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Voils CI, Coffman CJ, Wu RR, Grubber JM, Fisher DA, Strawbridge EM, Sperber N, Wang V, Scheuner MT, Provenzale D, Nelson RE, Hauser E, Orlando LA, Goldstein KM. A Cluster Randomized Trial of a Family Health History Platform to Identify and Manage Patients at Increased Risk for Colorectal Cancer. J Gen Intern Med 2023; 38:1375-1383. [PMID: 36307642 PMCID: PMC10160317 DOI: 10.1007/s11606-022-07787-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/06/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Obtaining comprehensive family health history (FHH) to inform colorectal cancer (CRC) risk management in primary care settings is challenging. OBJECTIVE To examine the effectiveness of a patient-facing FHH platform to identify and manage patients at increased CRC risk. DESIGN Two-site, two-arm, cluster-randomized, implementation-effectiveness trial with primary care providers (PCPs) randomized to immediate intervention versus wait-list control. PARTICIPANTS PCPs treating patients at least one half-day per week; patients aged 40-64 with no medical conditions that increased CRC risk. INTERVENTIONS Immediate-arm patients entered their FHH into a web-based platform that provided risk assessment and guideline-driven decision support; wait-list control patients did so 12 months later. MAIN MEASURES McNemar's test examined differences between the platform and electronic medical record (EMR) in rates of increased risk documentation. General estimating equations using logistic regression models compared arms in risk-concordant provider actions and patient screening test completion. Referral for genetic consultation was analyzed descriptively. KEY RESULTS Seventeen PCPs were randomized to each arm. Patients (n = 252 immediate, n = 253 control) averaged 51.4 (SD = 7.2) years, with 83% assigned male at birth, 58% White persons, and 33% Black persons. The percentage of patients identified as increased risk for CRC was greater with the platform (9.9%) versus EMR (5.2%), difference = 4.8% (95% CI: 2.6%, 6.9%), p < .0001. There was no difference in PCP risk-concordant action [odds ratio (OR) = 0.7, 95% CI (0.4, 1.2; p = 0.16)]. Among 177 patients with a risk-concordant screening test ordered, there was no difference in test completion, OR = 0.8 [0.5,1.3]; p = 0.36. Of 50 patients identified by the platform as increased risk, 78.6% immediate and 68.2% control patients received a recommendation for genetic consultation, of which only one in each arm had a referral placed. CONCLUSIONS FHH tools could accurately assess and document the clinical needs of patients at increased risk for CRC. Barriers to acting on those recommendations warrant further exploration. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT02247336 https://clinicaltrials.gov/ct2/show/NCT02247336.
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Affiliation(s)
- Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
- Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA.
| | - Cynthia J Coffman
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - R Ryanne Wu
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | - Deborah A Fisher
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | - Nina Sperber
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Virginia Wang
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Maren T Scheuner
- San Francisco VA Health Care System, San Francisco, VA, USA
- Departments of Medicine and Pediatrics, University of California at San Francisco, San Francisco, CA, USA
| | - Dawn Provenzale
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Richard E Nelson
- Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Elizabeth Hauser
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Lori A Orlando
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Karen M Goldstein
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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2
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Kumerow MT, Rodriguez JL, Dai S, Kolor K, Rotunno M, Peipins LA. Prevalence of Americans reporting a family history of cancer indicative of increased cancer risk: Estimates from the 2015 National Health Interview Survey. Prev Med 2022; 159:107062. [PMID: 35460723 PMCID: PMC9162122 DOI: 10.1016/j.ypmed.2022.107062] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/06/2022] [Accepted: 04/15/2022] [Indexed: 11/27/2022]
Abstract
The collection and evaluation of family health history in a clinical setting presents an opportunity to discuss cancer risk, tailor cancer screening recommendations, and identify people with an increased risk of carrying a pathogenic variant who may benefit from referral to genetic counseling and testing. National recommendations for breast and colorectal cancer screening indicate that men and women who have a first-degree relative affected with these types of cancers may benefit from talking to a healthcare provider about starting screening at an earlier age and other options for cancer prevention. The prevalence of reporting a first-degree relative who had cancer was assessed among adult respondents of the 2015 National Health Interview Survey who had never had cancer themselves (n = 27,999). We found 35.6% of adults reported having at least one first-degree relative with cancer at any site. Significant differences in reporting a family history of cancer were observed by sex, age, race/ethnicity, educational attainment, and census region. Nearly 5% of women under age 50 and 2.5% of adults under age 50 had at least one first-degree relative with breast cancer or colorectal cancer, respectively. We estimated that 5.8% of women had a family history of breast or ovarian cancer that may indicate increased genetic risk. A third of U.S. adults who have never had cancer report a family history of cancer in a first-degree relative. This finding underscores the importance of using family history to inform discussions about cancer risk and screening options between healthcare providers and their patients.
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Affiliation(s)
- Marie T Kumerow
- Tanaq Support Services, LLC, 3201 C St Site 602, Anchorage, AK 99503, USA.
| | - Juan L Rodriguez
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S107-4, Atlanta, GA 30341, USA.
| | - Shifan Dai
- Cyberdata Technologies, Inc., 455 Springpark Pl # 300, Herndon, VA 20701, USA.
| | - Katherine Kolor
- Office of Genomics and Precision Public Health, Centers for Disease Control and Prevention, 2500 Century Parkway NE, MS V25-5, Atlanta, GA 30345, USA.
| | - Melissa Rotunno
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr RM 4E548, Bethesda, MD 20892, USA.
| | - Lucy A Peipins
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S107-4, Atlanta, GA 30341, USA.
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3
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Pitsios C, Petalas K, Dimitriou A, Parperis K, Gerasimidou K, Chliva C. Workup and Clinical Assessment for Allergen Immunotherapy Candidates. Cells 2022; 11:cells11040653. [PMID: 35203303 PMCID: PMC8870157 DOI: 10.3390/cells11040653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 02/06/2023] Open
Abstract
Allergen Immunotherapy (AIT) is a well-established, efficient, and safe way to treat respiratory and insect-venom allergies. After determining the diagnosis of the clinically relevant culprit allergen, AIT can be prescribed. However, not all patients are eligible for AIT, since some diseases/conditions represent contraindications to AIT use, as described in several guidelines. Allergists are often preoccupied on whether an extensive workup should be ordered in apparently healthy AIT candidates in order to detect contra-indicated diseases and conditions. These preoccupations often arise from clinical, ethical and legal issues. The aim of this article is to suggest an approach to the workup and assessment of the presence of any underlying diseases/conditions in patients with no case history before the start of AIT. Notably, there is a lack of published studies on the appropriate evaluation of AIT candidates, with no globally accepted guidelines. It appears that Allergists are mostly deciding based on their AIT training, as well as their clinical experience. Guidance is based mainly on experts’ opinions; the suggested preliminary workup can be divided into mandatory and optional testing. The evaluation for possible underlying neoplastic, autoimmune, and cardiovascular diseases, primary and acquired immunodeficiencies and pregnancy, might be helpful but only in subjects for whom the history and clinical examination raise suspicion of these conditions. A workup without any reasonable correlation with potential contraindications is useless. In conclusion, the evaluation of each individual candidate for possible medical conditions should be determined on a case-by-case basis.
