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Almanzar A, Dahmani SL, Shoucair S, Alnajjar SR, Zheng KH, Gupta VK, Lisle DM. Low Rates of Colorectal Cancer Screening in First-Degree Relatives of Our Patients: Are We Failing Them? Dis Colon Rectum 2024; 67:903-910. [PMID: 38502565 DOI: 10.1097/dcr.0000000000003189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Guidelines recommend screening those with a family history of early-onset colorectal cancer at age 40 years or 10 years before the age of their relative's diagnosis. Currently, there is no literature reporting the screening rate in these individuals, and no protocols are in place to identify and target this population for screening awareness. OBJECTIVE This study aimed to assess adherence to current screening guidelines among first-degree relatives of patients with early-onset colorectal cancer. DESIGN Retrospective and qualitative study involving a telephone survey where patients were asked about relative's screening status and barriers to screening. SETTINGS Two community-based institutions between January 2018 and December 2021. PATIENTS Individuals diagnosed with early-onset colorectal cancer who had undergone surgery at our institutions. MAIN OUTCOME MEASURES Rate of screening in first-degree relatives of our patients with early-onset colorectal cancer. Other factors measured included demographics, clinicopathologic characteristics, and screening barriers. RESULTS Thirty-six patients were identified. The survey response rate was 66.6% (n = 24). A total of 88 first-degree relatives who met the screening criteria resulted in 67.1% of patients (n = 59) having a known screening status. Of the 59 patients with known screening status, only 44% (n = 26) had undergone screening. Patients of Black race, having stage III/IV disease, having Medicare/Medicaid insurance, and living within Baltimore City County were more likely to have family members with unknown or no screening. Lack of insurance coverage was the most common barrier, which was noted in 12.5% of patients (n = 3), whereas 54.1% of patients (n = 13) reported no barriers to screening. LIMITATIONS Retrospective design. CONCLUSIONS Most first-degree relatives of patients diagnosed with early-onset colorectal cancer do not undergo colorectal cancer screening. This could be attributed to the lack of protocols that could guarantee these individuals are informed of their elevated risk and the different options available for screening. Furthermore, our study suggests that racial and socioeconomic disparities exist among high-risk patients who should pursue screening. See Video Abstract . BAJAS TASAS DE DETECCIN DEL CNCER COLORRECTAL EN LOS FAMILIARES DE PRIMER GRADO DE NUESTROS PACIENTES LES ESTAMOS FALLANDO ANTECEDENTES:Las directrices recomiendan realizar pruebas de detección a las personas con antecedentes familiares de cáncer colorrectal de aparición temprana a los 40 años o 10 años antes de la edad del diagnóstico de su familiar. Actualmente, no hay literatura que informe la tasa de detección en estos individuos y no existen protocolos para identificar y dirigirse a esta población para concientizar sobre la detección.OBJETIVO:Evaluar el cumplimiento de las pautas de detección actuales entre los FDR de pacientes con cáncer colorrectal de aparición temprana.DISEÑO:Estudio retrospectivo y cualitativo que incluyó una encuesta telefónica en la que se preguntó a los pacientes sobre el estado de detección de sus familiares y las barreras para la detección.AJUSTES:Dos instituciones comunitarias entre enero de 2018 y diciembre de 2021.PACIENTES:Personas diagnosticadas con cáncer colorrectal de inicio temprano que habían sido intervenidas quirúrgicamente en nuestras instituciones.PRINCIPALES MEDIDAS DE RESULTADO:Tasa de detección en familiares de primer grado de nuestros pacientes con cáncer colorrectal de aparición temprana. Otros factores medidos incluyeron datos demográficos, características clínico-patológicas y barreras de detección.RESULTADOS:Se identificaron treinta y seis pacientes. La tasa de respuesta a la encuesta fue del 66,6% (n = 24). Resultaron un total de 88 familiares de primer grado que cumplieron con los criterios para la detección, y el 67,1% (n = 59) tenía un estado de detección conocido. De los 59 con estado de detección conocido, se informó que solo el 44% (n = 26) se había sometido a pruebas de detección. Los pacientes de raza afroamericana, enfermedad en etapa III/IV, Medicare/Medicaid y que vivían dentro del condado de la ciudad de Baltimore tenían más probabilidades de tener familiares con pruebas de detección desconocidas o sin ellas. La falta de cobertura de seguro fue la barrera más común observada por el 12,5% (n = 3); mientras que el 54,1% (n = 13) no informó ninguna barrera para el cribado.LIMITACIONES:Diseño retrospectivo.CONCLUSIONES:La mayoría de los familiares de primer grado de pacientes diagnosticados con cáncer colorrectal de aparición temprana no se someten a pruebas de detección de cáncer colorrectal. Esto podría atribuirse a la falta de protocolos que garanticen que estas personas estén informadas sobre su elevado riesgo y las diferentes opciones disponibles para el cribado. Además, nuestro estudio sugiere que existen disparidades raciales y socioeconómicas entre los pacientes de alto riesgo que deberían someterse a pruebas de detección. (Traducción-Dr. Francisco M. Abarca-Rendon).
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Affiliation(s)
- Anyelin Almanzar
- Department of General Surgery, Medstar Franklin Square Medical Center, Rossville, Maryland
| | - Sophia L Dahmani
- School of Medicine, Georgetown University, Washington, District of Columbia
| | - Sami Shoucair
- Department of General Surgery, Medstar Franklin Square Medical Center, Rossville, Maryland
| | - Said R Alnajjar
- Department of General Surgery, Medstar Franklin Square Medical Center, Rossville, Maryland
| | - Kan Hong Zheng
- Department of General Surgery, Medstar Franklin Square Medical Center, Rossville, Maryland
| | - Vinay K Gupta
- Department of General Surgery, Medstar Franklin Square Medical Center, Rossville, Maryland
| | - David M Lisle
- Department of General Surgery, Medstar Franklin Square Medical Center, Rossville, Maryland
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Chavez-Yenter D, Goodman MS, Chen Y, Chu X, Bradshaw RL, Lorenz Chambers R, Chan PA, Daly BM, Flynn M, Gammon A, Hess R, Kessler C, Kohlmann WK, Mann DM, Monahan R, Peel S, Kawamoto K, Del Fiol G, Sigireddi M, Buys SS, Ginsburg O, Kaphingst KA. Association of Disparities in Family History and Family Cancer History in the Electronic Health Record With Sex, Race, Hispanic or Latino Ethnicity, and Language Preference in 2 Large US Health Care Systems. JAMA Netw Open 2022; 5:e2234574. [PMID: 36194411 PMCID: PMC9533178 DOI: 10.1001/jamanetworkopen.2022.34574] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Clinical decision support (CDS) algorithms are increasingly being implemented in health care systems to identify patients for specialty care. However, systematic differences in missingness of electronic health record (EHR) data may lead to disparities in identification by CDS algorithms. OBJECTIVE To examine the availability and comprehensiveness of cancer family history information (FHI) in patients' EHRs by sex, race, Hispanic or Latino ethnicity, and language preference in 2 large health care systems in 2021. DESIGN, SETTING, AND PARTICIPANTS This retrospective EHR quality improvement study used EHR data from 2 health care systems: University of Utah Health (UHealth) and NYU Langone Health (NYULH). Participants included patients aged 25 to 60 years who had a primary care appointment in the previous 3 years. Data were collected or abstracted from the EHR from December 10, 2020, to October 31, 2021, and analyzed from June 15 to October 31, 2021. EXPOSURES Prior collection of cancer FHI in primary care settings. MAIN OUTCOMES AND MEASURES Availability was defined as having any FHI and any cancer FHI in the EHR and was examined at the patient level. Comprehensiveness was defined as whether a cancer family history observation in the EHR specified the type of cancer diagnosed in a family member, the relationship of the family member to the patient, and the age at onset for the family member and was examined at the observation level. RESULTS Among 144 484 patients in the UHealth system, 53.6% were women; 74.4% were non-Hispanic or non-Latino and 67.6% were White; and 83.0% had an English language preference. Among 377 621 patients in the NYULH system, 55.3% were women; 63.2% were non-Hispanic or non-Latino, and 55.3% were White; and 89.9% had an English language preference. Patients from historically medically undeserved groups-specifically, Black vs White patients (UHealth: 17.3% [95% CI, 16.1%-18.6%] vs 42.8% [95% CI, 42.5%-43.1%]; NYULH: 24.4% [95% CI, 24.0%-24.8%] vs 33.8% [95% CI, 33.6%-34.0%]), Hispanic or Latino vs non-Hispanic or non-Latino patients (UHealth: 27.2% [95% CI, 26.5%-27.8%] vs 40.2% [95% CI, 39.9%-40.5%]; NYULH: 24.4% [95% CI, 24.1%-24.7%] vs 31.6% [95% CI, 31.4%-31.8%]), Spanish-speaking vs English-speaking patients (UHealth: 18.4% [95% CI, 17.2%-19.1%] vs 40.0% [95% CI, 39.7%-40.3%]; NYULH: 15.1% [95% CI, 14.6%-15.6%] vs 31.1% [95% CI, 30.9%-31.2%), and men vs women (UHealth: 30.8% [95% CI, 30.4%-31.2%] vs 43.0% [95% CI, 42.6%-43.3%]; NYULH: 23.1% [95% CI, 22.9%-23.3%] vs 34.9% [95% CI, 34.7%-35.1%])-had significantly lower availability and comprehensiveness of cancer FHI (P < .001). CONCLUSIONS AND RELEVANCE These findings suggest that systematic differences in the availability and comprehensiveness of FHI in the EHR may introduce informative presence bias as inputs to CDS algorithms. The observed differences may also exacerbate disparities for medically underserved groups. System-, clinician-, and patient-level efforts are needed to improve the collection of FHI.
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Affiliation(s)
- Daniel Chavez-Yenter
- Huntsman Cancer Institute, University of Utah, Salt Lake City
- Department of Communication, University of Utah, Salt Lake City
| | - Melody S. Goodman
- School of Global Public Health, New York University, New York, New York
| | - Yuyu Chen
- School of Global Public Health, New York University, New York, New York
| | - Xiangying Chu
- School of Global Public Health, New York University, New York, New York
| | - Richard L. Bradshaw
- Department of Biomedical Informatics, University of Utah, Salt Lake City
- School of Medicine, University of Utah Health, Salt Lake City, Utah
| | | | | | - Brianne M. Daly
- Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Michael Flynn
- School of Medicine, University of Utah Health, Salt Lake City, Utah
| | - Amanda Gammon
- Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, Salt Lake City
- Department of Internal Medicine, University of Utah, Salt Lake City
| | - Cecelia Kessler
- Huntsman Cancer Institute, University of Utah, Salt Lake City
| | | | - Devin M. Mann
- Department of Population Health, New York University Grossman School of Medicine, New York University, New York, New York
| | - Rachel Monahan
- Perlmutter Cancer Center, NYU Langone Health, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York University, New York, New York
| | - Sara Peel
- Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City
| | | | - Saundra S. Buys
- Huntsman Cancer Institute, University of Utah, Salt Lake City
- Department of Internal Medicine, University of Utah, Salt Lake City
| | - Ophira Ginsburg
- Center for Global Health, National Cancer Institute, Rockville, Maryland
| | - Kimberly A. Kaphingst
- Huntsman Cancer Institute, University of Utah, Salt Lake City
- Department of Communication, University of Utah, Salt Lake City
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Underutilization of Lynch Syndrome Screening at Two Large Veterans Affairs Medical Centers. Dig Dis Sci 2020; 65:3305-3315. [PMID: 32500284 DOI: 10.1007/s10620-020-06340-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/12/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND Lynch syndrome (LS) is the most common hereditary colorectal cancer (CRC) syndrome, yet is grossly under-recognized. Multiple professional societies recommend screening all CRCs for LS by performing tumor testing. The veterans affairs system has not adopted universal tumor testing as a national performance metric and leaves screening for LS to clinical care at individual sites. AIMS Describe adherence to LS screening in the VA system. METHODS Dual-center, retrospective review of all CRCs diagnosed between 2010 and 2016. Rates of tumor testing, personal and family history of cancer were extracted from the medical record. Univariate and multivariate regression analysis was performed to determine predictors of tumor-based screening for LS. RESULTS A total of 421 cancers were reviewed. 15.1% of all cancers underwent either MSI and/or IHC for LS screening over the study period. There was improvement in LS screening from 3% of all CRCs in 2010 to 45% of all CRCs in 2016. 34% and 70% of patients did not have documentation of CRC in first- and second-degree relatives, respectively. Of the 73 patients who met one of the Revised Bethesda Criteria or had a PREMM1,2,6 score of ≥ 5, 34% and 56% underwent tumor testing, respectively. Younger age, non-Caucasian race, meeting Bethesda or PREMM1,2,6 criteria and right-sided tumor location were predictors of undergoing tumor testing. CONCLUSIONS CRC tumor screening for LS is grossly inadequate when left to routine clinical care. Our results lend support to implementation of reflexive universal tumor testing within the VA system.
