning this news on their cancer-related behaviors and cognitions, quality of life, and identity. Research suggests genetic information may foster unique responses among family members, shape perceptions of disease risk, and heighten disease-related worries. These issues take on great significance when the focus is children: knowledge of familial cancer risk information may affect developing adolescents' sense of self, worry about cancer, and create misperceptions about their own cancer risk elevations. This issue has been overlooked in the behavioral cancer control literature. In light of these issues, the primary aim of this study is to deepen our understanding of the long-term outcomes of disclosing familial cancer risk information to adolescents. We will accomplish this goal by conducting a mixed-methods, cross-sectional investigation of public health issues pertinent to cancer prevention and development among adolescents: cancer-related behaviors and cognitions, quality of life, and identity. These outcomes will be examined in a large, stratified sample of adolescents of mothers who participated in BRCA1/2 genetic testing 1-5 years previously and all of whom disclosed their genetic test results to their children. Incorporating maternal breast cancer un/affected status with BRCA test results into the study design affords us the opportunity to develop and strongly evaluate coherent, familial cancer risk-based hypotheses about adolescent psychosocial development in this context. Hypotheses will be tested in multivariate analyses guided by a family ecology, family systems, and stress-coping frameworks which comprehensively address public health translations of genomic conditions. Findings are expected to contribute to knowledge of long-term adolescent psychosocial and behavioral adaptation, and lay the groundwork for intervention with this growing population.