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Affiliation(s)
| | - Konstantinos Petalas
- Department of Allergy and Clinical Immunology, 251 General Airforce Hospital, 155 61 Athens, Greece;
| | | | | | - Kyriaki Gerasimidou
- Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece;
| | - Caterina Chliva
- Allergy Unit, 2nd Department of Dermatology and Venereology, “Attikon” General University Hospital, 124 61 Haidari, Greece;
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4
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Association of Family History with the Development of Breast Cancer: A Cohort Study of 129,374 Women in KoGES Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126409. [PMID: 34199253 PMCID: PMC8296242 DOI: 10.3390/ijerph18126409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 11/17/2022]
Abstract
Background: Breast cancer is the most common cancer among women. The Korean Genome and Epidemiology Study (KoGES) is a large cohort study that is available to the public. Using this large cohort study, we aimed to unravel the relationship between breast cancer development and a family history of breast cancer in Korea. Methods: This cohort study relied on data from the KoGES from 2001 through 2013. A total of 211,725 participants were screened. Of these, 129,374 women were evaluated. They were divided into two groups, including participants with and without breast cancer. A logistic regression model was used to retrospectively analyze the odds ratio of breast cancer history in families of women with and without breast cancer. Results: Of 129,374 women, 981 had breast cancer. The breast cancer group had more mothers and siblings with histories of breast cancer (p < 0.001). A history of breast cancer in the participant’s mother resulted in an odds ratio of 3.12 (1.75–5.59), and a history of breast cancer in the participant’s sibling resulted in an odds ratio of 2.63 (1.85–3.74). There was no interaction between the history of maternal breast cancer and the history of sibling breast cancer. Based on the subgroup analysis, family history was a stronger factor in premenopausal women than in menopausal and postmenopausal women. Conclusions: A family history of breast cancer is a significant risk factor for breast cancer in Korea. Premenopausal women with a maternal history of breast cancer are of particular concern. Intensive screening and risk-reducing strategies should be considered for this vulnerable subpopulation.
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5
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MacInnis RJ, Knight JA, Chung WK, Milne RL, Whittemore AS, Buchsbaum R, Liao Y, Zeinomar N, Dite GS, Southey MC, Goldgar D, Giles GG, Kurian AW, Andrulis IL, John EM, Daly MB, Buys SS, Phillips KA, Hopper JL, Terry MB. Comparing 5-Year and Lifetime Risks of Breast Cancer using the Prospective Family Study Cohort. J Natl Cancer Inst 2020; 113:785-791. [PMID: 33301022 DOI: 10.1093/jnci/djaa178] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/06/2020] [Accepted: 10/13/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Clinical guidelines often use predicted lifetime risk from birth to define criteria for making decisions regarding breast cancer screening rather than thresholds based on absolute 5-year risk from current age. METHODS We used the Prospective Family Cohort Study of 14 657 women without breast cancer at baseline in which, during a median follow-up of 10 years, 482 women were diagnosed with invasive breast cancer. We examined the performances of the International Breast Cancer Intervention Study (IBIS) and Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) risk models when using the alternative thresholds by comparing predictions based on 5-year risk with those based on lifetime risk from birth and remaining lifetime risk. All statistical tests were 2-sided. RESULTS Using IBIS, the areas under the receiver-operating characteristic curves were 0.66 (95% confidence interval = 0.63 to 0.68) and 0.56 (95% confidence interval = 0.54 to 0.59) for 5-year and lifetime risks, respectively (Pdiff < .001). For equivalent sensitivities, the 5-year incidence almost always had higher specificities than lifetime risk from birth. For women aged 20-39 years, 5-year risk performed better than lifetime risk from birth. For women aged 40 years or older, receiver-operating characteristic curves were similar for 5-year and lifetime IBIS risk from birth. Classifications based on remaining lifetime risk were inferior to 5-year risk estimates. Results were similar using BOADICEA. CONCLUSIONS Our analysis shows that risk stratification using clinical models will likely be more accurate when based on predicted 5-year risk compared with risks based on predicted lifetime and remaining lifetime, particularly for women aged 20-39 years.
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Affiliation(s)
- Robert J MacInnis
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia
| | - Julia A Knight
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Wendy K Chung
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.,Departments of Pediatrics and Medicine, Columbia University, New York, NY, USA
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Alice S Whittemore
- Department of Health Research and Policy and of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Richard Buchsbaum
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Yuyan Liao
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Nur Zeinomar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Gillian S Dite
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia
| | - Melissa C Southey
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Parkville, Victoria, Australia
| | - David Goldgar
- Department of Dermatology and Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, USA
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Allison W Kurian
- Department of Medicine and Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | | | - Irene L Andrulis
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.,Department of Molecular Genetics and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Esther M John
- Department of Epidemiology & Population Health and Medicine and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Saundra S Buys
- Department of Medicine and Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, USA
| | - Kelly-Anne Phillips
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia
| | - Mary Beth Terry
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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6
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Clinical and Genetic Characteristics of Colorectal Cancer in Persons under 50 Years of Age: A Review. Dig Dis Sci 2019; 64:3059-3065. [PMID: 31055721 DOI: 10.1007/s10620-019-05644-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/24/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The incidence of colorectal cancer (CRC) in persons under the age of 50 years (EOCRC) is increasing even as the incidence of CRC in persons over age 50 is decreasing. This has led to recommendations to lower the age of CRC screening to age 45. It is not clear whether EOCRC is identical to CRCs in older patients or whether there are distinctive features between the two groups. AIMS AND METHODS We reviewed the literature on the clinical and genetic aspects of EOCRC. RESULTS We found that there is an increased likelihood of a strong genetic basis for EOCRC, but that at least 80% of cases do not come from the known high-penetrance cancer syndromes. Early-onset CRCs tend to occur in the distal colon or rectum, are more likely to be detected due to cancer-related symptoms, appear to be increasing in whites more than non-whites on a population-wide analysis, and are more likely to present in an advanced stage of disease. There are some unique genetic features of EOCRC, including an increased proportion of tumors with LINE-1 hypomethylation, and combined chromosomal and microsatellite stability. CONCLUSIONS EOCRC deserves additional attention because of the high number of life years at risk with EOCRC, and the implications for earlier CRC screening. Additional focus is needed on determining whether some cases of EOCRC have a unique mechanistic basis.
