Heidi Hamann

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• Kaplan, D. M., Hamann, H. A., Price, S. N., Williamson, T. J., Ver Hoeve, E. S., McConnell, M. H., Duchschere, J. E., Garland, L. L., & Ostroff, J. S. (2022). Developing an ACT-based intervention to address lung cancer stigma: Stakeholder recommendations and feasibility testing in two NCI-designated cancer centers. Journal of psychosocial oncology, 1-17.
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  Few psychosocial interventions have been tailored to meet the unique needs of patients diagnosed with lung cancer. This pilot study developed and tested a six-week intervention for reducing lung cancer stigma. Guided by qualitative interviews conducted with 9 lung cancer patients and 5 thoracic oncology care providers, Acceptance and Commitment Therapy was adapted for treatment of lung cancer stigma (ACT-LCS). In a subsequent single arm pilot study, 22 lung cancer patients reporting high levels of stigma completed the intervention. NCI-designated cancer centers in the Southwestern and Eastern United States. Of 46 eligible patients, 22 provided consent, with 20 completing the intervention (10 in-person, 10 telehealth). Overall stigma decreased across timepoints, largely driven by reductions in internalized stigma. There were also significant reductions in social isolation, sleep disturbance, and fatigue. The ACT-LCS protocol demonstrates preliminary feasibility and acceptability. This intervention may be particularly suited for helping patients navigate feelings associated with internalized stigma.
• Peng, T., Hamann, H. A., & David, E. A. (2022). Stigma May Exacerbate Disproportionately Low Guideline-Concordant Treatment Rates for Patients With Advanced-Stage Lung Cancer in the United States.. JTO clinical and research reports, 3(4), 100302. doi:10.1016/j.jtocrr.2022.100302
• Price, S. N., Hamann, H. A., Halaby, L., Trejo, J. I., Corella, F., & Weihs, K. L. (2022). Poor Subjective Sleep Quality Among Patients with Cancer and Comorbid Depression: An Opportunity to Inform Screening and Intervention. Behavioral sleep medicine, 1-16.
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  Sleep disturbances are under-identified and under-treated in oncology settings, especially for underserved populations and those with psychiatric comorbidities. This study examined the prevalence and correlates of poor subjective sleep quality as well as clinical sleep recommendations among a socioeconomically and ethnically diverse population of patients with cancer referred for depression management.
• Torres, T. K., Chase, D. M., Salani, R., Hamann, H. A., & Stone, J. (2022). Implicit biases in healthcare: implications and future directions for gynecologic oncology. American journal of obstetrics and gynecology.
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  Health disparities have been found among patients with gynecologic cancers, with the greatest differences arising among groups based on racial, ethnic, and socioeconomic factors. Although there may be multiple social barriers that can influence health disparities, another potential influence may stem from healthcare system factors that unconsciously perpetuate bias toward patients who are racially and socioeconomically disadvantaged. More recent research suggested that providers hold these implicit biases (automatic and unconscious attitudes) for stigmatized populations with cancer, with emerging evidence for patients with gynecologic cancer. These implicit biases may guide providers' communication and medical judgments, which, in turn, may influence the patient's satisfaction with and trust in the provider. This narrative review consolidated the current research on implicit bias in healthcare, with a specific emphasis on oncology professionals, and identified future areas of research for examining and changing implicit biases in the field of gynecologic oncology.
• Banerjee, S. C., Haque, N., Bylund, C. L., Shen, M. J., Rigney, M., Hamann, H. A., Parker, P. A., & Ostroff, J. S. (2021). Responding empathically to patients: a communication skills training module to reduce lung cancer stigma. Translational behavioral medicine, 11(2), 613-618.
