Journal of Experimental & Clinical Cancer Research 2008, 27:75 http://www.jeccr.com/content/27/1/75 investigation does not improve ones quality of life (25%), higher levels of depression were seen compared to the subjects who, on the contrary, believed genetic analysis could improve the quality of life (p = 0.06). Eighteen per- cent were not sure of the aim of the genetic test, 7% felt that early diagnosis was a "waste of time" and moreover, this group had significantly higher levels of anxiety and depression compared to those who believed early diagno- sis to be useful(p = 0.02; p = 0.01). Ten percent of the sub- jects, felt that genetic testing was of no value as they were already symptomatic. Discussion According to available literature, certain similarities and even novelties in the psychosocial variables emerged in this Italian sample compared to subjects in other coun- tries who take advantage of oncological-genetic counsel- ling. For the risk perception variable, in agreement with previous works, [4,16,22,23], we found a high risk percep- tion of developing a tumour of the breast and/or ovaries and a high risk perception of being carrier of the genetic mutation BRCA1/BRCA2. Our sample showed a similar correlation between anxiety and risk perception found in literature. Literature reports [23,25,26] that a high level of psychological distress combined with high risk perception were both found to be predictors of the decision to undergo the genetic test. Whereas, in our study, the sub- jects discontinued genetic counselling despite the high level and combination of psychological distress and risk perception. One possible explanation of this discrepancy could be found in the retrospective design of the study. The sometime late request of informations about the dis- continuation and assessment of psychological distress could neither represent a punctual picture of the accuracy of the counsellor intervention, nor correlate emotional perturbations at the first step of genetic counselling. How- ever, the discontinuation from genetic counselling in spite of a high risk perception could be also explained by taking into account the difference between general distress and specific cancer distress. In fact, the latter unease about the onset of a tumour would seem to be useful in activating health orientated behaviour [23,26], in particular when associated with a high risk perception. [23,27]. On the contrary, high general distress (measured in this study with HADs) indicated refusal to undergo genetic testing, thereby reflecting and generating fatalism [28] about the future. The possibility that the high level of general dis- tress found in these subjects (disorders of adjustment and borderline anxiety) was one of the obstacles in the deci- sion to continue counselling is corroborated also by the high percentage of the same individuals who felt that genetic testing was "a waste of time" because it would not prevent the onset of the disease or improve the quality of their lives. Of interest, the subjects who have higher levels of anxiety and depression perceived that the testing and early diagnosis is of no use. This was in agreement with the hypothesis in literature that the perceived lack of con- trol over ones health combined with a high level of gen- eral distress seems to lead to avoidance or a sense of fatalism towards prevention [4]. As is true for oncological genetic testing, so it is for Huntington's syndrome [29,30], where the awareness of having a mutation is of no help in changing the course of the disease. In the latter case a refusal to undergo genetic testing is often found when the subjects have a high level of general distress caused by anxiety and depression [31]. Often, the possibility of pro- tecting one's children through awareness of their risk and prevention, is a major factor in the decision to undergo genetic testing [2,4,8,10]. Given this, the lack of motiva- tion to undergo genetic testing in this sample may be explained by the perception of not being able to protect their children, as they see it to be useless for cancer pre- vention. Therefore, it can be hypothesised that a positive correlation between the level of anxiety and number of children may depend on the perception of not being able to protect them. Furthermore, for the subjects who found genetic testing to be of no avail because they were already symptomatic, a lack of knowledge regarding preventive measures for themselves or their family can also be hypothesised. This data would seem to give further sup- port to the continuing attention paid in literature to the necessity of educational sessions of genetic counselling, which highlight the importance of diagnosis and the pos- sibly of adhering to check-up-surveillance programs. A high percentage of subjects feel incapable of handling their emotions regarding any eventual negative informa- tion about themselves or their family, the necessity to undergo frequent screening and the knowledge of being at a higher risk of developing breast or ovarian cancer. The latter data, frequently reported in literature, would confirm that the "anticipated emotional response" seen as unmanageable and insupportable, is one of the most fre- quent variables hindering the decision to undergo genetic testing. [5,32]. A large percentage of subjects claim they do not have the time to undergo testing, and it is interesting to note that they are mainly women who have reported the loss or absence of a partner (divorced, separate, wid- ows and single). Furthermore, even certain émpasse of an organisational form, such as the distance from the hospi- tal to the home, or busy phone lines seem to have an influence in the discontinuation of counselling, In agree- ment with literature, the number of family members affected by cancer is of great relevance regarding onco- genetic testing, in fact, the subjects with the least number of affected relatives say they do not wish to know whether or not they have a genetic mutation. Another very relevant variable which has a positive influence over the decision to undergo testing, is being able to count on the support of, and good communication within the family [4,11,24]. Page 6 of 8 (page number not for citation purposes)