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Kolb JM, Ahnen DJ, Samadder NJ. Evidenced-Based Screening Strategies for a Positive Family History. Gastrointest Endosc Clin N Am 2020; 30:597-609. [PMID: 32439091 PMCID: PMC7302941 DOI: 10.1016/j.giec.2020.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The most commonly recognized high-risk group for colorectal cancer (CRC) is individuals with a positive family history. It is generally recognized that those with a first-degree relative (FDR) with CRC are at a 2-fold or higher risk of CRC or advanced neoplasia. FDRs of patients with advanced adenomas have a similarly increased risk. Accordingly, all major US guidelines recommend starting CRC screening by age 40 in these groups. Barriers to screening this group include patient lack of knowledge on family and polyp history, provider limitations in collecting family history, and insufficient application of guidelines.
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Affiliation(s)
- Jennifer M. Kolb
- Division of Gastroenterology & Hepatology, University of Colorado Hospital, Anschutz Medical Campus, Aurora, CO, USA;,Corresponding author. Division of Gastroenterology & Hepatology, University of Colorado Hospital, Anschutz Medical Campus, 1635 Aurora Court, F735, Aurora, CO 80045.,
| | - Dennis J. Ahnen
- Division of Gastroenterology & Hepatology, University of Colorado Hospital, Anschutz Medical Campus, Aurora, CO, USA
| | - N. Jewel Samadder
- Division of Gastroenterology & Hepatology, Mayo Clinic, 5881 East Mayo Boulevard, Phoenix, AZ 85054, USA;,Department of Clinical Genomics, Mayo Clinic, Phoenix, AZ, USA
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Kolb JM, Molmenti CL, Patel SG, Lieberman DA, Ahnen DJ. Increased Risk of Colorectal Cancer Tied to Advanced Colorectal Polyps: An Untapped Opportunity to Screen First-Degree Relatives and Decrease Cancer Burden. Am J Gastroenterol 2020; 115:980-988. [PMID: 32618646 PMCID: PMC9351033 DOI: 10.14309/ajg.0000000000000639] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Advanced adenomas represent a subset of colorectal polyps that are known to confer an increased risk of colorectal neoplasia to the affected individual and their first-degree relatives (FDRs). Accordingly, professional guidelines suggest earlier and more intensive screening for FDRs of those with advanced adenomas similar to FDRs of those with colorectal cancer (CRC). Although the risk to family members is less clear among patients with advanced serrated polyps, they are often considered in the same category. Unfortunately, there is a growing concern that patients, endoscopists, and primary care providers are unaware of the familial risk associated with these polyps, leaving a wide gap in screening these high-risk individuals. Herein, we propose a standardized language around advanced colorectal polyps and present a detailed review of the literature on associated familial risk. We outline the challenges to implementing the current screening recommendations and suggest approaches to overcome these limitations, including a proposed new colonoscopy quality metric to capture communication of familial CRC risk. Improving screening in these high-risk groups has the potential to substantially reduce the burden of CRC.
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Affiliation(s)
- Jennifer M. Kolb
- Division of Gastroenterology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christine L. Molmenti
- Department of Occupational, Medicine, Epidemiology, and Prevention, Center for Health Innovations and Outcomes Research, Feinstein Institute for Medical Research, Hofstra/Northwell School of Medicine, Northwell Health, Manhasset, New York, USA
| | - Swati G. Patel
- Division of Gastroenterology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| | - David A. Lieberman
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon, USA
- Portland Veterans Affairs Medical Center, Portland, Oregon, USA
| | - Dennis J. Ahnen
- Division of Gastroenterology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Morrow A, Tucker KM, Shaw TJ, Parkinson B, Abraham C, Wolfenden L, Taylor N. Understanding implementation success: protocol for an in-depth, mixed-methods process evaluation of a cluster randomised controlled trial testing methods to improve detection of Lynch syndrome in Australian hospitals. BMJ Open 2020; 10:e033552. [PMID: 32540886 PMCID: PMC7299044 DOI: 10.1136/bmjopen-2019-033552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION In multisite intervention trials, implementation success often varies widely across settings. Process evaluations are crucial to interpreting trial outcomes and understanding contextual factors and causal chains necessary for successful implementation. Lynch syndrome is a hereditary cancer predisposition conferring an increased risk of colorectal, endometrial and other cancer types. Despite systematic screening protocols to identify Lynch syndrome, the condition remains largely underdiagnosed. The Hide and Seek Project ('HaSP') is a cluster randomised controlled trial determining the effectiveness of two approaches to improving Lynch syndrome detection at eight Australian hospital networks. To enhance widespread implementation of optimal Lynch syndrome identification, there is a need to understand not only what works, but also why, in what contexts, and at what costs. Here we describe an in-depth investigation of factors influencing successful implementation of procedures evaluated in the HaSP trial. METHODS AND ANALYSIS A mixed-methods, theory-driven process evaluation will be undertaken in parallel to the HaSP trial. Data will include: interviews of Implementation Leads and Lynch syndrome stakeholders, pre-post implementation questionnaires, audio analysis of meetings and focus groups, observation of multidisciplinary team meetings, fidelity checklists and project log analysis. Results will be triangulated and coded, drawing on the Theoretical Domains Framework, Consolidated Framework for Implementation Research and Proctor's implementation outcomes. ETHICS AND DISSEMINATION Use of a theory-based process evaluation will enhance interpretation and generalisability of HaSP trial findings, and contribute to the implementation research field by furthering understanding of the conditions necessary for implementation success. Ethical approval has been granted and results will be disseminated via publications in peer-reviewed journals and conference presentations. At trial completion, key findings will be fed back to sites to enable refinement of intervention strategies, both in the context of Lynch syndrome and for the possible generalisability of intervention components in other genetic and broader clinical specialties. HASP TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (Identifier: ACTRN12618001072202). Registered 27 June 2018. http://www.ANZCTR.org.au/ACTRN12618001072202.aspx.
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Affiliation(s)
- April Morrow
- Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
| | - Katherine M Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
- UNSW Prince of Wales Clinical School, Randwick, New South Wales, Australia
| | - Tim J Shaw
- Research in Implementation Science and eHealth (RISe), Faculty of Health Sciences, University of Sydney, Camperdown, New South Wales, Australia
| | - Bonny Parkinson
- The Macquarie University Centre for the Health Economy, Macquarie University, Macquarie, New South Wales, Australia
| | - Charles Abraham
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Natalie Taylor
- Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
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Jones S, Turton P, Achuthan R. Impact of family history risk assessment on surgical decisions and imaging surveillance at breast cancer diagnosis. Ann R Coll Surg Engl 2020; 102:590-593. [PMID: 32436722 DOI: 10.1308/rcsann.2020.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In June 2013, the National Institute for Health and Care Excellence (NICE) published guidance on the management of women with a family history (FH) of breast cancer (BC) and a personal diagnosis of BC. When diagnosed with BC, pressure of timely treatment takes priority and there is potential for a significant FH to be overlooked. This can affect treatment options and follow-up imaging (FUI) surveillance. METHODS The practice in our breast unit was compared with the NICE guidance with regard to arranging appropriate FUI and referral to the genetics team for women diagnosed with BC with a FH of BC. Data were obtained retrospectively on 200 women with BC, identified from the breast multidisciplinary team meetings from January to March 2014. Initial audit showed poor compliance with recording of FH. A standardised history taking proforma was produced for clinic use. A re-audit was conducted on a further 200 women between May and July 2016. RESULTS In the initial audit, FH was taken in 151 women (76%) compared with 174 women (87%) in the re-audit. Thirty-seven women (25%) were thought to be of moderate risk (MR) or high risk (HR) based on FH in the first audit. Re-audit identified 35 women (20%) with MR or HR FH. Under half (43%) of the women of HR were referred to the genetics team initially; this increased to 70% in the second audit. While almost half (46%) of the women with MR or HR had inappropriate FUI in the initial audit, this fell to 11% in the re-audit. CONCLUSIONS A proportion of women diagnosed with BC would fall into the MR or HR categories as defined in the NICE FH guidance. Inadequate recording of FH could result in inadequate FUI surveillance and in some cases missing the opportunity for a genetic referral to assess suitability for gene testing.
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Affiliation(s)
- S Jones
- Leeds Teaching Hospital NHS Trust, UK
| | - P Turton
- Leeds Teaching Hospital NHS Trust, UK
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Goh LH, Spigelman AD. Assessing the adherence to guidelines in Lynch syndrome patients: a pilot study. ANZ J Surg 2020; 90:1130-1135. [PMID: 32039553 DOI: 10.1111/ans.15690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 12/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cancer surveillance is important in the management of Lynch syndrome. In New South Wales, management guidelines for Lynch syndrome are published on the eviQ website. Benefits of cancer surveillance are maximized through adherence to guidelines. This has yet to be investigated in Sydney. Hence, this study aimed to determine the adherence rate of patients to these guidelines, assess their knowledge of the guidelines and determine potential factors hindering regular colonoscopies in these patients. METHODS A cross-sectional study was conducted among Lynch syndrome patients from the St Vincent's Hospital Cancer Genetics Unit, Sydney. Patients who appropriately fulfilled our inclusion criteria were mailed a questionnaire. The questionnaire was mailed twice to increase the response rate. Demographic and medical information were collected from patient medical records. Patient responses were analysed to determine adherence to the guidelines. RESULTS Sixty-two individuals were invited to participate in this study. Among them, 47 responded (76%) with two being excluded, due to potential confounding factors. Thirty (67%) had their colonoscopies at recommended intervals, while 15 (33%) had delays. Within these two groups, many were ultimately deemed non-adherent to the guidelines due to over-screening with other tests. In total, 31 (69%) participants were considered over-screening for cancer, leaving only seven (16%) participants fully adherent to the guidelines. Only three (7%) had knowledge of the eviQ guidelines. CONCLUSIONS Adherence to the eviQ guidelines was poor. The majority of participants were being over-screened for cancer. Knowledge of the guidelines needs to be improved.