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  Most lung cancer patients report perceiving stigma surrounding their diagnosis, and routine clinical interactions with their health care providers (HCPs) are reported as a common source. The adverse effects of lung cancer stigma are associated with several adverse psychosocial and behavioral outcomes. One potential clinician-level intervention target is empathic communication because of its association with higher rates of patients' satisfaction, treatment adherence, and lower levels of psychological distress. This study describes the conceptual model and evaluation of clinician-targeted empathic communication skills training to reduce lung cancer patients' experience of stigma. The goal of the training module is to enhance clinician recognition and responsiveness to lung cancer patients' empathic opportunities by communicating understanding, reducing stigma and distress, and providing support. Thirty multidisciplinary HCPs working in thoracic oncology, thoracic surgery, or pulmonary medicine participated in 2.25 hr of didactic and experiential training on responding empathically to patients with lung cancer. Overall, participants reported highly favorable evaluations of the training, with at least 90% of participants agreeing or strongly agreeing to 11 of the 12 items assessing clinical relevance, novelty, clarity, and facilitator effectiveness. Participants' self-efficacy to communicate empathically with lung cancer patients increased significantly from pretraining to posttraining, t(29) = -4.58, p < .001. The empathic communication skills training module was feasible and well received by thoracic and pulmonary medicine HCPs and demonstrated improvements in self-efficacy in empathic communication from pretraining to posttraining. The examination of patient outcomes is warranted.
• Hamann, H. A., Williamson, T. J., Studts, J. L., & Ostroff, J. S. (2021). Lung Cancer Stigma Then and Now: Continued Challenges Amid a Landscape of Progress. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 16(1), 17-20.
• Price, S. N., Flores, M., Hamann, H. A., & Ruiz, J. M. (2021). Ethnic Differences in Survival Among Lung Cancer Patients: A Systematic Review. JNCI cancer spectrum, 5(5), pkab062.
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  Despite a substantially worse risk factor profile, Hispanics in the United States experience lower incidence of many diseases and longer survival than non-Hispanic Whites (NHWs), an epidemiological phenomenon known as the Hispanic Health Paradox (HHP). This systematic review evaluated the published longitudinal literature to address whether this pattern extends to lung cancer survival.
• Ver Hoeve, E. S., Ali-Akbarian, L., Price, S. N., Lothfi, N. M., & Hamann, H. A. (2021). Patient-reported financial toxicity, quality of life, and health behaviors in insured US cancer survivors. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 29(1), 349-358.
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  Fighting cancer is a costly battle, and understanding the relationship between patient-reported financial toxicity (FT) and health outcomes can help inform interventions for post-treatment cancer survivors.
• Williamson, T. J., Ostroff, J. S., Martin, C. M., Banerjee, S. C., Bylund, C. L., Hamann, H. A., & Shen, M. J. (2021). Evaluating relationships between lung cancer stigma, anxiety, and depressive symptoms and the absence of empathic opportunities presented during routine clinical consultations. Patient education and counseling, 104(2), 322-328.
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  Empathic communication in clinical consultations is mutually constructed, with patients first presenting empathic opportunities (statements communicating emotions, challenges, or progress) to which clinicians can respond. We hypothesized that lung cancer patients who did not present empathic opportunities during routine consultations would report higher stigma, anxiety, and depressive symptoms than patients who presented at least one.
• Gerber, D. E., Hamann, H. A., Chavez, C., Dorsey, O., Santini, N. O., Browning, T., Ochoa, C. D., Adesina, J., Natchimuthu, V. S., Steen, E., Zhu, H., & Lee, S. J. (2020). Tracking the Nonenrolled: Lung Cancer Screening Patterns Among Individuals not Accrued to a Clinical Trial. Clinical lung cancer, 21(4), 326-332.
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  For lung cancer screening, the available data are often derived from patients enrolled prospectively in clinical trials. We, therefore, investigated lung cancer screening patterns among individuals eligible for, but not enrolled in, a screening trial.
• Lee, S. J., Hamann, H. A., Browning, T., Santini, N. O., Abbara, S., Balis, D. S., Chiu, H., Moran, B. A., McGuire, M., & Gerber, D. E. (2020). Stakeholder engagement to initiate lung cancer screening in an urban safety-net health system. Healthcare (Amsterdam, Netherlands), 8(1), 100370.
