A rapid genetic counselling and testing in newly diagnosed breast cancer is associated with high rate of risk-reducing mastectomy in BRCA1/2-positive Italian women.

BACKGROUND: Risk-reducing mastectomy (RRM) decreases breast cancer (BC) risk in BRCA1/2 mutation carriers by up to 95%, but the Italian attitude towards this procedure is reluctant. PATIENTS AND METHODS: This is an observational study with retrospective design, using quantitative and qualitative research methods, aimed at evaluating the attitude towards RRM by rapid genetic counselling and testing (RGCT), at the time of BC diagnosis, compared with traditional genetic counselling and testing (TGCT), after previous BC surgery. Secondary aims were to investigate patient satisfaction after RRM and the rate of occult tumour in healthy breasts. A total of 1168 patients were evaluated: 1058 received TGCT, whereas 110 underwent RGCT. RESULTS: In TGCT, among 1058 patients, 209 (19.7%) mutation carriers were identified, with the rate of RRM being 4.7% (10 of 209). Conversely in RGCT, among 110 patients, 36 resulted positive, of which, 15 (41.7%) underwent bilateral mastectomy at the BC surgery time, showing an overall good satisfaction, measured by interpretative phenomenological analysis 12 months after the intervention. CONCLUSIONS: Our study shows that RGCT in patients with a hereditary profile is associated with a high rate of RRM at the BC surgery time, this being the pathway offered within a multidisciplinary organization.

[Psychological issues related to multiple sclerosis]. / Aspetti psicologici dello sclerosi multipla.

This study sought to investigate some psychological issues related to multiple sclerosis (MS), in particular, the relations existing between illness representations, personality factors and coping strategies and, consequently, the specific coping strategies employed in adjusting emotionally to MS. Sixty-nine MS patients attending the University Polyclinic of Modena were administered the following battery: a questionnaire regarding demographic and illness features, the Illness Perception Questionnaire-Revised (IPQ-R), the Coping Orientations to Problems Experienced Questionnaire (COPE) and Cognitive Behavioural Assessment Hospital Form (CBA-H). Patients' physical disability level was also evaluated using the Expanded Disability Status Scale (EDSS). Results suggest that personality factors and patients' perception of their illness play an important role in activating one or other type of coping strategy. Regarding problem-focused coping strategies, the most significant predictors that emerged from stepwise linear multiple regression analysis were perception of the disease as cyclical (timeline cyclical dimension) and a low score in neuroticism, indicating good emotional stability of the subject. For emotion-centered coping strategies, the regression model identified as best predictors: the belief that chance or bad luck are the most important causes of the illness, perception of the disease as cyclical, extroversion and a cooperative mode of interacting with others, and the presence of interpersonal difficulties. Finally, with regard to disadaptive coping strategies, the best predictors resulting from the analysis were, once again, perception of the disease as cyclical, and interpersonal difficulties.