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Affiliation(s)
- Li-Han Goh
- Faculty of Medicine, St Vincent's Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.,Cancer Genetics Unit, The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Allan D Spigelman
- Faculty of Medicine, St Vincent's Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.,Cancer Genetics Unit, The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, New South Wales, Australia
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Moss CA, Cojocaru E, Hanwell J, Ward S, Xu W, van Zyl M, O'Leary L, de Bono JS, Banerji U, Kaye SB, Minchom A, George AJ, Lopez J, McVeigh TP. Multidisciplinary interventions in a specialist Drug Development Unit to improve family history documentation and onward referral of patients with advanced cancer to cancer genetics services. Eur J Cancer 2019; 114:97-106. [PMID: 31078974 DOI: 10.1016/j.ejca.2019.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/26/2019] [Accepted: 04/02/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Molecular aberrations in cancer may represent therapeutic targets, and, if arising from the germline, may impact further cancer risk management in patients and their blood relatives. Annually, 600-700 patients are referred for consideration of experimental drug trials in the Drug Development Unit (DDU) in our institution. A proportion of patients may merit germline genetic testing because of suspicious personal/family history or findings of tumour-based testing. We aimed to assess the impact of different multidisciplinary interventions on family history taking and referral rates from DDU to Cancer Genetics Unit (CGU). METHODS Over 42 months, three interventions were undertaken at different intervals: (1) embedding a genetics provider in the DDU review clinic, (2) 'traffic light' system flagging cancers with a heritable component and (3) virtual multidisciplinary meeting (MDM). Comparative analyses between intervals were undertaken, including referral rates to CGU, investigations and patient outcomes. Family history taking in a sample of 20 patients managed in each interval was assessed by a retrospective chart review. RESULTS Frequency of family history taking and referral to CGU, increased with each intervention, particularly, the virtual MDM (40% vs 85%). Referral rates increased over the study period, from 0.1 referral/week (5/year, 0.36% total referrals) to 1.2/week (projected 63/year, 3.81%). Forty-four (52%) patients referred required germline testing; in three of whom, variants were identified. Non-attendance rates were low (6, 7%). CONCLUSION Patients in the DDU are unique, with long cancer histories and often short estimated life expectancy. Multidisciplinary working between CGU and DDU facilitates germline testing of those patients who may otherwise miss the opportunity.
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Affiliation(s)
- Cathryn A Moss
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, UK
| | - Elena Cojocaru
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Janet Hanwell
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Simon Ward
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, UK
| | - Wen Xu
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Mary van Zyl
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Lorraine O'Leary
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Johann S de Bono
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Udai Banerji
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Stan B Kaye
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Anna Minchom
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Angela J George
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, UK; Gynaecological Oncology Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, UK
| | - Juanita Lopez
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Terri P McVeigh
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, UK.
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10
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Allen CG, Roberts M, Guan Y. Exploring Predictors of Genetic Counseling and Testing for Hereditary Breast and Ovarian Cancer: Findings from the 2015 U.S. National Health Interview Survey. J Pers Med 2019; 9:E26. [PMID: 31083288 PMCID: PMC6616387 DOI: 10.3390/jpm9020026] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 04/26/2019] [Accepted: 04/29/2019] [Indexed: 12/13/2022] Open
Abstract
Despite efforts to increase the availability of clinical genetic testing and counseling for Hereditary Breast and Ovarian (HBOC)-related cancers, these services remain underutilized in clinical settings. There have been few efforts to understand the public's use of cancer genetic services, particularly for HBOC-related cancers. This analysis is based on data from the 2015 National Health Interview Survey (NHIS), a U.S.-based nationwide probability sample, to better understand the public's use of HBOC-related clinical cancer genetic services. Bivariate analyses were used to compute percentages and examine the associations of familial cancer risk for three genetic services outcomes (ever had genetic counseling for cancer risk, ever discussed genetic testing for cancer risk with a provider, and ever had genetic testing for cancer risk). Multivariable logistic regression models were used to estimate the association of familial cancer risk and other demographic and health variables with genetic services. Most women (87.67%) in this study were at low risk based on self-reported family history of breast and ovarian cancer, 10.65% were at medium risk, and 1.68% were at high risk. Overall, very small numbers of individuals had ever had genetic counseling (2.78%), discussed genetic testing with their physician (4.55%) or had genetic testing (1.64%). Across all genetic services outcomes, individuals who were at higher familial risk were more likely to have had genetic counseling than those at lower risk (high risk: aOR = 5.869, 95% CI = 2.911-11.835; medium risk: aOR = 4.121, 95% CI = 2.934-5.789), discussed genetic testing (high risk: aOR = 5.133, 95% CI = 2.699-9.764; medium risk: aOR = 3.649, 95% CI = 2.696-4.938), and completed genetic testing (high risk: aOR = 8.531, 95% CI = 3.666-19.851; medium risk aOR = 3.057, 95% CI = 1.835-5.094). Those who perceived themselves as being more likely to develop cancer than the average woman were more likely to engage in genetic counseling (aOR = 1.916, 95% CI = 1.334-2.752), discuss genetic testing (aOR = 3.314, 95% CI = 2.463-4.459) or have had genetic testing (aOR = 1.947, 95% CI = 1.13-3.54). Personal cancer history was also a significant predictor of likelihood to have engaged in genetic services. Our findings highlight: (1) potential under-utilization of cancer genetic services among high risk populations in the U.S. and (2) differences in genetic services use based on individual's characteristics such as self-reported familial risk, personal history, and beliefs about risk of cancer. These results align with other studies which have noted that awareness and use of genetic services are low in the general population and likely not reaching individuals who could benefit most from screening for inherited cancers. Efforts to promote public awareness of familial cancer risk may lead to better uptake of cancer genetic services.
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Affiliation(s)
- Caitlin G Allen
- Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30307, USA.
| | - Megan Roberts
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA.
| | - Yue Guan
- Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30307, USA.
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11
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Allen C, Escoffery C, Haardörfer R, McBride C. Factors Influencing Not Perceiving Family Health History Assessments as Important: Opportunities to Improve Dissemination of Evidence-Based Population Screening for Cancer. Public Health Genomics 2019; 21:144-153. [DOI: 10.1159/000499125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 02/25/2019] [Indexed: 11/19/2022] Open
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12
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Ooi CY, Hanafi NS, Liew SM. Knowledge and practice of colorectal cancer screening in an urban setting: cross-sectional survey of primary care physicians in government clinics in Malaysia. Singapore Med J 2019; 60:596-604. [PMID: 30644527 DOI: 10.11622/smedj.2019011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) was the third most commonly diagnosed cancer worldwide in 2008 (1.23 million cases, 9.7%). CRC screening was shown to be effective in reducing 70% of CRC mortality. However, the screening rate for CRC remains poor. METHODS A cross-sectional survey was conducted among primary care physicians (PCPs) in public primary care clinics in Kuala Lumpur, Malaysia. A 30-item self-administered questionnaire was used to assess the knowledge and practice of CRC screening. RESULTS The response rate was 86.4% (n = 197/228). Less than half (39.1%) of the respondents answered correctly for all risk stratification scenarios. Mean knowledge score on CRC screening modalities was 48.7% ± 17.7%. The knowledge score was positively associated with having postgraduate educational qualification and usage of screening guidelines. Overall, 69.9% of PCPs reported that they practised screening. However, of these, only 25.9% of PCPs screened over 50% of all eligible patients. PCPs who agreed that screening was cost-effective (odds ratio [OR] 3.34, 95% confidence interval [CI] 1.69‒6.59) and those who agreed that they had adequate resources in their locality (OR 1.92, 95% CI 1.01‒3.68) were more likely to practise screening. Knowledge score was not associated with the practice of screening (p = 0.185). CONCLUSION Knowledge and practice of CRC screening was inadequate among PCPs. Knowledge of screening did not translate into its practice. PCPs' perceptions about cost-effectiveness of screening and adequate resources were important determinants of the practice of screening.
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Affiliation(s)
- Chor Yau Ooi
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Sarawak, Malaysia
| | - Nik Sherina Hanafi
- University of Malaya Primary Care Research Group, Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Su May Liew
- University of Malaya Primary Care Research Group, Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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13
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Cancer screening behaviors and risk perceptions among family members of colorectal cancer patients with unexplained mismatch repair deficiency. Fam Cancer 2017; 16:231-237. [PMID: 27832499 DOI: 10.1007/s10689-016-9947-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Communication gaps in families with unexplained mismatch repair (MMR) deficiency (UMMRD) could negatively impact the screening behaviors of relatives of individual with UMMRD. We evaluated cancer risk perception, screening behaviors, and family communication among relatives of colorectal cancer (CRC) patients with UMMRD. Fifty-one family members of 17 probands with UMMRD completed a questionnaire about cancer risk perception, adherence to Lynch syndrome (LS) screening recommendations, and communication with relatives. Clinical data about the probands were obtained from medical records. Thirty-eight participants (78%) were worried from having cancer and twenty-one participants (42%) had undergone colonoscopy in the past 2 years, as recommended for LS families. In terms of screening for extracolonic cancers, only two eligible participants (3.9%) were screened for gastric, endometrial (10.0%), and ovarian (9.5%) cancers. Additionally, 5 participants (10%) underwent genetic counseling. Most participants were not told by anyone to be screened for extracolonic cancers (84, 85, and 95% for gastric, ovarian, and endometrial cancers, respectively). A minority of family members of CRC patients with UMMRD follow cancer screening as recommended for LS families. Health care providers should encourage patients with UMMRD to share information on LS-related cancers screening, especially extracolonic cancers, with their relatives.
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14
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Burton-Chase AM, Parker WM, Polivka KM, Gritz ER, Amos CI, Lu KH, Lynch PM, Rodriguez-Bigas MA, Nancy You Y, Peterson SK. A comparison between Lynch syndrome and sporadic colorectal cancer survivors' satisfaction with their healthcare providers. Cancer Med 2017; 6:698-707. [PMID: 28211618 PMCID: PMC5345658 DOI: 10.1002/cam4.1033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 01/13/2017] [Accepted: 01/16/2017] [Indexed: 12/28/2022] Open
Abstract
This study evaluated provider satisfaction in a sample of colorectal cancer (CRC) survivors with and without Lynch syndrome (LS). Participants were case–case‐matched CRC survivors with (n = 75) or without (n = 75) LS (mean age of 55; range: 27–93). Participants completed a mailed questionnaire assessing demographics, clinical characteristics, healthcare utilization, psychosocial variables, and provider satisfaction. LS CRC survivors reported lower provider satisfaction scores on three subscales of the Primary Care Assessment Survey: communication (78.14 vs. 83.96; P < 0.05), interpersonal treatment (78.58 vs. 85.30; P < 0.05), and knowledge of the patient (60.34 vs. 69.86; P < 0.01). Among LS CRC survivors, predictors for mean communication and trust subscale scores were location of treatment and socioeconomic status. Higher mean depression scores also were associated with trust, while social support predicted higher satisfaction with communication. Sporadic CRC survivor satisfaction is driven largely by age (communication, interpersonal treatment) and patient anxiety (communication), while seeing a provider more often was associated with increased satisfaction with knowledge of the patient. LS CRC survivors reported lower levels of provider satisfaction than sporadic CRC survivors. LS survivors who received care at The University of Texas MD Anderson Cancer Center, a comprehensive cancer center (CCC), reported higher satisfaction than those receiving care at other institutions. Depressive symptoms and socioeconomic status may impact provider satisfaction ratings. Exploration of other potential predictors of provider satisfaction should be examined in this population. Additionally, further research is needed to examine the potential impact of provider satisfaction on adherence to medical recommendations in LS CRC survivors, particularly those being treated outside of CCCs.