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7
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Breast cancer risk assessment: Evaluation of screening tools for genetics referral. J Am Assoc Nurse Pract 2019; 31:562-572. [PMID: 31425377 DOI: 10.1097/jxx.0000000000000272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The United States Preventative Services Task Force (USPSTF) recommends breast cancer risk-screening tools to help primary care providers determine which unaffected patients to refer to genetic specialists. The USPSTF does not recommend one tool above others. The purpose of this study was to compare tool performance in identifying women at risk for breast cancer. METHODS Pedigrees of 85 women aged 40-74 years with first-degree female relative with breast cancer were evaluated using five tools: Family History Screen-7 (FHS-7), Pedigree Assessment Tool, Manchester Scoring System, Referral Screening Tool, and Ontario Family History Assessment Tool (Ontario-FHAT). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to describe each tool's ability to identify women with elevated risk as defined by Claus Model calculations (lifetime risk ≥15%). Receiver operating curves were plotted. Differences between areas under the curve were estimated and compared through logistic regression to assess for differences in tool performance. CONCLUSIONS Claus calculations identified 14 of 85 women with elevated risk. Two tools, Ontario-FHAT and FHS-7, identified all women with elevated risk (sensitivity 100%). The FHS-7 tool flagged all participants (specificity 0%). The Ontario-FHAT flagged 59 participants as needing referral (specificity 36.2%) and had a NPV of 100%. Area under the curve values were not significantly different between tools (all p values > .05), and thus were not helpful in discriminating between the tools. IMPLICATIONS FOR PRACTICE The Ontario-FHAT outperformed other tools in sensitivity and NPV; however, low specificity and PPV must be balanced against these findings. Thus, the Ontario-FHAT can help determine which women would benefit from referral to genetics specialists.
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8
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Hamada T, Yuan C, Yurgelun MB, Perez K, Khalaf N, Morales-Oyarvide V, Babic A, Nowak JA, Rubinson DA, Giannakis M, Ng K, Kraft P, Stampfer MJ, Giovannucci EL, Fuchs CS, Ogino S, Wolpin BM. Family history of cancer, Ashkenazi Jewish ancestry, and pancreatic cancer risk. Br J Cancer 2019; 120:848-854. [PMID: 30867564 PMCID: PMC6474278 DOI: 10.1038/s41416-019-0426-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/25/2019] [Accepted: 02/27/2019] [Indexed: 02/07/2023] Open
Abstract
Background Individuals with a family history of cancer may be at increased risk of pancreatic cancer. Ashkenazi Jewish (AJ) individuals carry increased risk for pancreatic cancer and other cancer types. Methods We examined the association between family history of cancer, AJ heritage, and incident pancreatic cancer in 49 410 male participants of the prospective Health Professionals Follow-up Study. Hazard ratios (HRs) were estimated using multivariable-adjusted Cox proportional hazards models. Results During 1.1 million person-years (1986–2016), 452 participants developed pancreatic cancer. Increased risk of pancreatic cancer was observed in individuals with a family history of pancreatic (HR, 2.79; 95% confidence interval [CI], 1.28–6.07) or breast cancer (HR, 1.40; 95% CI, 1.01–1.94). There was a trend towards higher risk of pancreatic cancer in relation to a family history of colorectal cancer (HR, 1.21; 95% CI, 0.95–1.55) or AJ heritage (HR, 1.29; 95% CI, 0.94–1.77). The risk was highly elevated among AJ men with a family history of breast or colorectal cancer (HR, 2.61 [95% CI, 1.41–4.82] and 1.92 [95% CI, 1.05–3.49], respectively). Conclusion Family history of pancreatic cancer was associated with increased risk of this malignancy. Family history of breast or colorectal cancer was associated with the increased risk among AJ men.
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Affiliation(s)
- Tsuyoshi Hamada
- Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Chen Yuan
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Matthew B Yurgelun
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Kimberly Perez
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Natalia Khalaf
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Vicente Morales-Oyarvide
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Ana Babic
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Jonathan A Nowak
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Douglas A Rubinson
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Marios Giannakis
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.,Broad Institute of Massachusetts Institute of Technology and Harvard, 415 Main Street, Cambridge, MA, 02142, USA.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Kimmie Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Peter Kraft
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Meir J Stampfer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA, 02115, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Edward L Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA, 02115, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Charles S Fuchs
- Yale Cancer Center, 333 Cedar Street, New Haven, CT, 06510, USA.,Department of Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.,Smilow Cancer Hospital, 20 York Street, New Haven, CT, 06519, USA
| | - Shuji Ogino
- Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.,Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.,Broad Institute of Massachusetts Institute of Technology and Harvard, 415 Main Street, Cambridge, MA, 02142, USA
| | - Brian M Wolpin
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.
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Ersig AL, Werner-Lin A, Hoskins L, Young J, Loud JT, Peters J, Greene MH. Legacies and Relationships: Diverse Social Networks and BRCA1/2 Risk Management Decisions and Actions. JOURNAL OF FAMILY NURSING 2019; 25:28-53. [PMID: 30537877 PMCID: PMC6581043 DOI: 10.1177/1074840718815844] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
In families with hereditary breast/ovarian cancer, complex disease histories challenge established patterns of family communication and influence decision-making for clinical surveillance, genetic testing, and risk management. An interdisciplinary team examined longitudinal interview data from women with identified BRCA1/2 mutations to assess interactions within family and social networks about risk information communication and management. We used interpretive description to identify motivation, content, and derived benefit of these interactions. Participants discussed risk information and management strategies with biological and nonbiological network members for multiple purposes: discharging responsibility for risk information dissemination, protecting important relationships, and navigating decision trajectories. Evolving interactions with loved ones balanced long-standing family communication patterns with differing personal preferences for privacy or open sharing, whereas interactions with nonbiological network members expanded participants' range of choices for sources of risk management information. Ongoing assessment of social networks may help support engagement with risk management by aligning with patient social needs.