• Williamson, T. J., Kwon, D. M., Riley, K. E., Shen, M. J., Hamann, H. A., & Ostroff, J. S. (2020). Lung Cancer Stigma: Does Smoking History Matter?. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 54(7), 535-540.
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  Lung cancer patients commonly report stigma, often attributing it to the well-established association of smoking as the leading preventable cause. Theory and research suggest that patients' smoking history may differentiate patients' experience of lung cancer stigma. However, there is inconsistent evidence whether lung cancer stigma varies by patients' smoking history, owing to limitations in the literature.
• Williamson, T. J., Ostroff, J. S., Haque, N., Martin, C. M., Hamann, H. A., Banerjee, S. C., & Shen, M. J. (2020). Dispositional shame and guilt as predictors of depressive symptoms and anxiety among adults with lung cancer: The mediational role of internalized stigma. Stigma and health, 5(4), 425-433.
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  The current study investigated whether dispositional tendencies to experience shame and guilt (i.e., shame- and guilt- proneness) were associated with higher levels of internalized stigma and, in turn, higher depressive symptoms and anxiety in adults with lung cancer.
• Johnson Shen, M., Ostroff, J. S., Hamann, H. A., Haque, N., Banerjee, S. C., McFarland, D. C., Molena, D., & Bylund, C. L. (2019). Structured Analysis of Empathic Opportunities and Physician Responses during Lung Cancer Patient-Physician Consultations. Journal of health communication, 24(9), 711-718.
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  Despite the importance of empathic communication in cancer patient outcomes, the majority of opportunities to respond empathically to a patient's concern within clinical consultations are "missed" (i.e., 70-90%), or not responded to by physicians. The present study examined the empathic opportunities and responses within clinical consultations of lung cancer patients and how these each are associated with patient-reported outcomes. Results indicate that lung cancer patients (n = 56) most commonly presented empathic opportunities related to emotions, anxiety was significantly associated with empathic opportunity type ( = .011), and physicians are most likely to respond with high empathy to statements around a patient making progress rather than bringing up a challenge or an emotion they felt ( = .031). The present study results highlight the need to train lung cancer physicians to respond with higher empathy to opportunities to respond to negative emotions, including mentions of challenges faced or emotions experienced, as these patients are at the highest risk of experiencing distress and the least likely to receive a high empathic response from physicians.
• Ostroff, J. S., Riley, K. E., Shen, M. J., Atkinson, T. M., Williamson, T. J., & Hamann, H. A. (2019). Lung cancer stigma and depression: Validation of the Lung Cancer Stigma Inventory. Psycho-oncology, 28(5), 1011-1017.
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  In an effort to provide further evidence for the validity of the Lung Cancer Stigma Inventory (LCSI), this paper examined group differences in lung cancer stigma for patients who report clinically significant depressive symptoms and established a suggested scoring benchmark to identify patients with clinically meaningful levels of lung cancer stigma.
• Price, S. N., Studts, J. L., & Hamann, H. A. (2019). Tobacco Use Assessment and Treatment in Cancer Patients: A Scoping Review of Oncology Care Clinician Adherence to Clinical Practice Guidelines in the U.S. The oncologist, 24(2), 229-238.
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  Smoking after a cancer diagnosis negatively impacts health outcomes; smoking cessation improves symptoms, side effects, and overall prognosis. The Public Health Service and major oncology organizations have established guidelines for tobacco use treatment among cancer patients, including clinician assessment of tobacco use at each visit. Oncology care clinicians (OCCs) play important roles in this process (noted as the 5As: Asking about tobacco use, Advising users to quit, Assessing willingness to quit, Assisting in quit attempts, and Arranging follow-up contact). However, OCCs may not be using the "teachable moments" related to cancer diagnosis, treatment, and survivorship to provide cessation interventions.
