A new population screening program for BRCA mutations in Israel – Attitudes and barriers among Ashkenazi Jewish women

Abstract

Israeli Jewish women of Ashkenazi ancestry have a high BRCA mutation carrier rate. Therefore, recently, Israel included free genetic testing among all Jewish women with Ashkenazi ancestry, 25 yrs. and older in its public health system. The aim of this study was to assess the intention of eligible women to be tested for BRCA mutations, and to find factors that may affect their decision. We distributed an online survey to a panel of participants in a commercial research institute. The survey included socio-demographic characteristics, attitudes towards preventive actions, views related to benefits and limitations of performing the BRCA test, worry regarding cancer morbidity, knowledge about breast cancer morbidity and hereditary breast cancer genetics. The survey concluded with a question regarding the woman’s interest in undergoing the BRCA test. The results showed that among the 506 respondents, 250 (49%) were interested in BRCA testing, 42 (8%) objected and 214 (43%) were undecided. In comparing the undecided to the other groups, we found that most presented a positive attitude towards screening tests and preventive medicine, they showed acceptable knowledge about the proposed test, and yet were interested in learning and further expanding the knowledge and the consequences of doing the test. Most respondents of all groups expressed concern of breast cancer morbidity and were reluctant to perform the test for reasons of reducing uncertainty, implications for children and implications for their own health. Within all groups, many women expressed their desire to consult with a medical professional about the test. We conclude that aiming to improve the performance of BRCA genetic testing, women need a thorough explanation about its implications. The main way to inform them would be by medical professionals, especially in primary care. This implies that front line nurses and physicians need to become more knowledgeable and committed to this subject.