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Affiliation(s)
- Allison M Burton-Chase
- Department of Population Health Sciences, Albany College of Pharmacy and Health Sciences, Albany, New York
| | - Wendy M Parker
- Department of Population Health Sciences, Albany College of Pharmacy and Health Sciences, Albany, New York
| | - Katrina M Polivka
- Division of Health Promotion & Behavioral Science, University of Texas Health Science Center-Houston School of Public Health, Houston, Texas
| | - Ellen R Gritz
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Christopher I Amos
- Department of Community and Family Medicine, Dartmouth College, Hanover, New Hampshire
| | - Karen H Lu
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Patrick M Lynch
- Department of Gastroenterology, Hepatology, & Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Miguel A Rodriguez-Bigas
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Y Nancy You
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
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15
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Steel E, Robbins A, Jenkins M, Flander L, Gaff C, Keogh L. How does genetic risk information for Lynch syndrome translate to risk management behaviours? Hered Cancer Clin Pract 2017; 15:1. [PMID: 28070225 PMCID: PMC5217251 DOI: 10.1186/s13053-016-0061-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/09/2016] [Indexed: 01/16/2023] Open
Abstract
Background There is limited research on why some individuals who have undergone predictive genetic testing for Lynch syndrome do not adhere to screening recommendations. This study aimed to explore qualitatively how Lynch syndrome non-carriers and carriers translate genetic risk information and advice to decisions about risk managment behaviours in the Australian healthcare system. Methods Participants of the Australasian Colorectal Cancer Family Registry who had undergone predictive genetic testing for Lynch syndrome were interviewed on their risk management behaviours. Transcripts were analysed thematically using a comparative coding analysis. Results Thirty-three people were interviewed. Of the non-carriers (n = 16), 2 reported having apparently unnecessary colonoscopies, and 6 were unsure about what population-based colorectal cancer screening entails. Of the carriers (n = 17), 2 reported they had not had regular colonoscopies, and spoke about their discomfort with the screening process and a lack of faith in the procedure’s ability to reduce their risk of developing colorectal cancer. Of the female carriers (n = 9), 2 could not recall being informed about the associated risk of gynaecological cancers. Conclusion Non-carriers and female carriers of Lynch syndrome could benefit from further clarity and advice about appropriate risk management options. For those carriers who did not adhere to colonoscopy screening, a lack of faith in both genetic test results and screening were evident. It is essential that consistent advice is offered to both carriers and non-carriers of Lynch syndrome.
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Affiliation(s)
- Emma Steel
- Centre for Health Equity, The University of Melbourne, Melbourne, Australia
| | - Andrew Robbins
- Centre for Health Equity, The University of Melbourne, Melbourne, Australia
| | - Mark Jenkins
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
| | - Louisa Flander
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
| | - Clara Gaff
- Walter and Eliza Hall Institute, Melbourne, Australia
| | - Louise Keogh
- Centre for Health Equity, The University of Melbourne, Melbourne, Australia
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16
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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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17
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Validation of an online questionnaire for identifying people at risk of familial and hereditary colorectal cancer. Fam Cancer 2016; 14:401-10. [PMID: 25800523 PMCID: PMC4559103 DOI: 10.1007/s10689-015-9792-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We developed and validated an online questionnaire to document familial cancer history, in order to facilitate the detection of persons with a familial or hereditary colorectal cancer (CRC) risk. The development of the self-administered online questionnaire for the assessment of familial and hereditary CRC risk was based on nationwide criteria for referral to genetic specialists due to a Lynch syndrome suspicion, as well as existing criteria for surveillance colonoscopies because of an increased risk of familial CRC. The questionnaire was validated at a private colonoscopy center. Patients scheduled for colonoscopy were enrolled (n = 150). Performance of the questionnaire was assessed by comparing referrals based on questionnaire data against referral decisions based on full pedigree data. In a second validation phase, referrals based on questionnaire data were compared with referrals based on data collected in a telephone interview. We also calculated inter-observer agreement in referral decisions. In the first validation phase, the questionnaire had a sensitivity of 90 % (95 % CI 55–98 %) at a specificity of 98 % (95 % CI 87–100 %) in identifying persons qualifying for referral. In the second validation phase, sensitivity was 100 % (95 % CI 63–100) at a specificity of 97 % (95 % CI 91–99 %). In both validation phases an inter-observer agreement of 100 % in referral decisions was achieved. The online questionnaire has a high sensitivity and specificity in identifying persons qualifying for referral because of suspected Lynch syndrome or familial CRC. Implementation of this tool in colonoscopy clinics can facilitate the detection of patients with hereditary or familial CRC.
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18
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McBride KA, Schlub TE, Ballinger ML, Thomas DM, Tattersall MHN. International survey of awareness of genetic risk in the clinical sarcoma community. Asia Pac J Clin Oncol 2016; 12:133-42. [DOI: 10.1111/ajco.12457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Kate A McBride
- School of Public Health; Sydney Medical School, University of Sydney; Camperdown New South Wales Australia
- The Familial Cancer Service; Crown Princess Mary Cancer Centre; Westmead Hospital; Westmead New South Wales Australia
| | - Timothy E Schlub
- School of Public Health; Sydney Medical School, University of Sydney; Camperdown New South Wales Australia
| | - Mandy L Ballinger
- Research Division; Peter MacCallum Cancer Centre; East Melbourne Victoria Australia
| | - David M Thomas
- The Kinghorn Cancer Centre; Garvan Institute of Medical Research; Darlinghurst New South Wales Australia
| | - Martin HN Tattersall
- Department of Cancer Medicine, The Chris O'Brien Lifehouse; Sydney Medical School, University of Sydney; Camperdown New South Wales Australia
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Koehly LM, Morris BA, Skapinsky K, Goergen A, Ludden A. Evaluation of the Families SHARE workbook: an educational tool outlining disease risk and healthy guidelines to reduce risk of heart disease, diabetes, breast cancer and colorectal cancer. BMC Public Health 2015; 15:1120. [PMID: 26566980 PMCID: PMC4643512 DOI: 10.1186/s12889-015-2483-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 11/10/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Common diseases such as heart disease, diabetes, and cancer are etiologically complex with multiple risk factors (e.g., environment, genetic, lifestyle). These risk factors tend to cluster in families, making families an important social context for intervention and lifestyle-focused disease prevention. The Families Sharing Health Assessment and Risk Evaluation (SHARE) workbook was designed as an educational tool outlining family health history based risk of heart disease, type 2 diabetes, breast cancer, and colorectal cancer. The current paper describes the steps taken to develop and evaluate the workbook employing a user-centered design approach. METHODS The workbook was developed in four steps, culminating in an evaluation focusing on understanding and usability of the tool. The evaluation was based on two Phases of data collected from a sample of mothers of young children in the Washington, D.C., area. A baseline assessment and follow-up approximately two weeks after receipt of the workbook were conducted, as well as focus groups with participants. The design of the workbook was refined in response to participant feedback from the first evaluation Phase and subsequently re-evaluated with a new sample. RESULTS After incorporating user-based feedback and revising the workbook, Phase 2 evaluation results indicated that understanding of the workbook components improved for all sections (from 6.26 to 6.81 on a 7-point scale). In addition, 100% of users were able to use the algorithm to assess their disease risk and over 60% used the algorithm to assess family members' disease risk. At follow-up, confidence to increase fruit, vegetable and fiber intake improved significantly, as well. CONCLUSIONS The Families SHARE workbook was developed and evaluated resulting in a family health history tool that is both understandable and usable by key stakeholders. This educational tool will be used in intervention studies assessing the effectiveness of family genomics health educators who use the Families SHARE workbook to disseminate family risk information and encourage risk reducing behaviors. TRIAL REGISTRATION ClinicalTrials.gov, NCT01498276 . Registered 21 December 2011.
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Affiliation(s)
- Laura M Koehly
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Building 31, Rm B1B54, Bethesda, MD, 20892-2073, USA.
| | - Bronwyn A Morris
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Building 31, Rm B1B54, Bethesda, MD, 20892-2073, USA.
| | - Kaley Skapinsky
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Building 31, Rm B1B54, Bethesda, MD, 20892-2073, USA.
| | - Andrea Goergen
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Building 31, Rm B1B54, Bethesda, MD, 20892-2073, USA.
| | - Amanda Ludden
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Building 31, Rm B1B54, Bethesda, MD, 20892-2073, USA.
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20
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Katz LH, Burton-Chase AM, Advani S, Fellman B, Polivka KM, Yuan Y, Lynch PM, Peterson SK. Screening adherence and cancer risk perceptions in colorectal cancer survivors with Lynch-like syndrome. Clin Genet 2015; 89:392-8. [PMID: 26272410 DOI: 10.1111/cge.12653] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/07/2015] [Accepted: 08/12/2015] [Indexed: 01/22/2023]
Abstract
Cancer screening recommendations for patients with Lynch-like syndrome (LLS) are not well defined. We evaluated adherence to Lynch syndrome (LS) screening recommendations, cancer risk perceptions, and communication within the families among colorectal cancer (CRC) survivors with LLS. Thirty-four participants with LLS completed a questionnaire about risk perception, adherence to LS screening recommendations, and communication with relatives. Clinical data were obtained from medical records. Most participants (76%) believed they should undergo colonoscopy every 1-2 years. Only 41% correctly interpreted their genetic tests as uninformative negative or as variant of unknown significance for LS. Less than half had had an upper gastrointestinal endoscopy for screening purpose. Among female participants, 86% had been screened for endometrial cancer (EC) and 71% for ovarian cancer. Most participants had informed relatives about the CRC diagnosis and advised them to undergo CRC screening, but only 50% advised female relatives to be screened for EC and only one-third advised relatives to have genetic counseling. Most CRC survivors with LLS follow the same cancer screening recommended for LS patients but do not understand the meaning of LLS. Greater care must be devoted to communicating the implications of nondiagnostic germline mutation testing among patients with LLS.
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Affiliation(s)
- L H Katz
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Gastroenterology, Sheba Medical Center, Tel-Aviv University, Ramat-Gan, Israel
| | - A M Burton-Chase
- Department of Behavioral Sciences, Sheba Medical Center, Tel-Aviv University, Ramat-Gan, Israel.,Department of Basic and Social Sciences, Albany College of Pharmacy and Health Sciences, Albany, NY, USA
| | - S Advani
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - B Fellman
- Department of Biostatistics, Sheba Medical Center, Tel-Aviv University, Ramat-Gan, Israel
| | - K M Polivka
- Department of Behavioral Sciences, Sheba Medical Center, Tel-Aviv University, Ramat-Gan, Israel
| | - Y Yuan
- Department of Biostatistics, Sheba Medical Center, Tel-Aviv University, Ramat-Gan, Israel
| | - P M Lynch
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S K Peterson
- Department of Behavioral Sciences, Sheba Medical Center, Tel-Aviv University, Ramat-Gan, Israel
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21
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Racial and Ethnic Disparities in Colonoscopic Examination of Individuals With a Family History of Colorectal Cancer. Clin Gastroenterol Hepatol 2015; 13:1487-95. [PMID: 25737445 PMCID: PMC4509986 DOI: 10.1016/j.cgh.2015.02.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 02/04/2015] [Accepted: 02/04/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Guidelines recommend that persons with a high-risk family history of colorectal cancer (CRC) undergo colonoscopy examinations every 5 years, starting when they are 40 years old. We investigated factors associated with colonoscopy screening of individuals with a family history of CRC, focusing on race and ethnicity. METHODS In a retrospective study, we analyzed data from the 2009 California Health Interview Survey on persons 40-80 years old with a first-degree relative (mother, father, sibling, or child) with CRC who had visited a physician within the past 5 years. Our study included an unweighted and population-weighted sample of 2539 and 870,214 individuals with a family history of CRC, respectively. We performed a survey-weighted logistic regression analysis to adjust for relevant demographic and socioeconomic variables and used estimates to calculate relative risks and 95% confidence intervals (CIs) for colonoscopy examination within the past 5 years. RESULTS In the weighted sample, 60.0% of subjects received a colonoscopy within the past 5 years. A physician recommendation for CRC screening increased the odds that an individual would undergo colonoscopy examination (relative risk, 1.89; 95% CI, 1.61-2.24). Latinos were 31% less likely to receive colonoscopies than whites (95% CI, 7%-55%). Among individuals 40-49 years old, blacks were 71% less likely to have had a colonoscopy than whites (95% CI, 13%-96%). CONCLUSION On the basis of an analysis of data from the California Health Interview Survey, less than two-thirds of individuals with a family history of CRC reported receiving guideline-recommended colonoscopy examinations within the past 5 years. We observed racial and ethnic disparities in colonoscopy screening of this high-risk group; Latinos and blacks were less likely to have had a colonoscopy than whites.