• Hamann, H. A., & Pujol, J. L. (2018). Introduction to the Special Section: The Experience and Impact of Lung Cancer Stigma. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 13(8), 1053-1054.
• Hamann, H. A., Shen, M. J., Thomas, A. J., Craddock Lee, S. J., & Ostroff, J. S. (2018). Development and Preliminary Psychometric Evaluation of a Patient-Reported Outcome Measure for Lung Cancer Stigma: The Lung Cancer Stigma Inventory (LCSI). Stigma and health, 3(3), 195-203.
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  Among patients with lung cancer, stigma is associated with negative psychosocial and behavioral outcomes. There is a need to develop psychometrically robust patient-reported outcome (PRO) measures for stigma that incorporate perspectives of patients diagnosed with lung cancer. As part of our multi-phase process of measure development and validation, we report on scale formation and preliminary psychometric evaluation of the Lung Cancer Stigma Inventory (LCSI).
• Hamann, H. A., Ver Hoeve, E. S., Carter-Harris, L., Studts, J. L., & Ostroff, J. S. (2018). Multilevel Opportunities to Address Lung Cancer Stigma across the Cancer Control Continuum. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 13(8), 1062-1075.
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  The public health imperative to reduce the burden of lung cancer has seen unprecedented progress in recent years. Fully realizing the advances in lung cancer treatment and control requires attention to potential barriers in their momentum and implementation. In this analysis, we present and evaluate the argument that stigma is a highly significant barrier to fulfilling the clinical promise of advanced care and reduced lung cancer burden. This evaluation of the stigma of lung cancer is based on a multilevel perspective that incorporates the individual, persons in the individual's immediate environment, the health care system, and the larger societal structure that shapes perceptions and decisions. We also consider current interventions and interventional needs within and across aspects of the lung cancer continuum, including prevention, screening, diagnosis, treatment, and survivorship. Current evidence suggests that stigma detrimentally affects psychosocial, communication, and behavioral outcomes over the entire lung cancer control continuum and across multiple levels. Interventional efforts to alleviate stigma in the context of lung cancer show promise, yet more work is needed to evaluate their impact. Understanding and addressing the multilevel role of stigma is a crucial area for future study to realize the full benefits offered by lung cancer prevention, control, and treatment. Coordinated, interdisciplinary, and well-conceptualized efforts have the potential to reduce the barrier of stigma in the context of lung cancer and facilitate demonstrable improvements in clinical care and quality of life.
• Marshall, C. A., Curran, M. A., Brownmiller, G., Solarte, A., Armin, J., Hamann, H. A., Crist, J. D., Niemelä, M., Badger, T. A., & Weihs, K. L. (2018). Oregon's Familias en Acción replicates benefits for underserved cancer co-survivors through Un Abrazo Para la Familia. Psycho-oncology, 27(10), 2405-2411.
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  Our goal in this study was to determine if we could replicate initial findings when providing the intervention, Un Abrazo Para La Familia ("Abrazo"). Abrazo is a community-focused psychoeducational preventive intervention addressing the cancer information and coping needs of low-income, underserved family members of cancer survivors, developed and first implemented in Tucson, Arizona.
• Rethorst, C. D., Hamann, H. A., Carmody, T. J., Sharp, K. J., Argenbright, K. E., Haley, B. B., Skinner, C. S., & Trivedi, M. H. (2018). The Promoting Activity in Cancer Survivors (PACES) trial: a multiphase optimization of strategy approach to increasing physical activity in breast cancer survivors. BMC cancer, 18(1), 744.
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  Despite the significant, empirically supported benefits of physical activity, the majority of breast cancer survivors do not meet recommended guidelines for physical activity. A variety of effective strategies to increase physical activity in breast cancer survivors have been identified. However, it is unknown which of these strategies is most effective or how these strategies might be combined to optimize intervention effectiveness.
• Gerber, D. E., Hamann, H. A., Santini, N. O., Abbara, S., Chiu, H., McGuire, M., Quirk, L., Zhu, H., & Lee, S. J. (2017). Patient navigation for lung cancer screening in an urban safety-net system: Protocol for a pragmatic randomized clinical trial. Contemporary clinical trials, 60, 78-85.