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Affiliation(s)
| | | | | | | | | | - June Peters
- National Institutes of Health, Bethesda, MD, USA
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10
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Abusamaan MS, Quillin JM, Owodunni O, Emidio O, Kang IG, Yu B, Ma B, Bailey L, Razzak R, Smith TJ, Bodurtha JN. The Role of Palliative Medicine in Assessing Hereditary Cancer Risk. Am J Hosp Palliat Care 2018; 35:1490-1497. [PMID: 29843526 PMCID: PMC6385866 DOI: 10.1177/1049909118778865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND: Hereditary cancer assessment and communication about family history risks can be critical for surviving relatives. Palliative care (PC) is often the last set of providers before death. METHODS: We replicated a prior study of the prevalence of hereditary cancer risk among patients with cancer receiving PC consultations, assessed the history in the electronic medical record (EMR), and explored patients' attitudes toward discussions about family history. This study was conducted at an academic urban hospital between June 2016 and March 2017. RESULTS: The average age of the 75 adult patients with cancer was 60 years, 49 (55%) male and 49 (65%) white. A total of 19 (25%) patients had no clear documentation of family history in the EMR, sometimes because no family history was included in the admission template or an automatically imported template lacked content. In all, 24 (32%) patients had high-risk pedigrees that merited referral to genetic services. And, 48 (64%) patients thought that PC was an appropriate venue to discuss the implications of family history. The mean comfort level in addressing these questions was high. CONCLUSIONS: At an academic center, 25% of patients had no family history documented in the EMR. And, 32% of pedigrees warranted referral to genetic services, which was rarely documented. There is substantial room for quality improvement for oncologists and PC specialists-often the last set of providers-to address family cancer risk before death and to increase use and ease of documenting family history in the EMR. Addressing cancer family history could enhance prevention, especially among high-risk families.
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Affiliation(s)
| | | | | | | | | | - Brandon Yu
- Johns Hopkins University, Baltimore MD, USA
| | | | | | - Rab Razzak
- Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Thomas J. Smith
- Johns Hopkins University School of Medicine, Baltimore MD, USA
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11
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Beebe-Dimmer JL, Yee C, Paskett E, Schwartz AG, Lane D, Palmer NRA, Bock CH, Nassir R, Simon MS. Family history of prostate and colorectal cancer and risk of colorectal cancer in the Women's health initiative. BMC Cancer 2017; 17:848. [PMID: 29237415 PMCID: PMC5729427 DOI: 10.1186/s12885-017-3873-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 12/04/2017] [Indexed: 12/21/2022] Open
Abstract
Background Evidence suggests that risk of colorectal and prostate cancer is increased among those with a family history of the same disease, particularly among first-degree relatives. However, the aggregation of colorectal and prostate cancer within families has not been well investigated. Methods Analyses were conducted among participants of the Women’s Health Initiative (WHI) observational cohort, free of cancer at the baseline examination. Subjects were followed for colorectal cancer through August 31st, 2009. A Cox-proportional hazards regression modeling approach was used to estimate risk of colorectal cancer associated with a family history of prostate cancer, colorectal cancer and both cancers among first-degree relatives of all participants and stratified by race (African American vs. White). Results Of 75,999 eligible participants, there were 1122 colorectal cancer cases diagnosed over the study period. A family history of prostate cancer alone was not associated with an increase in colorectal cancer risk after adjustment for confounders (aHR =0.94; 95% CI =0.76, 1.15). Separate analysis examining the joint impact, a family history of both colorectal and prostate cancer was associated with an almost 50% increase in colorectal cancer risk (aHR = 1.48; 95% CI = 1.04, 2.10), but similar to those with a family history of colorectal cancer only (95% CI = 1.31; 95% CI = 1.11, 1.54). Conclusions Our findings suggest risk of colorectal cancer is increased similarly among women with colorectal cancer only and among those with both colorectal and prostate cancer diagnosed among first-degree family members. Future studies are needed to determine the relative contribution of genes and shared environment to the risk of both cancers.
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Affiliation(s)
- Jennifer L Beebe-Dimmer
- Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, 48201, USA. .,Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, 48201, USA.
| | - Cecilia Yee
- Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, 48201, USA
| | - Electra Paskett
- Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA.,Department of Internal Medicine, School of Medicine, Columbus, OH, 43210, USA
| | - Ann G Schwartz
- Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, 48201, USA.,Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, 48201, USA
| | - Dorothy Lane
- Department of Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, New York, 11794, USA
| | - Nynikka R A Palmer
- Department of Medicine, University of California-San Francisco, San Francisco, California, 94110, USA
| | - Cathryn H Bock
- Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, 48201, USA.,Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, 48201, USA
| | - Rami Nassir
- Department of Biochemistry and Molecular Medicine, University of California-Davis, Davis, California, 95616, USA
| | - Michael S Simon
- Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, 48201, USA.,Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, 48201, USA
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12
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Şahin MK, Aker S. Family Physicians' Knowledge, Attitudes, and Practices Toward Colorectal Cancer Screening. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:908-913. [PMID: 27193411 DOI: 10.1007/s13187-016-1047-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The purpose of this study was to assess family physicians' knowledge, attitudes, and practices toward colorectal cancer (CRC) screening. The population in this cross-sectional study consisted of 290 family physicians working in Samsun, Turkey, contacted between 15 June and 15 July 2015 and agreeing to participate. A questionnaire prepared by the authors on the basis of the relevant literature was applied at face-to-face interviews. The first part of the questionnaire inquired into sociodemographic information, while the second contained questions evaluating family physicians' knowledge, attitudes, and practices toward CRC screening. Physicians completed the questionnaire in approximately 10 min. 65.9 % of the family physicians in the study were men. Mean age of the participants was 43.40 ± 6.54 years, and mean number of years in service was 18.43 ± 6.42. The average number of patients seen by physicians on a daily basis was 51-99. CRC screening was performed by 83.1 % of physicians. The fecal occult blood test (FOBT) was recommended at the correct frequency by 30.7 % of physicians and colonoscopy by 11.7 %. A further 68.6 % of physicians followed no CRC guideline. Only 3.8 % of those reporting using a guideline were able to name it. The great majority of physicians in this study apply CRC screening. However, family physicians lack sufficient information concerning the ages at which screening tests should be started and concluded and how frequently they should be performed. They also do not attach sufficient importance to CRC guidelines. This results in excessive demand for screening tests.
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Affiliation(s)
- Mustafa Kürşat Şahin
- Samsun Public Health Directorate, Canik Community Health Center, Gaziosmanpaşa Mah. Alaca Sok. No: 31, Canik, Samsun, Turkey.
| | - Servet Aker
- Samsun Public Health Directorate, Canik Community Health Center, Gaziosmanpaşa Mah. Alaca Sok. No: 31, Canik, Samsun, Turkey
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13
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Abstract
Colorectal cancer (CRC) contributes a major burden of cancer mortality in the United States. There are multiple effective screening approaches that can reduce CRC mortality. These approaches are supported by different levels of evidence, and each has its own advantages and disadvantages. Implementing a systematic approach to screening that addresses the multiple steps involved in the screening process is essential to improving population-level CRC screening. Offering patients stool-based screening is important for increasing screening uptake. However, programs that offer stool testing must support the population health infrastructure needed to promote adherence to repeat testing and follow-up of abnormal tests.
