Willingness of Chinese Breast Cancer Patients for Their Children to Undergo BRCA1/2 Genetic Testing and Associated Factors

Xue Yu,1,* Min Wu,2,* Lei Liu,3 Chun Zhang1 1Department of Breast Surgery, Peking University International Hospital, Beijing, People’s Republic of China; 2Department of Breast & Thyroid Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China; 3Department of Pathology, Peking University International Hospital, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chun Zhang, Department of Breast Surgery, Peking University International Hospital, Beijing, People’s Republic of China, Email chunzhang11@126.com Lei Liu, Department of Pathology, Peking University International Hospital, Beijing, People’s Republic of China, Email liulei1@pkuih.edu.cnBackground: Pathogenic variants in BRCA1/2 are important risk factors for breast cancer. However, little is known about whether Chinese breast cancer patients are willing for their children to undergo genetic testing. This study assessed patients’ knowledge and attitudes toward genetic testing and risk management, and identified factors associated with willingness for their children to undergo BRCA1/2 testing.Methods: A questionnaire-based survey was conducted among 608 newly diagnosed breast cancer patients at Peking University International Hospital between May 2020 and May 2025. Participants were asked whether they would be willing for their children to undergo BRCA1/2 genetic testing. Factors associated with reported willingness were analyzed using multivariable logistic regression.Results: The mean age was 51.8 ± 12.3 years (range, 22– 87 years). Most participants were married (96.9%) and had children (89.8%). Overall, 57.6% correctly recognized that breast cancer can be hereditary, while 37.2% were uncertain and 5.3% believed it was not hereditary. Only 61.7% knew that men can also develop breast cancer, and 42.2% did not correctly understand the relationship between pathogenic variants and breast cancer risk. Although 51.8% had heard of Angelina Jolie’s preventive mastectomy, only 23.2% had received genetic risk counseling from healthcare professionals. Overall, 67.4% reported willingness for their children to undergo BRCA1/2 testing. Older age (OR=0.976, 95% CI: 0.960– 0.992; P=0.003) and having only sons (OR=0.310, 95% CI: 0.142– 0.677; P=0.003) were independently associated with lower reported willingness, whereas awareness of the Angelina Jolie effect was associated with greater reported willingness (OR=2.036, 95% CI: 1.360– 3.048; P=0.001).Conclusion: Chinese breast cancer patients showed limited awareness of hereditary breast cancer risk. Several demographic and sociocultural factors were associated with reported willingness for children to undergo BRCA1/2 testing. These findings may help inform family-centered genetic counseling and hereditary cancer education in China.Keywords: breast cancer, BRCA1/2, genetic testing