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  The National Lung Screening Trial demonstrated improved lung cancer mortality with annual low-dose computed tomography (CT) screening, leading to lung cancer screening endorsement by the United States Preventive Services Task Force and coverage by the Centers for Medicare and Medicaid. Adherence to annual CT screens in that trial was 95%, which may not be representative of real-world, particularly medically underserved populations. This pragmatic trial will determine the effect of patient-focused, telephone-based patient navigation on adherence to CT-based lung cancer screening in an urban safety-net population. 340 adults who meet standard eligibility for lung cancer screening (age 55-77years, smoking history≥30 pack-years, quit within 15years if former smoker) are referred through an electronic medical record-based order by physicians in community- and hospital-based primary care settings within the Parkland Health and Hospital System in Dallas County, Texas. Eligible patients are randomized to usual care or patient navigation, which addresses adherence, patient-reported barriers, smoking cessation, and psycho-social concerns related to screening completion. Patients complete surveys and semi-structured interviews at baseline, 6-month, and 18-month follow-ups to assess attitudes toward screening. The primary endpoint of this pragmatic trial is adherence to three sequential, prospectively defined steps in the screening protocol. Secondary endpoints include self-reported tobacco use and other patient-reported outcomes. Results will provide real-world insight into the impact of patient navigation on adherence to CT-based lung cancer screening in a medically underserved population. This study was registered with the NIH ClinicalTrials.gov database (NCT02758054) on April 26, 2016.
• Riley, K. E., Ulrich, M. R., Hamann, H. A., & Ostroff, J. S. (2017). Decreasing Smoking but Increasing Stigma? Anti-tobacco Campaigns, Public Health, and Cancer Care. AMA journal of ethics, 19(5), 475-485.
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  Public health researchers, mental health clinicians, philosophers, and medical ethicists have questioned whether the public health benefits of large-scale anti-tobacco campaigns are justified in light of the potential for exacerbating stigma toward patients diagnosed with lung cancer. Although there is strong evidence for the public health benefits of anti-tobacco campaigns, there is a growing appreciation for the need to better attend to the unintended consequence of lung cancer stigma. We argue that there is an ethical burden for creators of public health campaigns to consider lung cancer stigma in the development and dissemination of hard-hitting anti-tobacco campaigns. We also contend that health care professionals have an ethical responsibility to try to mitigate stigmatizing messages of public health campaigns with empathic patient-clinician communication during clinical encounters.
• Hamann, H. A., Ostroff, J. S., Marks, E. G., Gerber, D. E., Schiller, J. H., & Lee, S. J. (2014). Stigma among patients with lung cancer: a patient-reported measurement model. Psycho-oncology, 23(1), 81-92.
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  Although stigma may have negative psychosocial and behavioral outcomes for patients with lung cancer, its measurement has been limited. A conceptual model of lung cancer stigma and a patient-reported outcome measure are needed to mitigate these sequelae. This study identified key stigma-related themes to provide a blueprint for item development through a thematic analysis of semi-structured interviews and focus groups with lung cancer patients.
• Makris, U. E., Melhado, T., Lee, S. C., Hamann, H. A., Walke, L. M., Gill, T. M., & Fraenkel, L. (2014). Illness representations of restricting back pain: the older Person’s perspective. Pain medicine (Malden, Mass.), 15(6), 938-46.
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  Back pain is the most common type of pain reported by older adults, leading to considerable morbidity and cost. Yet little is known about the segment of the population ≥80 years old that can be used to guide care in this age group. Illness representations provide a useful framework to understand older adults' beliefs and perceptions of their back pain. The objective of this study was to understand illness representations of back pain, severe enough to restrict activity (restricting back pain).