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22
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Knight SJ, Mohamed AF, Marshall DA, Ladabaum U, Phillips KA, Walsh JME. Value of Genetic Testing for Hereditary Colorectal Cancer in a Probability-Based US Online Sample. Med Decis Making 2015; 35:734-744. [PMID: 25589525 PMCID: PMC4501912 DOI: 10.1177/0272989x14565820] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND . While choices about genetic testing are increasingly common for patients and families, and public opinion surveys suggest public interest in genomics, it is not known how adults from the general population value genetic testing for heritable conditions. We sought to understand in a US sample the relative value of the characteristics of genetic tests to identify risk of hereditary colorectal cancer, among the first genomic applications with evidence to support its translation to clinical settings. METHODS . A Web-enabled choice-format conjoint survey was conducted with adults age 50 years and older from a probability-based US panel. Participants were asked to make a series of choices between 2 hypothetical blood tests that differed in risk of false-negative test, privacy, and cost. Random parameters logit models were used to estimate preferences, the dollar value of genetic information, and intent to have genetic testing. RESULTS . A total of 355 individuals completed choice-format questions. Cost and privacy were more highly valued than reducing the chance of a false-negative result. Most (97% [95% confidence interval (CI)], 95%-99%) would have genetic testing to reduce the risk of dying of colorectal cancer in the best scenario (no false negatives, results disclosed to primary care physician). Only 41% (95% CI, 25%-57%) would have genetic testing in the worst case (20% false negatives, results disclosed to insurance company). CONCLUSIONS . Given the characteristics and levels included in the choice, if false-negative test results are unlikely and results are shared with a primary care physician, the majority would have genetic testing. As genomic services become widely available, primary care professionals will need to be increasingly knowledgeable about genetic testing decisions.
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Affiliation(s)
- Sara J. Knight
- Health Services Research and Development Program, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, United States
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Ateesha F. Mohamed
- CHEOR, Specialty Medicine, Bayer Healthcare Pharmaceuticals Inc., Whippany, New Jersey, United States
| | - Deborah A. Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Uri Ladabaum
- Department of Medicine, Stanford University, Palo Alto, California, United States
| | - Kathryn A. Phillips
- Department of Clinical Pharmacy and Institute for Health Policy Studies, University of California at San Francisco, San Francisco, California, United States
| | - Judith M. E. Walsh
- Departments of Medicine and Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, United States
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Ma GK, Ladabaum U. Personalizing colorectal cancer screening: a systematic review of models to predict risk of colorectal neoplasia. Clin Gastroenterol Hepatol 2014; 12:1624-34.e1. [PMID: 24534546 DOI: 10.1016/j.cgh.2014.01.042] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 01/23/2014] [Accepted: 01/23/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS A valid risk prediction model for colorectal neoplasia would allow patients to be screened for colorectal cancer (CRC) on the basis of risk. We performed a systematic review of studies reporting risk prediction models for colorectal neoplasia. METHODS We conducted a systematic search of MEDLINE, Scopus, and Cochrane Library databases from January 1990 through March 2013 and of references in identified studies. Case-control, cohort, and cross-sectional studies that developed or attempted to validate a model to predict risk of colorectal neoplasia were included. Two reviewers independently extracted data and assessed model quality. Model quality was considered to be good for studies that included external validation, fair for studies that included internal validation, and poor for studies with neither. RESULTS Nine studies developed a new prediction model, and 2 tested existing models. The models varied with regard to population, predictors, risk tiers, outcomes (CRC or advanced neoplasia), and range of predicted risk. Several included age, sex, smoking, a measure of obesity, and/or family history of CRC among the predictors. Quality was good for 6 models, fair for 2 models, and poor for 1 model. The tier with the largest population fraction (low, intermediate, or high risk) depended on the model. For most models that defined risk tiers, the risk difference between the highest and lowest tier ranged from 2-fold to 4-fold. Two models reached the 0.70 threshold for the C statistic, typically considered to indicate good discriminatory power. CONCLUSIONS Most current colorectal neoplasia risk prediction models have relatively weak discriminatory power and have not demonstrated generalizability. It remains to be determined how risk prediction models could inform CRC screening strategies.
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Affiliation(s)
- Gene K Ma
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Uri Ladabaum
- Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California.
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Accuracy of ovarian and colon cancer risk assessments by U.S. physicians. J Gen Intern Med 2014; 29:741-9. [PMID: 24519100 PMCID: PMC4000350 DOI: 10.1007/s11606-014-2768-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 11/20/2013] [Accepted: 12/11/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Studies have shown a mismatch between published cancer screening and genetic counseling referral recommendations and physician-reported screening and referral practices. Inaccurate cancer risk assessment is one potential cause of this mismatch. OBJECTIVE To assess U.S. physicians' ability to accurately determine a woman's colon and ovarian cancer risk level. DESIGN, PARTICIPANTS Cross-sectional survey of U.S. family physicians, general internists, and obstetrician-gynecologists. A twelve-page questionnaire with a vignette of a woman's annual examination included a question about the patient's level of colon and ovarian cancer risk. The final study sample included 1,555 physicians weighted to represent practicing U.S. physicians nationally. MAIN MEASURE Accuracy of physicians' ovarian and colon cancer risk assessments. KEY RESULTS Overall, most physicians accurately assessed women's risk of ovarian (57.0%, CI 54.3, 59.6) and colon cancer (62.0%, CI 59.4, 64.6). However, 27.1% (CI 23.0, 31.6) of physicians overestimated the ovarian cancer risk among women at the same risk as the general population, and 65.1% (CI 60.2, 69.7) underestimated ovarian cancer risk among women at much higher risk than the general population. Physicians overestimated colon more than ovarian cancer risk (38.0%, CI 35.4, 40.6 vs. 27.1%, CI 23.0, 31.6) for women at the same risk as the general population. CONCLUSIONS Physicians' misestimation of patient ovarian and colon cancer risk may put average risk patients in jeopardy of unnecessary screening and higher risk patients in jeopardy of missed opportunities for prevention or early detection of cancers.
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Wood ME, Kadlubek P, Pham TH, Wollins DS, Lu KH, Weitzel JN, Neuss MN, Hughes KS. Quality of cancer family history and referral for genetic counseling and testing among oncology practices: a pilot test of quality measures as part of the American Society of Clinical Oncology Quality Oncology Practice Initiative. J Clin Oncol 2014; 32:824-9. [PMID: 24493722 DOI: 10.1200/jco.2013.51.4661] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Family history of cancer (CFH) is important for identifying individuals to receive genetic counseling/testing (GC/GT). Prior studies have demonstrated low rates of family history documentation and referral for GC/GT. METHODS CFH quality and GC/GT practices for patients with breast (BC) or colon cancer (CRC) were assessed in 271 practices participating in the American Society of Clinical Oncology Quality Oncology Practice Initiative in fall 2011. RESULTS A total of 212 practices completed measures regarding CFH and GC/GT practices for 10,466 patients; 77.4% of all medical records reviewed documented presence or absence of CFH in first-degree relatives, and 61.5% of medical records documented presence or absence of CFH in second-degree relatives, with significantly higher documentation for patients with BC compared with CRC. Age at diagnosis was documented for all relatives with cancer in 30.7% of medical records (BC, 45.2%; CRC, 35.4%; P ≤ .001). Referall for GC/GT occurred in 22.1% of all patients with BC or CRC. Of patients with increased risk for hereditary cancer, 52.2% of patients with BC and 26.4% of those with CRC were referred for GC/GT. When genetic testing was performed, consent was documented 77.7% of the time, and discussion of results was documented 78.8% of the time. CONCLUSION We identified low rates of complete CFH documentation and low rates of referral for those with BC or CRC meeting guidelines for referral among US oncologists. Documentation and referral were greater for patients with BC compared with CRC. Education and support regarding the importance of accurate CFH and the benefits of proactive high-risk patient management are clearly needed.
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Affiliation(s)
- Marie E Wood
- Marie E. Wood, University of Vermont, Burlington, VT; Pamela Kadlubek, Trang H. Pham, and Dana S. Wollins, American Society of Clinical Oncology, Alexandria, VA; Karen H. Lu, MD Anderson Cancer Center, Houston, TX; Jeffrey N. Weitzel, City of Hope, Duarte, CA; Michael N. Neuss, Vanderbilt- Ingram Cancer Center, Nashville, TN; and Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Mass General Hospital, Boston, MA
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Chan V, Blazey W, Tegay D, Harper B, Koehler S, Laurent B, Lipka S, Cohn J, Jung MK, Krishnamachari B. Impact of academic affiliation and training on knowledge of hereditary colorectal cancer. Public Health Genomics 2014; 17:76-83. [PMID: 24458016 DOI: 10.1159/000356938] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 10/31/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Knowledge about hereditary colorectal cancer (CRC) can aid cancer screening and prevention in high-risk patients. Genetic testing, once conducted primarily at academic centers, is now routinely performed in a variety of clinics. Nonacademic physicians may not be aware of hereditary CRC standards of care. METHODS From August to November 2012, a survey was administered to predominantly primary care physicians evaluating academic center affiliation, past training in genetics and knowledge regarding hereditary CRC. RESULTS One hundred forty physicians completed the survey. Knowledge of hereditary CRC was neither associated with academic affiliation nor with training during medical school or residency, but with continuing medical education (CME) training. Those with CME training were more likely to know that screening could be enhanced for patients with a hereditary cancer risk (OR = 4.49, 95% CI = 1.40-14.38) and that an individual with hereditary CRC would have different screening recommendations (OR = 7.49, 95% CI = 1.37-40.81). Residency training and CME training were associated with more frequent hereditary risk assessment. CONCLUSION Genetics training may be associated with physicians' knowledge and assessment of hereditary CRC. Training at the CME level in particular may be integral to the delivery of genetic services in clinical practice.
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Affiliation(s)
- V Chan
- Department of Medicine, NYIT College of Osteopathic Medicine, Old Westbury, N.Y., USA
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Chen YS, Xu SX, Ding YB, Huang XE, Deng B, Gao XF, Wu DC. Colorectal cancer screening in high-risk populations: a survey of cognition among medical professionals in Jiangsu, China. Asian Pac J Cancer Prev 2014; 14:6487-91. [PMID: 24377555 DOI: 10.7314/apjcp.2013.14.11.6487] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To investigate the cognition of medical professionals when following screening guidelines for colorectal cancer (CRC) and barriers to CRC screening. Between February 2012 and December 2012, an anonymous survey with 19-questions based on several CRC screening guidelines was randomly administered to gastroenterologists, oncologists, general surgeons, and general practitioners in Jiangsu, a developed area in China where the incidence of CRC is relatively high. The average cognitive score was 26.4% among 924 respondents. Gastroenterologists and oncologists had higher scores compared with others (p<0.01 and p<0.01, respectively); doctor of medicine (M.D.) with or without doctor of philosophy (Ph.D.) or holders with bachelor of medical science (BMS) achieved higher scores than other lower degree holders (P<0.05). More importantly, doctors who finished CRC related education in the past year achieved higher scores than the others (p<0.001). The most commonly listed barriers to referring high-risk patients for CRC screening were "anxiety about colonoscopy without anesthesia", "lack of awareness of the current guidelines" and "lack of insurance reimbursement. " Lack of cognition was detected among doctors when following CRC screening guidelines for high-risk populations. Educational programs should be recommended to improve their cognition and reduce barriers to CRC screening.