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Affiliation(s)
- Alison T Brenner
- Cecil G Sheps Center for Health Services Research, University of North Carolina, 725 Martin Luther King Jr Boulevard, CB# 7590, Chapel Hill, NC 27599-7590, USA.
| | - Michael Dougherty
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, 4182 Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, NC 27599-6134, USA
| | - Daniel S Reuland
- Division of General Internal Medicine, Department of Medicine, University of North Carolina, 725 Martin Luther King Jr Boulevard, CB# 7590, Chapel Hill, NC 27599-7590, USA
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14
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Ogunsanya ME, Brown CM, Odedina FT, Barner JC, Adedipe TB, Corbell B. Knowledge of Prostate Cancer and Screening Among Young Multiethnic Black Men. Am J Mens Health 2017; 11:1008-1018. [PMID: 28139152 PMCID: PMC5675316 DOI: 10.1177/1557988316689497] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study was to assess the knowledge of prostate cancer and screening and its associated factors in young Black men aged 18 to 40 years. This was a cross-sectional study conducted in a convenience sample of 267 young Black men in Austin, Texas. Knowledge about prostate cancer and screening was operationalized through 14 items, including 12 items from the Knowledge about Prostate Cancer Screening Questionnaire (PC knowledge), and two items assessing dietary knowledge and prostate cancer screening controversy. PC knowledge scores were regressed on age, cues to action, health screening experience, and demographic/personal factors. Most participants were African American men of American origin (65.3%) and were college freshmen (18.9%). PC knowledge scores were low, with mean correct responses of 28.5%, mean knowledge score of 5.25 ± 3.81 (possible score range of 0 to 14, with higher scores indicating higher PC knowledge) and a median score of 5.00. On average, 47% of the respondents replied “Don’t Know” to the questions. Overall, PC knowledge scores were low among these young Black men, especially in domains related to risk factors, screening age guidelines, limitations, and diet. It is thus important that these men be educated more on these important domains of prostate cancer and screening so that the decision to screen or not will be an informed one. Health screening experience, residence area, major field of study, and academic classification were significant predictors of knowledge.
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15
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Lowery JT, Ahnen DJ, Schroy PC, Hampel H, Baxter N, Boland CR, Burt RW, Butterly L, Doerr M, Doroshenk M, Feero WG, Henrikson N, Ladabaum U, Lieberman D, McFarland EG, Peterson SK, Raymond M, Samadder NJ, Syngal S, Weber TK, Zauber AG, Smith R. Understanding the contribution of family history to colorectal cancer risk and its clinical implications: A state-of-the-science review. Cancer 2016; 122:2633-45. [PMID: 27258162 PMCID: PMC5575812 DOI: 10.1002/cncr.30080] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 01/08/2016] [Accepted: 01/15/2016] [Indexed: 12/14/2022]
Abstract
Persons with a family history (FH) of colorectal cancer (CRC) or adenomas that are not due to known hereditary syndromes have an increased risk for CRC. An understanding of these risks, screening recommendations, and screening behaviors can inform strategies for reducing the CRC burden in these families. A comprehensive review of the literature published within the past 10 years has been performed to assess what is known about cancer risk, screening guidelines, adherence and barriers to screening, and effective interventions in persons with an FH of CRC and to identify FH tools used to identify these individuals and inform care. Existing data show that having 1 affected first-degree relative (FDR) increases the CRC risk 2-fold, and the risk increases with multiple affected FDRs and a younger age at diagnosis. There is variability in screening recommendations across consensus guidelines. Screening adherence is <50% and is lower in persons under the age of 50 years. A provider's recommendation, multiple affected relatives, and family encouragement facilitate screening; insufficient collection of FH, low knowledge of guidelines, and poor family communication are important barriers. Effective interventions incorporate strategies for overcoming barriers, but these have not been broadly tested in clinical settings. Four strategies for reducing CRC in persons with familial risk are suggested: 1) improving the collection and utilization of the FH of cancer, 2) establishing a consensus for screening guidelines by FH, 3) enhancing provider-patient knowledge of guidelines and communication about CRC risk, and 4) encouraging survivors to promote screening within their families and partnering with existing screening programs to expand their reach to high-risk groups. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2633-2645. © 2016 American Cancer Society.
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Affiliation(s)
- Jan T Lowery
- Colorado School of Public Health, Aurora, Colorado
| | - Dennis J Ahnen
- School of Medicine and Gastroenterology of the Rockies, University of Colorado, Boulder, Colorado
| | - Paul C Schroy
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Heather Hampel
- Comprehensive Cancer Center, Ohio State University, Columbus, Ohio
| | | | | | - Randall W Burt
- Huntsman Cancer Institute, University of Utah Health Care, Salt Lake City, Utah
| | - Lynn Butterly
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | | | - W Gregory Feero
- Maine Dartmouth Family Medicine Residency Program, Augusta, Maine
| | | | - Uri Ladabaum
- Stanford University School of Medicine, Stanford, California
| | | | | | - Susan K Peterson
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - N Jewel Samadder
- Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah
| | | | | | - Ann G Zauber
- Memorial Sloan Kettering Cancer Center, New York, New York
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16
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Boone PM. Adolescents, Family History, and Inherited Disease Risk: An Opportunity. Pediatrics 2016; 138:peds.2016-0579. [PMID: 27371759 DOI: 10.1542/peds.2016-0579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Philip M Boone
- Boston Combined Residency Program in Pediatrics, Boston, Massachusetts and Harvard Medical School Genetics Training Program, Boston, Massachusetts
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17
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Nurmsoo S. Significance and reporting of incidental findings concerning family medical history. Am J Med Genet A 2015; 167A:2865. [DOI: 10.1002/ajmg.a.37237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 06/22/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Sean Nurmsoo
- Department of Pediatrics; Dalhousie University; Halifax Canada
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18
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A primary care audit of familial risk in patients with a personal history of breast cancer. Fam Cancer 2015; 13:591-4. [PMID: 25096803 DOI: 10.1007/s10689-014-9737-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Breast cancer is the most common cancer diagnosed in women, both in the UK and worldwide. A small proportion of women are at very high risk of breast cancer, having a particularly strong family history. The National Institute for Health and Clinical Excellence (NICE) has advised that practitioners should not, in most instances, actively seek to identify women with a family history of breast cancer. An audit was undertaken at an urban primary care practice of 15,000 patients, using a paper-based, self-administered questionnaire sent to patients identified with a personal history of breast cancer. The aim of this audit was to determine whether using targeted screening of relatives of patients with breast cancer to identify familial cancer risk is worthwhile in primary care. Since these patients might already expected to have been risk assessed following their initial diagnosis, this audit acts as a quality improvement exercise. The audit used a validated family history questionnaire and risk assessment tool as a screening approach for identifying and grading familial risk in line with the NICE guidelines, to guide referral to the familial cancer screening service. The response rate to family history questionnaires was 54 % and the majority of patients responded positively to their practitioner seeking to identify familial cancer risks in their family. Of the 57 returned questionnaires, over a half (54 %) contained pedigrees with individuals eligible for referral. Patients and their relatives who are often registered with the practice welcome the discussion. An appropriate referral can therefore be made. The findings suggest a role for primary care practitioners in the identification of those at higher familial risk. However integrated systems and processes need designing to facilitate this work.