• Croom, A. R., Hamann, H. A., Kehoe, S. M., Paulk, E., & Wiebe, D. J. (2013). Illness perceptions matter: understanding quality of life and advanced illness behaviors in female patients with late-stage cancer. The journal of supportive oncology, 11(4), 165-73.
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  Patients with late-stage cancer are living longer, making it important to understand factors that contribute to maintaining quality of life (QOL) and completing advanced illness behaviors (eg, advance directives).
• Hamann, H. A., Lee, J. W., Schiller, J. H., Horn, L., Wagner, L. I., Chang, V. T., & Fisch, M. J. (2013). Clinician perceptions of care difficulty, quality of life, and symptom reports for lung cancer patients: an analysis from the Symptom Outcomes and Practice patterns (SOAPP) study. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 8(12), 1474-83.
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  Despite recent therapeutic advances, lung cancer is a difficult disease to manage. This study assessed clinicians' perceptions of care difficulty, quality of life (QOL), and symptom reports for their lung cancer patients compared with their patients with breast, prostate, and colon cancer.
• Hamann, H. A., Tiro, J. A., Sanders, J. M., Melhado, T. V., Funk, R. K., Carpentier, M. Y., Bartholomew, L. K., Argenbright, K. E., & Vernon, S. W. (2013). Validity of self-reported genetic counseling and genetic testing use among breast cancer survivors. Journal of cancer survivorship : research and practice, 7(4), 624-9.
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  Despite the value of genetic counseling (GC) and genetic testing (GT) for high-risk breast cancer survivors, little is known about their uptake and validity of self-report data. This study evaluated the accuracy of self-reported genetic counseling and testing rates among breast cancer survivors.
• Gerber, D. E., Hamann, H. A., Rasco, D. W., Woodruff, S., & Lee, S. J. (2012). Patient comprehension and attitudes toward maintenance chemotherapy for lung cancer. Patient education and counseling, 89(1), 102-8.
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  Maintenance chemotherapy is a recently approved approach to the treatment of advanced non-small cell lung cancer (NSCLC). We sought to gain insight into patients' perceptions of maintenance chemotherapy using qualitative methods.
• Hamann, H. A., Smith, T. W., Smith, K. R., Croyle, R. T., Ruiz, J. M., Kircher, J. C., & Botkin, J. R. (2008). Interpersonal responses among sibling dyads tested for BRCA1/BRCA2 gene mutations. Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 27(1), 100-9.
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  The familial context plays an important role in psychosocial responses to genetic testing. The purpose of this study was to compare sibling pairs with different combinations of BRCA1/BRCA2 test results on measures of affect, interpersonal responses, and physiological reactions.
• Venne, V. L., & Hamann, H. A. (2007). Successful use of peer educators for sharing genetic information. Journal of genetic counseling, 16(4), 515-25.
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  This study examined the impact of a genetics education module provided by Reach to Recovery peer volunteers. Participants included 113 women with confirmed breast cancer diagnoses. Eighty-eight of these women (78%) completed a baseline survey, participated in a peer-led intervention, and completed a follow-up survey. Approximately half of the women received an education module that included a genetic component, while the other half did not. Results indicated that women who received the genetics module had greater increases in genetics knowledge than the group that did not receive the module. However, follow-up interest in genetic testing was not significantly different between the two groups. Results indicate that a peer-led genetics module can increase knowledge about genetics. However, it does not appear to have a differential effect on genetic testing interest.
• Garofalo, J. P., Hamann, H. A., Ashworth, K., & Baum, A. (2006). Stress and quality of life in African American cancer survivors. Ethnicity & disease, 16(3), 732-8.
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  The quality of life (QOL) of cancer survivors must be investigated as we learn about the risks and protective factors associated with cancer survival. Little research has included African American cancer survivors, and this group could be more or less vulnerable to the added stress of cancer. By virtue of the greater stress burden imposed by minority status, lower socioeconomic status, and other social/ cultural factors, African Americans may be at increased risk for poor QOL and poor health outcomes. Alternatively, they may be protected from some of these negative outcomes. We propose a model to better understand the unique sociocultural features that influence QOL for certain cancer sites where racial disparities are well established. A comprehensive knowledge of QOL among these survivors will guide future research and facilitate the development of interventions to improve QOL, possibly reducing observed health disparities.
