Should genetic testing for adult onset disease be extended to children? Parent perceptions of the risks and benefits of testing children for BRCA1/2

Genetic testing to quantify risks for adult-onset disease is not currently recommended for children. Yet, given the promise of genetic medicine, debate continues over the risks and benefits of testing of minor children (<18YO) for predisposition to adult disease. Many parents (37%) who have had BRCA1/2 testing support testing minors in response to dichotomous query. Parent negative BRCA1/2 test result (p= 0.02), parent male gender (p=0.03) and minority race (p=0.01) are associated with supporting testing minors. To further explore these associations and parents' reported reasons to support or oppose testing minors, we evaluated open-ended responses from interviews with 238 parents. These additional analyses suggest that parents report similar reasons for supporting or opposing testing minors, but weight them differently based on their own test results. Parents with true negative results describe opportunities to foster preventive health behaviors at higher frequencies (43%) than parents with other test results (7.5-13%). Fathers opposing testing exclusively described the lack of medical indication, while mothers more frequently reported psychological risks to testing minors. Non-white participants endorsed medical benefits (45%) at higher rates than white participants (26%). These analyses suggest that biospychosocial factors and genetic test experiences may impact how parents perceive and weight the risks and benefits of testing minors. Parent opinions regarding testing minors remain divided and further research is needed to evaluate the perceived risks and benefits of providing genetic risk information and genetic testing to minors for adult-onset disease is needed to inform clinical practice and guidelines.