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Keeler Bruce L, Paul P, Kim KK, Kim J, Keegan THM, Hiatt RA, Ohno-Machado L. Family and personal history of cancer in the All of Us research program for precision medicine. PLoS One 2023; 18:e0288496. [PMID: 37459328 PMCID: PMC10351738 DOI: 10.1371/journal.pone.0288496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/28/2023] [Indexed: 07/20/2023] Open
Abstract
The All of Us (AoU) Research Program is making available one of the largest and most diverse collections of health data in the US to researchers. Using the All of Us database, we evaluated family and personal histories of five common types of cancer in 89,453 individuals, comparing these data to 24,305 participants from the 2015 National Health Interview Survey (NHIS). Comparing datasets, we found similar family cancer history (33%) rates, but higher personal cancer history in the AoU dataset (9.2% in AoU vs. 5.11% in NHIS), Methodological (e.g. survey-versus telephone-based data collection) and demographic variability may explain these between-data differences, but more research is needed.
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Affiliation(s)
- Lauryn Keeler Bruce
- Department of Biomedical Informatics, University of California (UC), San Diego, La Jolla, CA, United States of America
| | - Paulina Paul
- Department of Biomedical Informatics, University of California (UC), San Diego, La Jolla, CA, United States of America
| | - Katherine K. Kim
- Department of Public Health Sciences, UC Davis School of Medicine, Davis, CA, United States of America
| | - Jihoon Kim
- Department of Biomedical Informatics, University of California (UC), San Diego, La Jolla, CA, United States of America
| | - Theresa H. M. Keegan
- Division of Hematology and Oncology, Center for Oncology Hematology Outcomes Research and Training, UC Davis School of Medicine, Davis, CA, United States of America
| | - Robert A. Hiatt
- Department of Epidemiology & Biostatistics, UC San Francisco, San Francisco, CA, United States of America
- Helen Diller Family Comprehensive Cancer Center, UC San Francisco, San Francisco, CA, United States of America
| | - Lucila Ohno-Machado
- Section of Biomedical Informatics & Data Science, Yale University School of Medicine, New Haven, CT, United States of America
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Huq MR, Woodard N, Okwara L, McCarthy S, Knott CL. Breast cancer knowledge & information seeking among African American women below screening age. PATIENT EDUCATION AND COUNSELING 2023; 106:194-200. [PMID: 36257892 DOI: 10.1016/j.pec.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 09/13/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES African American women below screening age disproportionately face greater mortality from breast cancer relative to peers of other races and African American women of screening age. The current study examines breast cancer knowledge and health information seeking of African American women below screening age. METHODS We collected survey data from 99 African American women below screening age on their breast cancer knowledge and health information seeking behaviors. As secondary analysis, we harmonized data from a previous study to compare breast cancer knowledge between African American women below and of (N = 209) screening age. RESULTS The average woman below screening age correctly answered 2.84 (SD=1.08) of six breast cancer knowledge items, 2.67 (SD=1.01) of five mammogram items, 1.44 (SD=0.86) of three treatment items, and had lower knowledge (p < .001) in each area relative to screening age women. Women below screening age sought information primarily from medical providers and the internet. CONCLUSIONS A strategy for eliminating early-onset breast cancer disparities impacting African American women is addressing the limited breast cancer knowledge in this age group. Practice Implications In addition to age-appropriate information for this group, guidance for medical providers would be beneficial, as providers are this group's most common source of health information.
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Affiliation(s)
- Maisha R Huq
- Department of Behavioral and Community Health, University of Maryland, College Park, College Park, MD, USA.