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19
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Koeneman MM, Kruse AJ, Sep SJS, Gubbels CS, Slangen BFM, van Gorp T, Lopes A, Gomez-Garcia E, Kruitwagen RFPM. A family history questionnaire improves detection of women at risk for hereditary gynecologic cancer: a pilot study. Fam Cancer 2015; 13:469-75. [PMID: 24633857 DOI: 10.1007/s10689-014-9711-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Pilot study to evaluate whether the use of a standardized questionnaire to document family history of cancer improves identification of women who warrant referral to cancer genetic services (CGS) for increased risk of hereditary cancer, compared to their identification in usual care. Prospective intervention study with historic control group. Gynecology outpatient clinic, Maastricht University Medical Centre, the Netherlands. The prospective intervention group consisted of new outpatients between June 1 and August 1, 2011. The historic control group consisted of new outpatients between May 1, 2009 and April 30, 2010. A standardized questionnaire based on established referral criteria for hereditary breast/ovarian cancer and Lynch syndrome was completed for the intervention group. The referral rate in routine consultation, based on non-standardized family history recording, was determined retrospectively for the control group. The difference in referral rate between intervention and control group, tested by Chi square test. In the control group, 8 of 3,036 women (0.26 %) were referred to CGS. In the intervention group, 209 (42 %) of 500 screening questionnaires were completed. Nineteen women (9, 1 %) met the referral guidelines, of which 5 were newly referred to CGS (2, 4 %). Referral rates differed significantly (p < 0.001) between the two groups. This pilot study shows that the routine use of a screening questionnaire may improve detection and referral rate to CGS of individuals at risk for hereditary cancer. Improving genetic literacy of physicians and use of web-site questionnaires deserve attention in future studies.
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Affiliation(s)
- Margot M Koeneman
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Postbus 5800, 6202 AZ, Maastricht, The Netherlands,
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20
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Cancer family history triage: a key step in the decision to offer screening and genetic testing. Fam Cancer 2014; 12:497-502. [PMID: 23238844 DOI: 10.1007/s10689-012-9589-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The Macmillan Cancer Family History Service in Teesside has provided genetic risk assessment for individuals with a personal or family history of cancer since 2004. We sought to examine the effect of risk assessment on patient management, with particular emphasis on referral for clinical screening and selection of families for tertiary genetics assessment. The degree of concordance between the initial risk assignment (using diagnoses reported by the family) and final risk assignment (using confirmed diagnoses) was no greater than 72.3 % in 1,363 breast cancer families; a similar effect was seen in 764 colorectal cancer families (77.3 %). Clinically important risk reassignment occurred at the three key stages in the risk assessment pathway. Overall, genetic risk was reassigned in almost 30 % of colorectal families and 20 % of breast cancer families, resulting in a change in screening recommendation and/or referral for tertiary genetic assessment. Careful, detailed family history assessment, with confirmation of reported diagnoses where it may affect risk assignment, is an important process for the point of view of patient management and resource allocation.
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21
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Quillin JM, Krist AH, Gyure M, Corona R, Rodriguez V, Borzelleca J, Bodurtha JN. Patient-reported hereditary breast and ovarian cancer in a primary care practice. J Community Genet 2014; 5:179-83. [PMID: 23872790 PMCID: PMC3955454 DOI: 10.1007/s12687-013-0161-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 07/05/2013] [Indexed: 02/07/2023] Open
Abstract
Identifying women appropriate for cancer genetic counseling referral depends on patient-reported family history. Understanding predictors of reporting a high-risk family is critical in ensuring compliance with current referral guidelines. Our objectives were to (1) assess prevalence of candidates for BRCA1 and BRCA2 counseling referral in a primary care setting, (2) explore associations with high-risk status and various patient (e.g., race) and family structure (e.g., number of relatives) characteristics, and (3) determine whether high-risk patients had genetic counseling and/or testing. Survey and pedigree data were collected between 2010 and 2012 for 486 Women's Health Clinic patients. Analyses in 2013 investigated perceived cancer risk and worry, family structure, and receipt of genetic counseling. We explored whether these were associated with meeting USPSTF guidelines for genetic counseling referral. Twenty-two (4.5 %) women met the criteria for BRCA referral. Only one of these women had previous genetic counseling, and one reported prior genetic testing. Older women were more likely to meet BRCA referral criteria (P < 0.001). Although perceived risk was higher among high-risk women, 27 % of high-risk women felt their breast cancer risk was "low", and 32 % felt their risk was lower than average. About one in 22 women in primary care may require genetics services for hereditary breast and ovarian cancer, but alarmingly, few actually receive these services. Also, a significant proportion do not perceive that they are at increased risk. Educational interventions may be needed for both providers and patients to increase awareness of familial risk and appropriate genetic counseling services.
