Psychological Impact of BRCA Genetic Testing: Analysis of Positive and Negative Affect Changes according to Test Results.

BRCA1/2 genetic testing may provoke complex emotional reactions that extend beyond simple relief or distress. This study examined affective changes before and after testing and identified demographic, clinical, and familial factors associated with these responses using overall and facet-level scores from the Positive and Negative Affect Schedule (PANAS). A total of 640 individuals undergoing BRCA1/2 testing were enrolled between 2018 and 2025; 392 with complete pre- and post-test PANAS data were included. Changes in affect were modeled according to test result (positive versus negative/variant of uncertain significance [VUS]), age, menopausal status, personal cancer history, and family cancer history. Facet-level analyses explored discrete emotions. Distinct affective patterns were observed. Among 41 to 60-year-olds, positive affect decreased in BRCA-negative/VUS participants, whereas negative affect increased in BRCA-positive individuals. Postmenopausal women and participants with a cancer history who received negative/VUS results showed reduced positive affect. In contrast, BRCA-positive individuals with cancer histories exhibited increases in both positive and negative affect. Absence of family cancer history was linked to reduced positive affect after negative/VUS results. Facet analyses showed diminished self-assurance and greater guilt in negative/VUS participants, and heightened fear, hostility, guilt, and distress in BRCA-positive individuals. BRCA testing elicits heterogeneous emotional responses shaped by test results, cancer history, and demographic and familial factors. Facet-level analysis revealed nuanced shifts in discrete emotions-such as decreased self-assurance in non-carriers and heightened fear and guilt in carriers-highlighting the need for tailored, culturally informed genetic counseling, while acknowledging that these findings reflect short-term affective responses and result-related uncertainty.