| | - Nathaniel Woodard
- Department of Behavioral and Community Health, University of Maryland, College Park, College Park, MD, USA
| | - Leonore Okwara
- Department of Behavioral and Community Health, University of Maryland, College Park, College Park, MD, USA
| | - Sharon McCarthy
- Department of Behavioral and Community Health, University of Maryland, College Park, College Park, MD, USA
| | - Cheryl L Knott
- Department of Behavioral and Community Health, University of Maryland, College Park, College Park, MD, USA; Community Outreach and Engagement in the University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
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Identification of women at risk for hereditary breast and ovarian cancer in a sample of 1000 Slovenian women: a comparison of guidelines. BMC Cancer 2021; 21:665. [PMID: 34082720 PMCID: PMC8176743 DOI: 10.1186/s12885-021-08400-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 05/24/2021] [Indexed: 12/20/2022] Open
Abstract
Background An important number of breast and ovarian cancer cases is due to a strong genetic predisposition. The main tool for identifying individuals at risk is recognizing a suggestive family history of cancer. We present a prospective study on applying three selected clinical guidelines to a cohort of 1000 Slovenian women to determine the prevalence of at-risk women according to each of the guidelines and analyze the differences amongst the guidelines. Methods Personal and family history of cancer was collected for 1000 Slovenian women. Guidelines by three organizations: National Comprehensive Cancer Network (NCCN), American College of Medical Genetics in cooperation with National Society of Genetic Counselors (ACMG/NSGC), and Society of Gynecologic Oncology (SGO) were applied to the cohort. The number of women identified, the characteristics of the high-risk population, and the agreement between the guidelines were explored. Results NCCN guidelines identify 13.2% of women, ACMG/NSGC guidelines identify 7.1% of women, and SGO guidelines identify 7.0% of women from the Slovenian population, while 6.2% of women are identified by all three guidelines as having high-risk for hereditary breast and ovarian cancer. Conclusions We identified 13.7% of women from the Slovenian population as being at an increased risk for breast and ovarian cancer based on their personal and family history of cancer using all of the guidelines. There are important differences between the guidelines. NCCN guidelines are the most inclusive, identifying nearly twice the amount of women as high-risk for hereditary breast and ovarian cancer as compared to the AGMG/NSCG and SGO guidelines in the Slovenian population. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08400-8.
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Taksler GB, Dalton JE, Perzynski AT, Rothberg MB, Milinovich A, Krieger NI, Dawson NV, Roach MJ, Einstadter D. Opportunities, Pitfalls, and Alternatives in Adapting Electronic Health Records for Health Services Research. Med Decis Making 2021; 41:133-142. [PMID: 32969760 PMCID: PMC7878193 DOI: 10.1177/0272989x20954403] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Electronic health records (EHRs) offer the potential to study large numbers of patients but are designed for clinical practice, not research. Despite the increasing availability of EHR data, their use in research comes with its own set of challenges. In this article, we describe some important considerations and potential solutions for commonly encountered problems when working with large-scale, EHR-derived data for health services and community-relevant health research. Specifically, using EHR data requires the researcher to define the relevant patient subpopulation, reliably identify the primary care provider, recognize the EHR as containing episodic (i.e., unstructured longitudinal) data, account for changes in health system composition and treatment options over time, understand that the EHR is not always well-organized and accurate, design methods to identify the same patient across multiple health systems, account for the enormous size of the EHR, and consider barriers to data access. Associations found in the EHR may be nonrepresentative of associations in the general population, but a clear understanding of the EHR-based associations can be enormously valuable to the process of improving outcomes for patients in learning health care systems. In the context of building 2 large-scale EHR-derived data sets for health services research, we describe the potential pitfalls of EHR data and propose some solutions for those planning to use EHR data in their research. As ever greater amounts of clinical data are amassed in the EHR, use of these data for research will become increasingly common and important. Attention to the intricacies of EHR data will allow for more informed analysis and interpretation of results from EHR-based data sets.