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Affiliation(s)
- John M Quillin
- Department of Human and Molecular Genetics, Virginia Commonwealth University, 1101 E. Marshall St, Richmond, VA, 23298-0033, USA,
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22
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Lu KH, Wood ME, Daniels M, Burke C, Ford J, Kauff ND, Kohlmann W, Lindor NM, Mulvey TM, Robinson L, Rubinstein WS, Stoffel EM, Snyder C, Syngal S, Merrill JK, Wollins DS, Hughes KS. American Society of Clinical Oncology Expert Statement: collection and use of a cancer family history for oncology providers. J Clin Oncol 2014; 32:833-40. [PMID: 24493721 PMCID: PMC3940540 DOI: 10.1200/jco.2013.50.9257] [Citation(s) in RCA: 176] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Karen H. Lu
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Marie E. Wood
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Molly Daniels
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Cathy Burke
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - James Ford
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Noah D. Kauff
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Wendy Kohlmann
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Noralane M. Lindor
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Therese M. Mulvey
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Linda Robinson
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Wendy S. Rubinstein
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Elena M. Stoffel
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Carrie Snyder
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Sapna Syngal
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Janette K. Merrill
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Dana Swartzberg Wollins
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Kevin S. Hughes
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
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Carney PA, O'Malley JP, Gough A, Buckley DI, Wallace J, Fagnan LJ, Morris C, Mori M, Heintzman JD, Lieberman D. Association between documented family history of cancer and screening for breast and colorectal cancer. Prev Med 2013; 57:679-84. [PMID: 24029558 PMCID: PMC4041693 DOI: 10.1016/j.ypmed.2013.08.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 08/28/2013] [Accepted: 08/31/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous research on ascertainment of cancer family history and cancer screening has been conducted in urban settings. PURPOSE To examine whether documented family history of breast or colorectal cancer is associated with breast or colorectal cancer screening. METHODS Medical record reviews were conducted on 3433 patients aged 55 and older from four primary care practices in two rural Oregon communities. Data collected included patient demographic and risk information, including any documentation of family history of breast or colorectal cancer, and receipt of screening for these cancers. RESULTS A positive breast cancer family history was associated with an increased likelihood of being up-to-date for mammography screening (OR 2.09, 95% CI 1.45-3.00 relative to a recorded negative history). A positive family history for colorectal cancer was associated with an increased likelihood of being up-to-date with colorectal cancer screening according to U.S. Preventive Services Task Force low risk guidelines for males (OR 2.89, 95% CI 1.15-7.29) and females (OR 2.47, 95% CI 1.32-4.64) relative to a recorded negative family history. The absence of any recorded family cancer history was associated with a decreased likelihood of being up-to-date for mammography screening (OR 0.70, 95% CI 0.56-0.88 relative to recorded negative history) or for colorectal cancer screening (OR 0.75, 95% CI 0.60-0.96 in females, OR 0.68, 95% CI 0.53-0.88 in males relative to recorded negative history). CONCLUSION Further research is needed to determine if establishing routines to document family history of cancer would improve appropriate use of cancer screening.
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Affiliation(s)
- Patricia A Carney
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA; Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR, USA.
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van Altena AM, van Aarle S, Kiemeney LALM, Hoogerbrugge N, Massuger LFAG, de Hullu JA. Adequacy of family history taking in ovarian cancer patients: a population-based study. Fam Cancer 2013; 11:343-9. [PMID: 22388872 PMCID: PMC3496539 DOI: 10.1007/s10689-012-9518-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The aim of this study was to evaluate the adequacy of family history taking in epithelial ovarian cancer (EOC) patients and to identify factors that determine adequacy. Furthermore, the validity of family history taking was assessed by comparison with self-administered questionnaires. Medical records of all 1,112 EOC patients registered by the nation-wide cancer registry and diagnosed in eleven Dutch hospitals between 1996 and 2006 were reviewed. Adequate family history taking was defined as a written notification of the presence or absence of relatives with breast or ovarian cancer. Factors that were correlated with family history taking were identified using univariable and multivariable logistic regression. 147 patients filled in a postal questionnaire. An adequate family history was taken in 41% of all cases. Younger age, an academic hospital and having undergone surgery and/or chemotherapy were associated with adequate family history taking. The comparison with self-administered questionnaires showed a disagreement in 64% mainly due to missing data in medical records. Documentation on family history is either absent or inadequate in the medical records in the majority of EOC patients. These data urge for better uptake of hereditary cancer risk assessment. Different strategies for this assessment like improved family history taking and genetic testing in EOC patients should be explored.
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Affiliation(s)
- Anne M van Altena
- Department of Obstetrics and Gynecology, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Mitchell JA, Hawkins J, Watkins DC. Factors Associated With Cancer Family History Communication Between African American Men and Their Relatives. ACTA ACUST UNITED AC 2013; 21:97-111. [PMID: 31289433 DOI: 10.3149/jms.2102.97] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
African American men bear a disproportionately high burden from cancer in the U.S. The American Cancer Society reports that for all cancer sites combined, African American men are 32% more likely to die than white men (American Cancer Society, 2011). Having a family history of cancer elevates an individual's risk for the disease and should inform decision-making around the use of specific cancer screening tests as well as earlier onset and frequency of cancer screening. Adult African American men who attended an annual hospital-based community health fair in the Midwest which targeted minority men, were approached to complete a paper-based survey. Participants were asked "have you ever talked with any of your relatives about your family history of cancer (about any members of your family who have been diagnosed with cancer)?" Predictors were evaluated using bivariate analysis and logistic regression; they included socio-demographic, health access, health behavior, health status, and communication variables. Participants were 558 African American men with a mean age of 54 years old. African American men were most likely to have ever discussed their family history of cancer with a relative if they had specific knowledge of their family history of cancer and if they had ever talked to a physician about their family history of cancer. For African American men with a familial predisposition to cancer, further examination of barriers and facilitators to discussion with relatives, specifically those related to health access and knowledge, is warranted.
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Wood ME, Flynn BS, Stockdale A. Primary care physician management, referral, and relations with specialists concerning patients at risk for cancer due to family history. Public Health Genomics 2013; 16:75-82. [PMID: 23328214 DOI: 10.1159/000343790] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 09/17/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Risk stratification based on family history is a feature of screening guidelines for a number of cancers and referral guidelines for genetic counseling/testing for cancer risk. AIMS Our aim was to describe primary care physician perceptions of their role in managing cancer risk based on family history. METHODS Structured interviews were conducted by a medical anthropologist with primary care physicians in 3 settings in 2 north-eastern states. Transcripts were systematically analyzed by a research team to identify major themes expressed by participants. RESULTS Forty interviews were conducted from May 2003 through May 2006. Physicians provided a diversity of views on roles in management of cancer risk based on family history, management practices and patient responses to risk information. They also provided a wide range of perspectives on criteria used for referral to specialists, types of specialists referred to and expected management roles for referred patients. CONCLUSION Some primary care physicians appeared to make effective use of family history information for cancer risk management, but many in this sample did not. Increased focus on efficient assessment tools based on recognized guidelines, accessible guides to management options, and patient education and decision aids may be useful directions to facilitate broader use of family history information for cancer risk management.
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Affiliation(s)
- M E Wood
- Division of Hematology/Oncology, Department of Family Medicine, College of Medicine, University of Vermont, Burlington, VT 05405, USA.