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Affiliation(s)
- Yao-Sheng Chen
- Department of Gastroenterology, Yangzhou NO.1 People's Hospital, Yangzhou, China E-mail :
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Jimbo M, Shultz CG, Nease DE, Fetters MD, Power D, Ruffin MT. Perceived barriers and facilitators of using a Web-based interactive decision aid for colorectal cancer screening in community practice settings: findings from focus groups with primary care clinicians and medical office staff. J Med Internet Res 2013; 15:e286. [PMID: 24351420 PMCID: PMC3875904 DOI: 10.2196/jmir.2914] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 11/18/2013] [Accepted: 11/22/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Information is lacking about the capacity of those working in community practice settings to utilize health information technology for colorectal cancer screening. OBJECTIVE To address this gap we asked those working in community practice settings to share their perspectives about how the implementation of a Web-based patient-led decision aid might affect patient-clinician conversations about colorectal cancer screening and the day-to-day clinical workflow. METHODS Five focus groups in five community practice settings were conducted with 8 physicians, 1 physician assistant, and 18 clinic staff. Focus groups were organized using a semistructured discussion guide designed to identify factors that mediate and impede the use of a Web-based decision aid intended to clarify patient preferences for colorectal cancer screening and to trigger shared decision making during the clinical encounter. RESULTS All physicians, the physician assistant, and 8 of the 18 clinic staff were active participants in the focus groups. Clinician and staff participants from each setting reported a belief that the Web-based patient-led decision aid could be an informative and educational tool; in all but one setting participants reported a readiness to recommend the tool to patients. The exception related to clinicians from one clinic who described a preference for patients having fewer screening choices, noting that a colonoscopy was the preferred screening modality for patients in their clinic. Perceived barriers to utilizing the Web-based decision aid included patients' lack of Internet access or low computer literacy, and potential impediments to the clinics' daily workflow. Expanding patients' use of an online decision aid that is both easy to access and understand and that is utilized by patients outside of the office visit was described as a potentially efficient means for soliciting patients' screening preferences. Participants described that a system to link the online decision aid to a computerized reminder system could promote a better understanding of patients' screening preferences, though some expressed concern that such a system could be difficult to keep up and running. CONCLUSIONS Community practice clinicians and staff perceived the Web-based decision aid technology as promising but raised questions as to how the technology and resultant information would be integrated into their daily practice workflow. Additional research investigating how to best implement online decision aids should be conducted prior to the widespread adoption of such technology so as to maximize the benefits of the technology while minimizing workflow disruptions.
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Affiliation(s)
- Masahito Jimbo
- University of Michigan, Departments of Family Medicine and Urology, Ann Arbor, MI, United States.
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Affiliation(s)
- Susanne B Haga
- Institute for Genome Sciences & Policy, Duke University, 304 Research Drive, Box 90141, Durham, NC 27708, USA
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Park J, Lee SY, Kim DW, Kang SB, Jeong SY, Park KJ. Knowledge of and practice patterns for hereditary colorectal cancer syndromes in korean surgical residents. Ann Coloproctol 2013; 29:186-91. [PMID: 24278856 PMCID: PMC3837083 DOI: 10.3393/ac.2013.29.5.186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 09/27/2013] [Indexed: 12/26/2022] Open
Abstract
Purpose Obtaining a detailed family history through detailed pedigree is essential in recognizing hereditary colorectal cancer (CRC) syndromes. This study was performed to assess the current knowledge and practice patterns of surgery residents regarding familial risk of CRC. Methods A questionnaire survey was performed to evaluate the knowledge and the level of recognition for analyses of family histories and hereditary CRC syndromes in 62 residents of the Department of Surgery, Seoul National University Hospital. The questionnaire consisted of 22 questions regarding practice patterns for, knowledge of, and resident education about hereditary CRC syndromes. Results Two-thirds of the residents answered that family history should be investigated at the first interview, but only 37% of them actually obtained pedigree detailed family history at the very beginning in actual clinical practice. Three-quarters of the residents answered that the quality of family history they obtained was poor. Most of them could diagnose hereditary nonpolyposis colorectal cancer and recommend an appropriate colonoscopy surveillance schedule; however, only 19% knew that cancer surveillance guidelines differed according to the family history. Most of our residents lacked knowledge of cancer genetics, such as causative genes, and diagnostic methods, including microsatellite instability test, and indicated a desire and need for more education regarding hereditary cancer and genetic testing during residency. Conclusion This study demonstrated that surgical residents' knowledge of hereditary cancer was not sufficient and that the quality of the family histories obtained in current practice has to be improved. More information regarding hereditary cancer should be considered in education programs for surgery residents.
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Affiliation(s)
- Jangho Park
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
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Rothenmund H, Singh H, Candas B, Chodirker BN, Serfas K, Aronson M, Holter S, Volenik A, Green J, Dicks E, Woods MO, Gilchrist D, Gryfe R, Cohen Z, Foulkes WD. Hereditary colorectal cancer registries in Canada: report from the Colorectal Cancer Association of Canada consensus meeting; Montreal, Quebec; October 28, 2011. ACTA ACUST UNITED AC 2013; 20:273-8. [PMID: 24155632 DOI: 10.3747/co.20.1566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
At a consensus meeting held in Montreal, October 28, 2011, a multidisciplinary group of Canadian experts in the fields of genetics, gastroenterology, surgery, oncology, pathology, and health care services participated in presentation and discussion sessions for the purpose of developing consensus statements pertaining to the development and maintenance of hereditary colorectal cancer registries in Canada. Five statements were approved by all participants.
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Affiliation(s)
- H Rothenmund
- Hereditary Colorectal Cancer Registry, Cancer Prevention Centre, Jewish General Hospital, Montreal, QC
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Screening patterns in patients with a family history of colorectal cancer often do not adhere to national guidelines. Dig Dis Sci 2013; 58:1841-8. [PMID: 23371014 DOI: 10.1007/s10620-013-2567-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 01/05/2013] [Indexed: 01/29/2023]
Abstract
BACKGROUND Currently, there are no data on adherence to guidelines for colorectal cancer (CRC) screening in patients with a family history. AIM We conducted a retrospective study to assess if such patients were being appropriately screened according to American Gastroenterological Association (AGA) guidelines. METHODS Two independent reviewers performed a comprehensive medical record review of family and CRC screening history on 362 adults with a family history of CRC in a first-degree relative who had recently undergone screening colonoscopy. The endpoint was appropriate initiation of screening and endoscopist-recommended subsequent screening intervals, as compared to AGA guideline recommendations. RESULTS Of 362 subjects, only 146 (40.3 %) were screened appropriately; 213 (58.9 %) had late initiation of screening (i.e., screening was started ≥5 years later than the age recommended by guidelines) and three (0.8 %) had premature initiation (i.e., screening was started ≥1 year too early). Of cases involving delayed screening initiation, 126 were not under primary care at the time when screening was supposed to have started, while most of the remaining received either no or incorrect screening recommendations from their primary care provider. Of 270 subjects with no neoplasia found on initial screening, 112 (41.5 %) had endoscopist-recommended subsequent screening intervals that were ≥2 years shorter than that recommended by guidelines. Results were similar if American Society of Gastrointestinal Endoscopy or American College of Gastroenterology guidelines were used. CONCLUSIONS Patients with a family history often suffer from late initiation of screening and overly short endoscopist-recommended subsequent intervals for colonoscopy. Further education of patients and providers on screening recommendations may be helpful.
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Singal AG, Tiro JA, Gupta S. Improving hepatocellular carcinoma screening: applying lessons from colorectal cancer screening. Clin Gastroenterol Hepatol 2013; 11. [PMID: 23200983 PMCID: PMC3610769 DOI: 10.1016/j.cgh.2012.11.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hepatocellular carcinoma (HCC) screening is a complex process, with failure at any step in the process contributing to a gap between its efficacy and effectiveness. Important lessons can be learned from colorectal cancer (CRC) screening studies to improve the HCC screening process in clinical practice. Lack of provider recommendations is a barrier for both CRC and HCC screening; however, under-recognition of at-risk individuals appears to be unique to HCC. Future HCC screening interventions should help providers identify at-risk patients as well as promote ordering of HCC screening among those with cirrhosis. Patient adherence, a well-recognized barrier to CRC screening, does not appear to be a major issue in HCC screening. Poor patient adherence may become an important factor in the future when upstream provider-level factors are addressed. Other steps in the screening process, including radiology capacity and timely follow-up, have been demonstrated as barriers for CRC screening but have yet to be assessed for HCC screening. Overall, many lessons learned from challenges to CRC screening can be applied to rapidly optimize HCC screening delivery.
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Affiliation(s)
- Amit G Singal
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8887, USA.
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Thompson T, Seo J, Griffith J, Baxter M, James A, Kaphingst KA. "You don't have to keep everything on paper": African American women's use of family health history tools. J Community Genet 2013; 4:251-61. [PMID: 23397492 PMCID: PMC3666835 DOI: 10.1007/s12687-013-0138-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 01/27/2013] [Indexed: 01/30/2023] Open
Abstract
Little is known about African American women's collection of family health history (FHH) information and use of FHH tools. Most FHH research has investigated tools that use a biomedical paradigm, but other kinds of tools, such as those that include information about family social context, have been developed for use in diverse populations. Using mixed methods, we interviewed 32 African American women about behavioral steps to collecting FHH, family communication about health, and reactions to a biomedical FHH tool. Participants chose one of two FHH tools to take home. A follow-up call three weeks later assessed tool use. Many participants expressed support for writing down FHH information, but at baseline few had done so; most participants who had collected FHH information had done so verbally. Participants reacted positively to the biomedical FHH tool used during the interview, with many saying it allowed them to see patterns in their FHH. At follow-up, 67 % reported using their FHH tool, primarily to promote discussion among family members; only 32 % used the tool to write down FHH information. Although participants thought collecting FHH information was important and had positive reactions to both tools, the majority did not use the tools to write down information and instead collected FHH informally. These findings underline the importance of separating the components of FHH collection behaviors to analyze the steps used in FHH creation. Practitioners should consider additional methods of encouraging patients to create written FHHs in order to share the information with health care providers.
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Affiliation(s)
- Tess Thompson
- Health Communication Research Laboratory, Washington University in St. Louis, 700 Rosedale Avenue, St. Louis, MO, 63112, USA,
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Dekker N, Hermens RPMG, Nagengast FM, van Zelst-Stams WAG, Hoogerbrugge N. Familial colorectal cancer risk assessment needs improvement for more effective cancer prevention in relatives. Colorectal Dis 2013; 15:e175-85; discussion p.e185. [PMID: 23451840 DOI: 10.1111/codi.12117] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 09/29/2012] [Indexed: 12/15/2022]
Abstract
AIM Twelve to thirty % of colorectal cancer (CRC) patients and relatives with an increased familial risk of CRC are referred for preventive measures. New guidelines recommend genetic counselling for high-risk families and surveillance colonoscopy for moderate-risk families. Assessment of familial risk of CRC and referral rates for these preventive measures were determined 1 year after the introduction of new guidelines. METHOD Assessment of familial risk of CRC and referral for preventive measures were measured in clinical practice among 358 patients with CRC in 18 hospitals using medical records and questionnaires. Additionally, a knowledge survey was performed among 312 clinicians. RESULTS Sixty-seven % of patients with an increased familial risk (n = 65/97) were referred for preventive measures, as were 23% (61/261) of low-risk patients. The uptake of genetic counselling in high-risk families was 33% (12/36). The uptake of surveillance colonoscopy in moderate-risk families was 34% (21/61). In the knowledge survey clinicians correctly determined familial risk in 55% and preventive measures in 65% of cases. CONCLUSION Currently 67% of individuals with an increased familial risk of CRC were referred for preventive measures. Only one-third were referred in accordance with guidelines.
