Adolescent girls with family breast cancer history do not experience negative psychological effects

More and more girls are expected to have to confront breast cancer fears as modern genomics technology makes it easier to detect strong risk factors such as inherited BRCA1/2 mutations. But a new study shows that adolescent girls in families with a history of breast cancer or a high-risk BRCA1/2 mutation do not experience negative psychological effects, on average, and even seem to have higher self-esteem than their peers. The study, from researchers at the Perelman School of Medicine at the University of Pennsylvania and the Basser Center for BRCA in Penn's Abramson Cancer Center, is published this month in the Journal of Clinical Oncology.

"Overall, girls in families with a history of breast cancer seem to cope pretty well over time; they do worry more about breast cancer than their peers do, particularly as they get older, but that doesn't seem to impact them in terms of depression, anxiety, and general psychosocial adjustment," said lead author Angela R. Bradbury, MD, an assistant professor of Hematology/Oncology in Penn's Abramson Cancer Center.

The new study, which examines psychological adjustments of girls aged 11-19, follows a 2015 study from the same research team which showed similar results in pre-adolescent girls, aged 10-13.

The new research followed 320 girls, 208 of whom were from families with a history of breast cancer or BRCA1/2 mutations in near relatives, while 112 were "controls" with no such family history. The researchers interviewed the girls and their birth mothers and administered standard tests to assess their psychosocial adjustment, perception of breast cancer risk, and breast cancer-specific distress.

Predictably, the girls with a family breast cancer history scored much higher on measures of perceived breast cancer risk and breast-cancer-specific distress compared to the controls, yet they scored no worse on measures of general psychosocial adjustment including anxiety and depression. Intriguingly, the girls from breast cancer history families scored modestly—but significantly—higher on a measure of self-esteem.

"Self-esteem was higher among girls with a stronger family history of breast cancer, whereas depression was lower with increasing number of relatives with breast cancer," Bradbury said. "It may be that exposure to relatives with cancer fosters adaptive responses, although there may be other individual, mother, and family factors at work here."

For all the girls in the study, perceptions of breast cancer risk rose as they grew older and matured mentally, and in terms of breast development. But the perceived risk was always higher among the girls with a breast cancer family history.

"Girls from breast cancer families do worry more about breast cancer than their peers do, and that's not really surprising," Bradbury said. "We don't have evidence yet that that worry is a harmful thing; it may even be a motivating factor to adopt a healthier diet or to exercise more."

The research team is examining how heightened concerns over breast cancer risk affect the behaviors of girls as they mature into women, and whether interventions are needed. "If it's a harmful thing for a girl to know she's at risk, we need to know which girls are anxious and how we can help them, and if it's a beneficial thing we need to know how best to capitalize on it," Bradbury said.