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27
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Ogino S, Nishihara R, Lochhead P, Imamura Y, Kuchiba A, Morikawa T, Yamauchi M, Liao X, Qian ZR, Sun R, Sato K, Kirkner GJ, Wang M, Spiegelman D, Meyerhardt JA, Schernhammer ES, Chan AT, Giovannucci E, Fuchs CS. Prospective study of family history and colorectal cancer risk by tumor LINE-1 methylation level. J Natl Cancer Inst 2013; 105:130-40. [PMID: 23175808 PMCID: PMC3545905 DOI: 10.1093/jnci/djs482] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/27/2012] [Accepted: 10/18/2012] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Beyond known familial colorectal cancer (CRC) syndromes, the mechanisms underlying the elevated CRC risk associated with CRC family history remain largely unknown. A recent retrospective study suggests familial clustering of CRC with hypomethylation in long interspersed nucleotide element 1 (LINE-1). We tested the hypothesis that CRC family history might confer a higher risk of LINE-1 methylation-low CRC. METHODS Using the Nurses' Health Study and the Health Professionals Follow-up Study, we prospectively examined the association between CRC family history and the risk of rectal and colon cancer (N = 1224) according to tumor LINE-1 methylation level by duplication method Cox proportional hazards regression. We examined microsatellite instability (MSI) status to exclude the influence of Lynch syndrome. All statistical tests were two-sided. RESULTS The association between CRC family history and non-MSI CRC risk differed statistically significantly by LINE-1 methylation level (P (heterogeneity) = .02). CRC family history was associated with a statistically significantly higher risk of LINE-1 methylation-low non-MSI cancer (multivariable hazard ratio [HR] = 1.68, 95% confidence interval [CI] = 1.19 to 2.38 for 1 vs 0 first-degree relatives with CRC; multivariable HR = 3.48, 95% CI = 1.59 to 7.6 for ≥2 vs 0 first-degree relatives with CRC; P (trend) < .001). In contrast, CRC family history was not statistically significantly associated with LINE-1 methylation-high non-MSI cancer (P (trend) = .35). CONCLUSIONS This molecular pathological epidemiology study shows that CRC family history is associated with a higher risk of LINE-1 methylation-low CRC, suggesting previously unrecognized heritable predisposition to epigenetic alterations. Additional studies are needed to evaluate tumor LINE-1 methylation as a molecular biomarker for familial cancer risk assessment.
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Affiliation(s)
- Shuji Ogino
- Center for Molecular Oncologic Pathology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, 450 Brookline Ave, Rm JF-215C, Boston, MA 02215, USA.
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Khoury MJ, Coates RJ, Fennell ML, Glasgow RE, Scheuner MT, Schully SD, Williams MS, Clauser SB. Multilevel research and the challenges of implementing genomic medicine. J Natl Cancer Inst Monogr 2012; 2012:112-20. [PMID: 22623603 DOI: 10.1093/jncimonographs/lgs003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Advances in genomics and related fields promise a new era of personalized medicine in the cancer care continuum. Nevertheless, there are fundamental challenges in integrating genomic medicine into cancer practice. We explore how multilevel research can contribute to implementation of genomic medicine. We first review the rapidly developing scientific discoveries in this field and the paucity of current applications that are ready for implementation in clinical and public health programs. We then define a multidisciplinary translational research agenda for successful integration of genomic medicine into policy and practice and consider challenges for successful implementation. We illustrate the agenda using the example of Lynch syndrome testing in newly diagnosed cases of colorectal cancer and cascade testing in relatives. We synthesize existing information in a framework for future multilevel research for integrating genomic medicine into the cancer care continuum.
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Affiliation(s)
- Muin J Khoury
- Office of Public Health Genomics, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop E61, Atlanta, GA 30333, USA.
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Abstract
In this paper I will review different aspects of genetic risk in the context of preconception care. I restrict myself to the knowledge of risk which is relevant for care and/or enables reproductive choice. The paper deals with chromosomes, genes and the genetic classification of diseases, and it explains why Mendelian disorders frequently do not show the expected pattern of occurrence in families. Factors that amplify genetic risk are also discussed. Of the two methods of genetic risk assessment—history taking and genetic screening—the former method is examined to some extent, and the consequences of an inadequate family history are illustrated in a case report. The paper ends with a review of the sparse literature available on the frequency of a positive family history and an outline of the challenges and rewards faced by professionals when confronted with a positive history.
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Cunningham AP, Antoniou AC, Easton DF. Clinical software development for the Web: lessons learned from the BOADICEA project. BMC Med Inform Decis Mak 2012; 12:30. [PMID: 22490389 PMCID: PMC3507671 DOI: 10.1186/1472-6947-12-30] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 03/27/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the past 20 years, society has witnessed the following landmark scientific advances: (i) the sequencing of the human genome, (ii) the distribution of software by the open source movement, and (iii) the invention of the World Wide Web. Together, these advances have provided a new impetus for clinical software development: developers now translate the products of human genomic research into clinical software tools; they use open-source programs to build them; and they use the Web to deliver them. Whilst this open-source component-based approach has undoubtedly made clinical software development easier, clinical software projects are still hampered by problems that traditionally accompany the software process. This study describes the development of the BOADICEA Web Application, a computer program used by clinical geneticists to assess risks to patients with a family history of breast and ovarian cancer. The key challenge of the BOADICEA Web Application project was to deliver a program that was safe, secure and easy for healthcare professionals to use. We focus on the software process, problems faced, and lessons learned. Our key objectives are: (i) to highlight key clinical software development issues; (ii) to demonstrate how software engineering tools and techniques can facilitate clinical software development for the benefit of individuals who lack software engineering expertise; and (iii) to provide a clinical software development case report that can be used as a basis for discussion at the start of future projects. RESULTS We developed the BOADICEA Web Application using an evolutionary software process. Our approach to Web implementation was conservative and we used conventional software engineering tools and techniques. The principal software development activities were: requirements, design, implementation, testing, documentation and maintenance. The BOADICEA Web Application has now been widely adopted by clinical geneticists and researchers. BOADICEA Web Application version 1 was released for general use in November 2007. By May 2010, we had > 1200 registered users based in the UK, USA, Canada, South America, Europe, Africa, Middle East, SE Asia, Australia and New Zealand. CONCLUSIONS We found that an evolutionary software process was effective when we developed the BOADICEA Web Application. The key clinical software development issues identified during the BOADICEA Web Application project were: software reliability, Web security, clinical data protection and user feedback.
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Affiliation(s)
- Alex P Cunningham
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
| | - Antonis C Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
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Pyeritz RE. The family history: the first genetic test, and still useful after all those years? Genet Med 2011; 14:3-9. [PMID: 22237427 DOI: 10.1038/gim.0b013e3182310bcf] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The family history has its origins in genealogy and over the past century has become embedded in clinical practice. Its importance in specialized circumstances is unquestioned but largely untested. Moreover, the relevance of the family history to common diseases, especially in an era of genomic markers that convey risk and the emphasis on "personalized medicine," must be given careful scrutiny. Given the time and expertise needed to obtain and interpret the family history, without a clearer sense of clinical validity and utility, its role will likely diminish. The time to perform the requisite investigations is now.
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Affiliation(s)
- Reed E Pyeritz
- Center for the Integration of Genetic Healthcare Technologies, Departments of Medicine and Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Revisiting family history. Nat Rev Clin Oncol 2011; 8:507. [DOI: 10.1038/nrclinonc.2011.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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