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Affiliation(s)
- Glen B. Taksler
- Medicine Institute, Cleveland Clinic, Cleveland, OH
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
- Center for Health Care Research and Policy, The MetroHealth System and Case Western Reserve University, Cleveland, OH
| | - Jarrod E. Dalton
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
- Center for Health Care Research and Policy, The MetroHealth System and Case Western Reserve University, Cleveland, OH
| | - Adam T. Perzynski
- Center for Health Care Research and Policy, The MetroHealth System and Case Western Reserve University, Cleveland, OH
| | | | - Alex Milinovich
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Nikolas I. Krieger
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Neal V. Dawson
- Center for Health Care Research and Policy, The MetroHealth System and Case Western Reserve University, Cleveland, OH
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - Mary J. Roach
- Center for Health Care Research and Policy, The MetroHealth System and Case Western Reserve University, Cleveland, OH
| | - Douglas Einstadter
- Center for Health Care Research and Policy, The MetroHealth System and Case Western Reserve University, Cleveland, OH
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
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Weigl K, Tikk K, Hoffmeister M, Hampe J, Igel S, Kolligs F, Klug SJ, Mansmann U, Müller O, Nagel JM, Pichler M, Schwab M, Schweigler D, Stephan AM, De Toni EN, Brenner H. Prevalence of a First-Degree Relative With Colorectal Cancer and Uptake of Screening Among Persons 40 to 54 Years Old. Clin Gastroenterol Hepatol 2020; 18:2535-2543.e3. [PMID: 31809916 DOI: 10.1016/j.cgh.2019.11.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 11/14/2019] [Accepted: 11/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS People with a first-degree relative with colorectal cancer (CRC) are recommended to start CRC screening at age 40. However, there is limited information on how many people in different age groups have a known family history of CRC and how many of them have had a colonoscopy. METHODS We set up a multicenter, cross-sectional, population-based study in Germany to determine what proportions of persons in age groups from 40 to 54 years old have a known family history of CRC. We invited 160,000 persons to participate in an online survey from 2015 through 2016. We investigated what proportions of persons in each age group reported a family history of CRC and what proportions of persons underwent a colonoscopy examination using descriptive statistics and multiple logistic regression models. RESULTS Of 28,711 responders to the online questionnaire (8428 were age 40-44 years, 9879 were age 45-49 years, and 10,404 were age 50-54 years), 2705 stated that they had a first-degree relative with CRC (9.4%). The prevalence of a first-degree relative with CRC increased with age: 7.5%, 9.6%, and 10.9% for people 40 to 44 years old, 45 to 49 years old, and 50 to 54 years old, respectively. The prevalence of a first-degree relative who received a diagnosis of CRC at age 70 years or older increased steadily with each age group. Although a greater proportion of people with a family history of CRC had undergone a colonoscopy examination (54.5%) than people without a family history of CRC (25.7%; P < .0001), large proportions of people within this risk group were not in compliance with the guidelines (54.8%, 47.6%, and 38.6% for ages 40-44 y, 45-49 y, and 50-54 y, respectively). CONCLUSIONS One in 10 persons in Germany age 40 to 54 years old has a first-degree relative with CRC. Guidelines recommend initiation of screening at ages 40 to 45 years for people with a family history, yet at this age many people do not have a family history of CRC yet, and almost half of persons 40 to 54 years old with a family history of CRC have not yet received a screening colonoscopy.
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Affiliation(s)
- Korbinian Weigl
- Division of Clinical Epidemiology and Aging Research, Heidelberg, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Kaja Tikk
- Division of Clinical Epidemiology and Aging Research, Heidelberg, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | | | - Jochen Hampe
- Gastroenterology and Hepatology, Medical Klinic I, University Clinic Dresden, Dresden, Germany
| | - Svitlana Igel
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
| | - Frank Kolligs
- German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany; Department of Medicine II, University of Munich, Munich, Germany; Department of Medicine, Gastroenterology, Hepatology and Infectiology, Helios Clinic Berlin-Buch, Berlin, Germany
| | - Stefanie J Klug
- Cancer Epidemiology, University Cancer Center, Technical University, Dresden, Germany; Epidemiology, Department of Sport und Health Sciences, Technical University of Munich, Munich, Germany
| | - Ulrich Mansmann
- Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Oliver Müller
- Outpatient Gastroenterology Clinic "Am Pragsattel," Stuttgart, Germany
| | - Jutta M Nagel
- Department of Medicine II, University of Munich, Munich, Germany
| | - Marcus Pichler
- Outpatient Gastroenterology Clinic "Am Pragsattel," Stuttgart, Germany
| | - Matthias Schwab
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany; German Cancer Consortium, German Cancer Research Center (Partner Site), Tuebingen, Germany; Department of Clinical Pharmacology, University Hospital, Department of Biochemistry and Pharmacy, University of Tuebingen, Stuttgart, Germany