• Botkin, J. R., Smith, K. R., Croyle, R. T., Baty, B. J., Wylie, J. E., Dutson, D., Chan, A., Hamann, H. A., Lerman, C., McDonald, J., Venne, V., Ward, J. H., & Lyon, E. (2003). Genetic testing for a BRCA1 mutation: prophylactic surgery and screening behavior in women 2 years post testing. American journal of medical genetics. Part A, 118A(3), 201-9.
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  Mutations in the BRCA1 gene are associated with an increased risk of breast and ovarian cancer in carrier women. An understanding of behavioral responses to BRCA1 mutation testing by mutation carriers and non-carriers is important to guide the clinical application of this new technology. This study examined the utilization of genetic testing for a BRCA1 mutation in high-risk individuals and the response of tested women with respect to interventions for early cancer detection and prevention. This study assessed the utilization of genetic testing for both men and women in a large kindred and the behavioral responses by women with respect to use of health care interventions during the 2 years following testing. Participants were offered BRCA1 mutation testing. Surveillance behaviors related to breast and ovarian cancer were assessed by computer-assisted telephone interviews at baseline (prior to genetic counseling and testing), 1-2 weeks, 4-6 months, 1 and 2 years after the provision of test results. Mutation carriers, non-carriers, and individuals of unknown mutation status were compared to determine the impact of test results. Utilization of genetic testing for both men and women are reported and, for women, mammography, breast self-exam, clinical breast exam, mastectomy, oophorectomy, transvaginal ultrasound, and CA125 screening were assessed. Of those fully informed of the opportunity for testing, 55% of the women and 52% of the men pursued genetic testing. With respect to mammography for women 40 years and older, 82% of mutation carriers obtained a mammogram in each year following testing compared to 72% of non-carrier women the first year and 67% the second year. This mammography utilization represents a significant increase over baseline for both mutation carriers and non-carriers. Younger carrier women also significantly increased their mammography utilization from baseline. Overall, 29% of the carrier women did not obtain a single mammogram by 2 years post-testing. At 2 years, 83% of the carrier women and 74% of the non-carriers reported adherence to recommendations for breast self-exam and over 80% of carrier women had obtained a clinical breast examination each year following testing. None of the carrier women had obtained a prophylactic mastectomy by 2 years after testing, although 11% were considering this procedure. Of carrier women 25 years of age and older who had at least one intact ovary at the time of testing, 46% of carriers had obtained an oophorectomy 2 years after testing, including 78% of women 40 years of age and older. The majority of carrier women (73%) had discussed their genetic test results with a medical doctor or health care provider. Our results indicate utilization of genetic testing by a majority of high-risk individuals who received information about testing. Both carriers and non-carriers increased their utilization of mammography and breast self-exam following testing. Oophorectomy was obtained by a large proportion of carrier women in contrast to mastectomy which was not utilized within the first 2 years following testing.
• Lerman, C., Croyle, R. T., Tercyak, K. P., & Hamann, H. (2002). Genetic testing: psychological aspects and implications. Journal of consulting and clinical psychology, 70(3), 784-97.
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  As the number of genes associated with inherited disease continues to grow, researchers and practitioners in behavioral medicine will encounter complex psychological issues faced by individuals at risk for these diseases. A review of the literature concerning prenatal, carrier, and predictive genetic testing suggests that the severity of psychological risks posed by research-based genetic testing is not great. However, subgroups of individuals with particular psychological traits may be more vulnerable to adverse effects. Available data do not provide evidence that genetic testing promotes changes in health-related behaviors. Thus, although there may be less of a role for mental health professionals in the psychological counseling of genetic testing participants, there is a need for research and practice to facilitate health protective behaviors in response to genetic risk information.