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Affiliation(s)
- N Dekker
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Courtney RJ, Paul CL, Carey ML, Sanson-Fisher RW, Macrae FA, D'Este C, Hill D, Barker D, Simmons J. A population-based cross-sectional study of colorectal cancer screening practices of first-degree relatives of colorectal cancer patients. BMC Cancer 2013; 13:13. [PMID: 23305355 PMCID: PMC3556153 DOI: 10.1186/1471-2407-13-13] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 12/27/2012] [Indexed: 12/14/2022] Open
Abstract
Background The aim of this study was to determine the proportions and predictors of first-degree relatives (FDRs) of colorectal cancer (CRC) patients (i) ever receiving any CRC testing and (ii) receiving CRC screening in accordance with CRC screening guidelines. Methods Colorectal cancer patients and their FDRs were recruited through the population-based Victorian Cancer Registry, Victoria, Australia. Seven hundred and seven FDRs completed telephone interviews. Of these, 405 FDRs were deemed asymptomatic and eligible for analysis. Results Sixty-nine percent of FDRs had ever received any CRC testing. First-degree relatives of older age, those with private health insurance, siblings and FDRs who had ever been asked about family history of CRC by a doctor were significantly more likely than their counterparts to have ever received CRC testing. Twenty-five percent of FDRs “at or slightly above average risk” were adherent to CRC screening guidelines. For this group, adherence to guideline-recommended screening was significantly more likely to occur for male FDRs and those with a higher level of education. For persons at “moderately increased risk” and “potentially high risk”, 47% and 49% respectively adhered to CRC screening guidelines. For this group, guideline-recommended screening was significantly more likely to occur for FDRs who were living in metropolitan areas, siblings, those married or partnered and those ever asked about family history of CRC. Conclusions A significant level of non-compliance with screening guidelines was evident among FDRs. Improved CRC screening in accordance with guidelines and effective systematic interventions to increase screening rates among population groups experiencing inequality are needed. Trial Registration Australian and New Zealand Clinical Trial Registry: ACTRN12609000628246
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Affiliation(s)
- Ryan J Courtney
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, Australia.
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Abstract
OBJECTIVES A personal or family history of colorectal adenomas increases the risk of colorectal cancer (CRC). We aimed to compare physicians' communication with polyp patients vs. non-polyp patients, assess whether polyps or CRC family history were associated with physician-patient communication, and describe patients' disclosure of colonoscopy and polyp diagnosis to their relatives. METHODS Four hundred nine patients completed an online survey regarding physician-patient communication of colonoscopy results, perceived personal and familial risk of polyps and CRC, and disclosure of colonoscopy results to relatives. RESULTS Six percent of participants reported that their physicians discussed familial risks. Polyp diagnosis and family history predicted physician-patient discussions about familial CRC risks. Polyp diagnosis predicted physician-patient discussions of future surveillance. Twenty-two percent of patients told none of their relatives that they had a colonoscopy. Family history, gender, and education were associated with patient-family communication. CONCLUSIONS There is room for improvement in physician-patient and patient-family communication following colonoscopy.
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Kaphingst KA, Goodman M, Pandya C, Garg P, Stafford J, Lachance C. Factors affecting frequency of communication about family health history with family members and doctors in a medically underserved population. PATIENT EDUCATION AND COUNSELING 2012; 88:291-7. [PMID: 22197261 PMCID: PMC3443406 DOI: 10.1016/j.pec.2011.11.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Revised: 11/07/2011] [Accepted: 11/27/2011] [Indexed: 05/04/2023]
Abstract
OBJECTIVE Family history contributes to risk for many common chronic diseases. Little research has investigated patient factors affecting communication of this information. METHODS 1061 adult community health center patients were surveyed. We examined factors related to frequency of discussions about family health history (FHH) with family members and doctors. RESULTS Patients who talked frequently with family members about FHH were more likely to report a family history of cancer (p =.012) and heart disease (p < .001), seek health information frequently in newspapers (p < .001) and in general (p < .001), and be female (p < .001). Patients who talked frequently with doctors about FHH were more likely to report a family history of heart disease (p = .011), meet physical activity recommendations (p = .022), seek health information frequently in newspapers (p < .001) and in general (p < .001), be female (p < .001), and not have experienced racial discrimination in healthcare (p < .001). CONCLUSION Patients with a family history of some diseases, those not meeting physical activity recommendations, and those who do not frequently seek health information may not have ongoing FHH discussions. PRACTICE IMPLICATIONS Interventions are needed to encourage providers to update patients' family histories systematically and assist patients in initiating FHH conversations in order to use this information for disease prevention and control.
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Affiliation(s)
- Kimberly A Kaphingst
- Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO 63110, USA.
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Lin OS. Colorectal cancer screening in patients at moderately increased risk due to family history. World J Gastrointest Oncol 2012; 4:125-30. [PMID: 22737273 PMCID: PMC3382658 DOI: 10.4251/wjgo.v4.i6.125] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 05/07/2012] [Accepted: 05/14/2012] [Indexed: 02/05/2023] Open
Abstract
Patients with a positive family history have an increased risk of colorectal cancer (CRC) and, in many countries, more intensive screening regimens, sometimes involving the use of colonoscopy as opposed to sigmoidoscopy or fecal occult blood testing, are recommended. This review discusses current screening guidelines in the United States and other countries, data on the magnitude of CRC risk in the presence of a family history and the efficacy of recommended screening programs, as well as ancillary issues such as compliance, cost-effectiveness and accuracy of family history ascertainment. We focus on the relatively common “sporadic” family histories of CRC, which typically imparts a mild to moderate elevation in the risk for CRC development in the proband. Defined familial syndromes associated with extremely high risks of CRC, such as hereditary non-polyposis colorectal syndrome or familial adenomatous polyposis, require specialized management approaches and are beyond the scope of this article. We will also not discuss colonoscopic surveillance in patients with a personal history of adenomas or CRC.
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Affiliation(s)
- Otto S Lin
- Otto S Lin, C3-Gas, Gastroenterology Section, Virginia Mason Medical Center, Seattle, WA 98101, United States
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Maceachern J, Mathews M, Green J, Pullman D. Specialists' perceptions of hereditary colorectal cancer screening in Newfoundland and Labrador. Curr Oncol 2012; 19:e123-8. [PMID: 22670101 DOI: 10.3747/co.19.932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE Colorectal cancer (CRC) screening is particularly valuable in Newfoundland and Labrador (NL), where a substantial proportion of CRC cases have a hereditary link. We examined the perceptions of gastroenterologists and general surgeons with respect to screening practices for patients with hereditary crc. METHODS We surveyed all gastroenterologists and general surgeons in NL to determine demographic and professional practice characteristics and screening knowledge, practices, and attitudes for four groups of patients with hereditary CRC. RESULTS Of the 43 eligible physicians, 36 (83.7%) responded. Most of the physicians surveyed knew the correct age to start screening, preferred screening by colonoscopy, had a systematic means in their own practice of prioritizing patients for screening, and felt that family doctors or patients (or both) should be responsible for monitoring screening compliance. Most physicians reported that patients with hereditary nonpolyposis CRC and familial adenomatous polyposis waited 3 months for screening; patients with a family history of CRC or adenomatous polyp waited 6 months or longer. Although respondents agreed on the need for a province-wide CRC registry [4.36 on a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree)], they disagreed that wait times were reasonable (2.81) and that other health professionals should perform colonoscopies (2.86). They were equivocal about the need for centralized bookings (3.25) and about whether genetic testing is useful for prioritizing patients (3.25). CONCLUSIONS Gastroenterologists and general surgeons in NL were knowledgeable about screening, but had varying opinions about individual roles in screening, wait times, and the means for prioritizing and providing screening for patients with hereditary CRC.
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Affiliation(s)
- J Maceachern
- Division of Community Health and Humanities, Memorial University of Newfoundland, St. John's, NL
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Moole S, McGarrity TJ, Baker MJ. Screening for Familial Colorectal Cancer Risk amongst Colonoscopy Patients New to an Open-Access Endoscopy Center. ISRN GASTROENTEROLOGY 2012; 2012:152980. [PMID: 22536519 PMCID: PMC3319995 DOI: 10.5402/2012/152980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 12/20/2011] [Indexed: 12/25/2022]
Abstract
Purpose. We evaluated a questionnaire to aid in the recognition of CRC risk, as well as patient interest in their risk status within an open-access endoscopy center. Methods. A questionnaire was administered to new patients presenting for colonoscopy from May 2007 to February 2008. 287 patients were enrolled. Family history was evaluated using Amsterdam 1, II, and Revised Bethesda criteria. Recognition of risk and referral for counseling was assessed. Patients' interest to be contacted by a genetic counselor was also assessed. Results. 13.2 % (38/287) of patients met Revised Bethesda criteria. Of these, 18 (47.4 %) were previously told about their increased risk for CRC. Only 1 patient who met Revised Bethesda criteria (2.6 %) was previously referred for genetics, whereas none of the 3 patients who met Amsterdam I or II criteria were referred. 23.7 % of high-risk patients did not want to be contacted if found to be at increased risk for cancer. Conclusion. In our open-access endoscopy system, a significant number of high-risk patients remain unidentified and underreferred for genetic counseling due to numerous barriers. Our findings lend support to taking a public health approach to identifying those at risk for Lynch syndrome by implementing universal screening of all CRC specimens.
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Affiliation(s)
- Sumana Moole
- Division of Gastroenterology & Hepatology, Department of Medicine, Penn State Hershey College of Medicine, Hershey, PA 17033-0850, USA
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Courtney RJ, Paul CL, Sanson-Fisher RW, Macrae FA, Carey ML, Attia J, McEvoy M. Colorectal cancer risk assessment and screening recommendation: a community survey of healthcare providers' practice from a patient perspective. BMC FAMILY PRACTICE 2012; 13:17. [PMID: 22414115 PMCID: PMC3323420 DOI: 10.1186/1471-2296-13-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 03/14/2012] [Indexed: 01/14/2023]
Abstract
Background Family history is a common risk factor for colorectal cancer (CRC), yet it is often underused to guide risk assessment and the provision of risk-appropriate CRC screening recommendation. The aim of this study was to identify from a patient perspective health care providers' current practice relating to: (i) assessment of family history of CRC; (ii) notification of "increased risk" to patients at "moderately/potentially high" familial risk; and (iii) recommendation that patients undertake CRC screening. Methods 1592 persons aged 56-88 years randomly selected from the Hunter Community Study (HCS), New South Wales, Australia were mailed a questionnaire. 1117 participants (70%) returned a questionnaire. Results Thirty eight percent of respondents reported ever being asked about their family history of CRC. Ever discussing family history of CRC with a health care provider was significantly more likely to occur for persons with a higher level of education, who had ever received screening advice and with a lower physical component summary score. Fifty one percent of persons at "moderately/potentially high risk" were notified of their "increased risk" of developing CRC. Thirty one percent of persons across each level of risk had ever received CRC screening advice from a health care provider. Screening advice provision was significantly more likely to occur for persons who had ever discussed their family history of CRC with a health care provider and who were at "moderately/potentially high risk". Conclusions Effective interventions that integrate both the assessment and notification of familial risk of CRC to the wider population are needed. Systematic and cost-effective mechanisms that facilitate family history collection, risk assessment and provision of screening advice within the primary health care setting are required.
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Affiliation(s)
- Ryan J Courtney
- The Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Newcastle, Australia.
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Family history and risk of breast cancer: nurses' health study. Breast Cancer Res Treat 2012; 133:1097-104. [PMID: 22350789 DOI: 10.1007/s10549-012-1985-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 02/01/2012] [Indexed: 01/07/2023]
Abstract
Family history of cancer remains underused in general clinical practice. We assess age at diagnosis and the role of family history in risk of breast cancer. Prospective follow-up of nurses' health study participants from 1980 to 2006. Updated assessment of family history in mother and sister including age at diagnosis. We used youngest age at diagnosis for family member when classifying risk. We confirmed 4327 incident invasive breast cancers confirmed. Breast cancer incidence models fitted to women with and without family history to assess variation in the risk for established risk factors. Compared to women with no family history those whose mother was diagnosed before age 50 had an adjusted relative risk of 1.69 (95% CI 1.39-2.05) and those with mother diagnosed at 50 or older had a relative risk of 1.37 (1.22-1.53). Sister history was associated with increased relative risk; 1.66 (1.38-1.99) for those with sister history before age 50 and 1.52 (1.29-1.77) for those with sister diagnosed at age 50 or older. Women with either mother or sister diagnosed before age 50 had a relative risk of 1.70 (1.48-1.95) significantly higher than those with diagnosis at age 50 or older (RR = 1.30; (1.27-1.54), P = 0.016). The magnitude of risk associated with established reproductive and lifestyle risk factors did not differ significantly between women with and those without family history with the exception of risk after bilateral oophorectomy in which setting women with family history had greater reduction in risk of subsequent breast cancer. Women with a family member diagnosed with breast cancer before age 50 had increased risk of breast cancer compared to women with family members diagnosed at older ages. Consistent findings for risk factors regardless of family history adds to robust evidence for risk identification and risk stratification in clinical settings where prevention strategies will apply equally to women with and without family history.