| | - Dirk Schweigler
- Cancer Epidemiology, University Cancer Center, Technical University, Dresden, Germany
| | - Anna-Magdalena Stephan
- Gastroenterology and Hepatology, Medical Klinic I, University Clinic Dresden, Dresden, Germany
| | - Enrico N De Toni
- German Cancer Consortium, German Cancer Research Center (Partner Site), Tuebingen, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, Heidelberg, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center, National Center of Tumor Diseases, Heidelberg, Germany
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Pendleton C, Everson MC, Puffer RC, Spinner RJ. Personal and Familial Malignancy History in Patients with Malignant Peripheral Nerve Sheath Tumors with a Focus on Sporadic Tumors. World Neurosurg 2020; 141:e778-e782. [DOI: 10.1016/j.wneu.2020.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/31/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
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Sieverding M, Arbogast AL, Zintel S, von Wagner C. Gender differences in self-reported family history of cancer: A review and secondary data analysis. Cancer Med 2020; 9:7772-7780. [PMID: 32835456 PMCID: PMC7571831 DOI: 10.1002/cam4.3405] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/20/2020] [Accepted: 08/06/2020] [Indexed: 12/20/2022] Open
Abstract
Background Assessment of family history of cancer (FHC) mostly relies on self‐report. Our goal was to find out whether there is a systematic gender difference in self‐reported FHC. Methods We identified nine population‐based studies which provided statistics of FHC in men and women (N1 = 404 541). Furthermore, we analyzed data (N2 = 167 154) from several iterations of the US‐based Health Information National Trends Survey (HINTS) and the National Health Interview Survey (NHIS). We calculated the proportion of positive FHC, odds ratios (OR M/F), 95% confidence intervals, and aggregated statistics. We additionally analyzed in‐depth questions about FHC from HINTS 5 Cycle 2. Results In the reviewed studies the odds of men reporting a FHC were lower compared with the odds of women with an average OR of 0.84 [0.71; 1.00] across all studies and an OR of 0.75 [0.70; 0.80] for the six studies from the US and Europe. The gender gap was replicated in our own analyses of HINTS and NHIS with an average OR of 0.75 [0.71; 0.79]. In HINTS 5 Cycle 2 men described themselves as less familiar with their FHC and less confident answering questions regarding FHC. They were also less likely to discuss FHC with family members. Conclusions Men— at least in the US and Europe—were consistently less likely to report FHC compared with women. Future research should investigate how the assessment of FHC can be improved to reduce these differences. Health care professionals should also consider the potential for biased reporting by gender when assessing FHC.
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Affiliation(s)
- Monika Sieverding
- Department of Psychology, Ruprecht Karls University Heidelberg, Heidelberg, Germany
| | - Anna Lisa Arbogast
- Department of Psychology, Ruprecht Karls University Heidelberg, Heidelberg, Germany
| | - Stephanie Zintel
- Department of Psychology, Ruprecht Karls University Heidelberg, Heidelberg, Germany
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
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John EM, Canchola AJ, Sangaramoorthy M, Koo J, Whittemore AS, West DW. Race/Ethnicity and Accuracy of Self-Reported Female First-Degree Family History of Breast and Other Cancers in the Northern California Breast Cancer Family Registry. Cancer Epidemiol Biomarkers Prev 2019; 28:1792-1801. [PMID: 31488412 DOI: 10.1158/1055-9965.epi-19-0444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/18/2019] [Accepted: 08/27/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Few studies have evaluated accuracy of self-reported family history of breast and other cancers in racial/ethnic minorities. METHODS We assessed the accuracy of cancer family history reports by women with breast cancer (probands) from the Northern California Breast Cancer Family Registry compared with 2 reference standards: personal cancer history reports by female first-degree relatives and California Cancer Registry records. RESULTS Probands reported breast cancer in first-degree relatives with high accuracy, but accuracy was lower for other cancers. Sensitivity (percentage correctly identifying relatives with cancer) was 93% [95% confidence interval (CI), 89.5-95.4] when compared with the relatives' self-report of breast cancer as the reference standard and varied little by proband race/ethnicity and other demographic factors, except for marginally lower sensitivity for Hispanic white probands (87.3%; 95% CI, 78.0-93.1; P = 0.07) than non-Hispanic white probands (95.1%; 95% CI, 88.9-98.0). Accuracy was also high when compared with cancer registry records as the reference standard, with a sensitivity of 95.5% (95% CI, 93.4-96.9) for breast cancer, but lower sensitivity for Hispanic white probands (91.2%; 95% CI, 84.4-95.2; P = 0.05) and probands with low English language proficiency (80%; 95% CI, 52.8-93.5; P < 0.01). CONCLUSIONS Non-Hispanic white, African American, and Asian American probands reported first-degree breast cancer family history with high accuracy, although sensitivity was lower for Hispanic white probands and those with low English language proficiency. IMPACT Self-reported family history of breast cancer in first-degree relatives is highly accurate and can be used as a reliable standard when other validation methods are not available.
