ONCOGENETIC AND DECISION MAKING PROCESS. MEN¿S ADHERENCE TO CASCADE SCREENING FOR HEREDITARY CANCER SYNDROMES.

Introduction. Pathogenic variants occurring in the BRCA1 and BRCA2 genes significantly increase the relative and absolute risks of developing breast, ovarian, prostate, pancreatic cancer, and melanoma. Clinical guidelines advocate for the use of cascade screening (CS) to increase the identification rates of at-risk family members and advance genetically targeted disease prevention. However, despite the benefits of CS, testing uptake is relatively low, particularly in at-risk men, for whom the decision-making process regarding CS appears to be influenced by familial rather than individual disease risk, emphasizing the role of familial obligation. Little is known about the motivational drives and psychological determinants of men’s adherence to CS, as well as about factors that hinder or enhance the implementation of CS in at-risk men in BRCA1/2 positive families. Methods. A mixed-method study has been developed to explore this understudied theme. Applying the Health Action Process Approach model, a longitudinal RCT study tested a) the effectiveness of two messages in promoting intention to adhere to CS in a sample of at-risk men, and b) a model of relationships on the adherence to CS. Additionally, a qualitative study was designed to explore facilitators and barriers for CS in not-yet-tested men. Results. The study found no significant differences in the impact of the two messages on the intention to adhere to CS. However, several noteworthy associations emerged, including links between the intention to adhere to CS and age, parental status, perceived risk of breast cancer, self-referred outcome expectancies, perceived benefits, coping self-efficacy, and planning. Intention was identified as a crucial mediator in the relationship between perceived benefits of genetic testing and planning of the action. From the qualitative study, several factors at the individual and interpersonal as well as provider levels, and a few factors at the environmental level, has been described as barriers and promoting factors to CS for HBOC. Conclusions. Our findings offer valuable insights for future interventions targeting at-risk male relatives. Gender-specific educational materials, continued education, and public awareness campaigns highlighting male involvement in HBOC syndrome, their cancer risk, and surveillance strategies are crucial for improving CS uptake. To address the challenges of low uptake, it is essential to explore alternative delivery methods, such as direct approaches where trained providers engage directly with at-risk male relatives, moving beyond traditional patient-mediated methods.