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White PM, Sahu M, Poles MA, Francois F. Colorectal cancer screening of high-risk populations: A national survey of physicians. BMC Res Notes 2012; 5:64. [PMID: 22272666 PMCID: PMC3284403 DOI: 10.1186/1756-0500-5-64] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 01/24/2012] [Indexed: 12/28/2022] Open
Abstract
Background The incidence of colorectal cancer can be decreased by appropriate use of screening modalities. Patients with a family history of colon cancer and of African-American ethnicity are known to be at higher risk of developing colorectal cancer. We aimed to determine if there is a lack of physician knowledge for colorectal cancer screening guidelines based on family history and ethnicity. Between February and April 2009 an anonymous web-based survey was administered to a random sample selected from a national list of 25,000 internists, family physicians and gastroenterologists. A stratified sampling strategy was used to include practitioners from states with high as well as low CRC incidence. All data analyses were performed following data collection in 2009. Results The average knowledge score was 37 ± 18% among the 512 respondents. Gastroenterologists averaged higher scores compared to internists, and family physicians, p = 0.001. Only 28% of physicians correctly identified the screening initiation point for African-Americans while only 12% of physicians correctly identified the screening initiation point and interval for a patient with a family history of CRC. The most commonly cited barriers to referring high-risk patients for CRC screening were "patient refusal" and "lack of insurance reimbursement." Conclusions There is a lack of knowledge amongst physicians of the screening guidelines for high-risk populations, based on family history and ethnicity. Educational programs to improve physician knowledge and to reduce perceived barriers to CRC screening are warranted to address health disparities in colorectal cancer.
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Affiliation(s)
- Pascale M White
- Division of Gastroenterology and Department of Medicine, New York University Langone Medical Center, New York, NY, USA.
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Ready K, Arun BK, Schmeler KM, Uyei A, Litton JK, Lu KH, Sun CC, Peterson SK. Communication of BRCA1 and BRCA2 genetic test results to health care providers following genetic testing at a tertiary care center. Fam Cancer 2011; 10:673-9. [PMID: 21681553 DOI: 10.1007/s10689-011-9460-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Individuals at high risk for hereditary cancers often receive genetic counseling and testing at tertiary care centers; however, they may receive care for long-term management of their cancer risk in community settings. Communication of genetic test results to health care providers outside of tertiary care settings can facilitate the long-term management of high risk individuals. This study assessed women's communication of BRCA1/BRCA2 genetic test results to health care providers outside of tertiary care settings (termed "outside" health care providers, or OHCPs) and women's perceptions regarding communication of results. Women (n = 312) who underwent BRCA1/BRCA2 genetic counseling and testing completed a questionnaire assessing whether or not they shared test results with OHCPs and perceptions regarding the communication of test results to OHCPs. Most (72%) shared genetic test results with OHCPs. Women with no personal history of cancer were more likely to have shared results compared to women with a personal history of cancer. Mutation status did not significantly predict sharing of genetic information. Most reported positive perceptions regarding the disclosure of genetic test results to OHCPs. The majority did not report any concerns about potential insurance discrimination (88%) and indicated that OHCPs were able to appropriately address their questions (81%). Although most women shared their genetic test results with OHCPs, those with a personal history of cancer may need further encouragement to share this information. Tertiary care centers should facilitate outreach and education with OHCPs in order to assure appropriate long-term cancer risk management for high risk populations.
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Affiliation(s)
- K Ready
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA
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Watkins KE, Way CY, Fiander JJ, Meadus RJ, Esplen MJ, Green JS, Ludlow VC, Etchegary HA, Parfrey PS. Lynch syndrome: barriers to and facilitators of screening and disease management. Hered Cancer Clin Pract 2011; 9:8. [PMID: 21899746 PMCID: PMC3180430 DOI: 10.1186/1897-4287-9-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 09/07/2011] [Indexed: 01/01/2023] Open
Abstract
Background Lynch syndrome is a hereditary cancer with confirmed carriers at high risk for colorectal (CRC) and extracolonic cancers. The purpose of the current study was to develop a greater understanding of the factors influencing decisions about disease management post-genetic testing. Methods The study used a grounded theory approach to data collection and analysis as part of a multiphase project examining the psychosocial and behavioral impact of predictive DNA testing for Lynch syndrome. Individual and small group interviews were conducted with individuals from 10 families with the MSH2 intron 5 splice site mutation or exon 8 deletion. The data from confirmed carriers (n = 23) were subjected to re-analysis to identify key barriers to and/or facilitators of screening and disease management. Results Thematic analysis identified personal, health care provider and health care system factors as dominant barriers to and/or facilitators of managing Lynch syndrome. Person-centered factors reflect risk perceptions and decision-making, and enduring screening/disease management. The perceived knowledge and clinical management skills of health care providers also influenced participation in recommended protocols. The health care system barriers/facilitators are defined in terms of continuity of care and coordination of services among providers. Conclusions Individuals with Lynch syndrome often encounter multiple barriers to and facilitators of disease management that go beyond the individual to the provider and health care system levels. The current organization and implementation of health care services are inadequate. A coordinated system of local services capable of providing integrated, efficient health care and follow-up, populated by providers with knowledge of hereditary cancer, is necessary to maintain optimal health.
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Affiliation(s)
- Kathy E Watkins
- Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, St, John's, NL, Canada.
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Rudert M, Holzapfel BM, Jakubietz MG. Adjuvant Radiotherapy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:553. [PMID: 21912576 DOI: 10.5372/1905-7415.0504.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Abstract
Background: Familial adenomatous polyposis (FAP) is an inherited colorectal cancer predisposing syndrome that has an autosomal dominant mode of inheritance with complete penetrance. Although the disease-causing gene of FAP, the adenomatous polyposis coli (APC) gene, is well understood, genetic testing for FAP remains uncommon in Thailand, possibly because of its high cost.
Objective: Present a family in southern Thailand that had benefited from this test.
Subject and methods: The proband was a 31-year-old man who had rectal cancer with profuse adenomatous polyposis of his colon.
Results: APC mutation screening revealed a novel mutation at codon 1249 (TGC1249TAA) that could predict a premature stop codon. On screening of three siblings in the same generation who were alive and 11 members of the descendant generation, four cases were positive for the mutation. The positive members were confirmed to have a type of diffuse colonic polyposis by endoscopy, and a prophylactic colectomy was performed without complications for every affected individual.
Conclusion: A genetic test is cost-effective. It should be considered for FAP, especially when the number of at-risk family members is high.
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Dandapani M, Stoffel EM. CLINICAL MANAGEMENT OF FAMILIES WITH HEREDITARY COLORECTAL CANCER SYNDROMES. SEMINARS IN COLON AND RECTAL SURGERY 2011; 22:100-104. [PMID: 21743786 PMCID: PMC3129991 DOI: 10.1053/j.scrs.2010.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hereditary colorectal cancer syndromes can be associated with a lifetime risk of CRC of >70% in the absence of specialized surveillance. Diagnosing a genetic predisposition to cancer allows clinicians to tailor cancer prevention strategies for patients and families at highest risk. Once a genetic syndrome has been identified in a family, communication with family members, timely implementation of screening tests and/or surgeries, and psychosocial support are all instrumental for effective cancer prevention.Molecular screening of tumors, computerized risk assessment models, and genetic testing can help clinicians identify individuals at risk for hereditary cancer syndromes. This review discusses some of the complexities involved in the diagnosis and management of families with hereditary CRC syndromes and provides strategies for coordinating clinical care.
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Affiliation(s)
- Monica Dandapani
- Cancer Risk and Prevention Clinic, Dana-Farber Cancer Institute, Boston, MA
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Challen K, Harris H, Kristoffersson U, Nippert I, Schmidtke J, Ten Kate LP, Benjamin C, Anionwu E, Plass AM, Julian-Reynier C, Harris R. General practitioner management of genetic aspects of a cardiac disease: a scenario-based study to anticipate providers' practices. J Community Genet 2011; 1:83-90. [PMID: 21475668 PMCID: PMC3063843 DOI: 10.1007/s12687-010-0013-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 07/28/2010] [Indexed: 11/25/2022] Open
Abstract
It is increasingly recognised that genetics will have to be integrated into all parts of primary health care. Previous research has demonstrated that involvement and confidence in genetics varies amongst primary care providers. We aimed to analyse perceptions of primary care providers regarding responsibility for genetic tasks and factors affecting those perceptions. Postal questionnaire including a hypothetical case management scenario of a cardiac condition with a genetic component was sent to random samples of medically qualified general practitioners in France, Germany, Netherlands, Sweden and UK (n = 1,168). Logistic regression analysis of factors affecting primary care practitioners' willingness to carry out genetic tasks themselves was conducted; 61% would take a family history themselves but only 38% would explain an inheritance pattern and 16% would order a genetic test. In multivariate analysis, only the country of practice was consistently predictive of willingness to carry out genetic tasks, although male gender predicted willingness to carry out the majority of tasks studied. The stage of career at which education in genetics had been provided was not predictive of willingness to carry out any of the tasks analysed. Country of practice is significantly predictive of attitudes towards genetics in primary care practice and therefore genetic education structure and content in Europe will need to be significantly tailored towards country-specific approaches.
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Affiliation(s)
- Kirsty Challen
- GenEd Co-ordinating Centre, University of Manchester, Manchester, UK
| | - Hilary Harris
- GenEd Co-ordinating Centre, University of Manchester, Manchester, UK
| | - Ulf Kristoffersson
- Department of Clinical Genetics, University and Regional Laboratories, Lund University, Lund, Sweden
| | - Irmgard Nippert
- Women’s Health Research, Westfaelische Wilhelms-Universitaet Muenster, Muenster, Germany
| | - Joerg Schmidtke
- Insititut fur Humangenetik, Medizinische Hochschule Hannover, Hannover, Germany
| | - Leo P. Ten Kate
- Department of Clinical Genetics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Caroline Benjamin
- School of Health Sciences, University of Birmingham and Liverpool Women’s NHS Foundation Trust, Liverpool, UK
| | - Elizabeth Anionwu
- Emeritus Professor of Nursing, Thames Valley University, Reading, UK
| | | | | | - Rodney Harris
- GenEd Co-ordinating Centre, University of Manchester, Manchester, UK
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A novel approach to increase awareness about hereditary colon cancer using a state cancer registry. Genet Med 2011; 12:721-5. [PMID: 20808227 DOI: 10.1097/gim.0b013e3181f1366a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The aim of this project was to conduct educational outreach about hereditary colon cancer to a targeted high risk population identified through a state cancer registry. METHODS Individuals who met one of the first three Bethesda criteria guidelines were identified through the Colorado Central Cancer Registry. The physician of record received a brochure, survey and form to provide written consent to contact patient(s). Cases were mailed an educational brochure, initial and follow-up survey. RESULTS Five hundred seventy-five cases and 412 physicians were identified; 81% provided consent. Ninety percent of physicians felt the registry should provide this information to at-risk patients. Twenty-three percent of the cases returned the survey. Cases were generally glad to get the information. Only four cases reported concern. The majority agreed the cancer registry should send the information, however most preferred their physicians be consented first. At follow-up, 20 cases reported having or intending to have a risk assessment. CONCLUSIONS Response from physicians and cases was positive, suggesting that targeted outreach using cancer registries, in combination with physician notification, may be a viable approach to educational outreach about cancer genetics. A proportion of cases sought risk assessment, suggesting that mail-based outreach may be effective in increasing uptake of information and/or genetic services.
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