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Affiliation(s)
- Esther M John
- Cancer Prevention Institute of California, Fremont, California. .,Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, California.,Department of Health Research and Policy (Epidemiology), Stanford University of School of Medicine, Stanford, California.,Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Alison J Canchola
- Cancer Prevention Institute of California, Fremont, California.,Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Meera Sangaramoorthy
- Cancer Prevention Institute of California, Fremont, California.,Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Jocelyn Koo
- Cancer Prevention Institute of California, Fremont, California.,Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Alice S Whittemore
- Department of Health Research and Policy (Epidemiology), Stanford University of School of Medicine, Stanford, California.,Department of Biomedical Data Science, Stanford University of School of Medicine, Stanford, California
| | - Dee W West
- Cancer Prevention Institute of California, Fremont, California.,Department of Health Research and Policy (Epidemiology), Stanford University of School of Medicine, Stanford, California
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Defining low-value PSA testing in a large retrospective cohort: Finding common ground between discordant guidelines. Cancer Epidemiol 2018; 56:112-117. [PMID: 30130683 DOI: 10.1016/j.canep.2018.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/06/2018] [Accepted: 08/10/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Reports of low-value prostate-specific antigen (PSA) testing (testing in which the harms outweigh the benefits) generally employ population level data sources. While such results may be generalizable, they often lack the detail necessary to understand provider clinical decision making and guideline concordance. Using a retrospective study of PSA testing at our institution we intend to characterize the frequency and patterns associated with low-value PSA testing. METHODS We leveraged the electronic health record to determine guideline-defined low-value testing in our health system from 07/01/2012 to 06/30/2017. Secondarily, we measured the between-testing interval for repeat tests and the rates of prostate cancer risk factors and comorbidities among men receiving screening. RESULTS Overall, 21,145 PSA tests were performed on 12,303 men. The rate of low-value testing ranged from 23.4 to 56.8%, depending upon the specific guideline. For repeat tests, the median between-testing interval was 12.6 months. Risk factors for prostate cancer were uncommon, but more frequent in men age <55 years compared to men age 55-69 years (17.6% vs. 13.5%, p < 0.001). Screened older men (age >70 years) were more likely to have a Charlson Comorbidity Index ≥ 3, compared to the 55-69 reference group (31.4% vs. 17.3%, p < 0.001). CONCLUSION Low-value prostate cancer testing is prevalent. Between-testing intervals were often times shorter than recommended. Screening among younger men was frequent despite low rates of risk factors. High rates of comorbidity may limit life expectancy among older men receiving screening. These findings highlight the need for improved guidance with prostate cancer screening.
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Utilization of colonoscopy and colonoscopic findings among individuals aged 40-54 years with a positive family history of colorectal cancer: a cross-sectional study in general practice. Eur J Cancer Prev 2017; 27:539-545. [PMID: 28692588 DOI: 10.1097/cej.0000000000000399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Guidelines recommend early colonoscopy for individuals with a positive family history of colorectal cancer (CRC), but little is known about the utilization of colonoscopy and the frequency of colorectal neoplasms among younger affected individuals in Germany. The aim of this study was to determine the utilization of colonoscopy and the frequency of colorectal neoplasms in this risk group. We conducted a cross-sectional study in a general practice setting. Patients aged 40-54 years with at least one first-degree relative with CRC were identified, counseled on their increased risk, and referred to colonoscopy if they decided to undergo this procedure. We assessed the reported utilization of colonoscopy before study participation with a questionnaire and obtained results of colonoscopies performed during the study period from colonoscopy reports. Out of 484 patients with a positive family history of CRC, 191 (39.5%) fulfilled the inclusion criteria and participated in the study: 54% reported that at least one colonoscopy had been performed before study participation. Out of 191 participants, 86 (45%) underwent a colonoscopy during study period. No CRC was found, but 16.3% had any adenoma, and 7.0% had advanced adenomas. Overall, 155 (82%) study participants underwent a colonoscopy either before or during the study period. The utilization of colonoscopies among participants was remarkably high even before study participation. This rate increased up to 82% after counseling by general practitioners. A relevant number of participants had (advanced) adenomas. It appears worthwhile to involve general practitioners in identifying and counseling younger individuals with familial risk for CRC.
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Plath J, Siebenhofer A, Koné I, Hechtner M, Schulz-Rothe S, Beyer M, Gerlach FM, Guethlin C. Frequency of a positive family history of colorectal cancer in general practice: a cross-sectional study. Fam Pract 2017; 34:30-35. [PMID: 27920116 DOI: 10.1093/fampra/cmw118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Evidence on the frequency of a positive family history of colorectal cancer (CRC) among individuals aged <55 years is lacking. General practice setting might be well suited for the identification of individuals in this above-average risk group. OBJECTIVE To determine the frequency of a reported positive family history of CRC among patients aged 40 to 54 years in a general practice setting. METHODS We conducted a cross-sectional study in 21 general practices in Germany. Patients aged 40 to 54 years were identified by means of the practice software and interviewed by health care assistants using a standardized four-item questionnaire. Outcome was occurrence of a positive family history of CRC, defined as at least one first-degree relative (FDR: parents, siblings, or children) with CRC. Further measurements were FDRs with CRC / colorectal polyps (adenomas) diagnosed before the age of 50 and occurrence of three or more relatives with colorectal, stomach, cervical, ovarian, urethel or renal pelvic cancer. RESULTS Out of 6723 participants, 7.2% (95% confidence interval [CI] 6.6% to 7.8%) reported at least one FDR with CRC and 1.2% (95% CI 0.9% to 1.5%) reported FDRs with CRC diagnosed before the age of 50. A further 2.6% (95% CI 2.3% to 3.0%) reported colorectal polyps in FDRs diagnosed before the age of 50 and 2.1% (95% CI 1.8% to 2.5%) reported three or more relatives with entities mentioned above. CONCLUSION One in 14 patients reported at least one FDR with CRC. General practice should be considered when defining requirements of risk-adapted CRC screening.
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Affiliation(s)
- Jasper Plath
- Institute of General Practice, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany, .,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Frankfurt/Mainz, Germany.,Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstraße 30, 28359 Bremen, Germany
| | - Andrea Siebenhofer
- Institute of General Practice, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany, .,Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Auenbruggerplatz 2/9, 8036 Graz, Austria and
| | - Insa Koné
- Institute of General Practice, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Marlene Hechtner
- German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Frankfurt/Mainz, Germany.,Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University Mainz, Obere Zahlbacher Str. 69, 55131 Mainz, Germany
| | - Sylvia Schulz-Rothe
- Institute of General Practice, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Martin Beyer
- Institute of General Practice, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Ferdinand M Gerlach
- Institute of General Practice, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Corina Guethlin
- Institute of General Practice, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
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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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13
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Oh H, Bodelon C, Palakal M, Chatterjee N, Sherman ME, Linville L, Geller BM, Vacek PM, Weaver DL, Chicoine RE, Papathomas D, Patel DA, Xiang J, Clare SE, Visscher DW, Mies C, Hewitt SM, Brinton LA, Storniolo AMV, He C, Garcia-Closas M, Chanock SJ, Gierach GL, Figueroa JD. Ages at menarche- and menopause-related genetic variants in relation to terminal duct lobular unit involution in normal breast tissue. Breast Cancer Res Treat 2016; 158:341-50. [PMID: 27342457 DOI: 10.1007/s10549-016-3859-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/07/2016] [Indexed: 12/21/2022]
Abstract
Reduced levels of terminal duct lobular unit (TDLU) involution, as reflected by higher numbers of TDLUs and acini per TDLU, have been associated with higher breast cancer risk. Younger age at menarche and older age at menopause have been previously related to lower levels of TDLU involution. To determine a possible genetic link, we examined whether single-nucleotide polymorphisms (SNPs) previously established in genome-wide association studies (GWAS) for ages at menarche and menopause are associated with TDLU involution. We conducted a pooled analysis of 862 women from two studies. H&E tissue sections were assessed for numbers of TDLUs and acini/TDLU. Poisson regression models were used to estimate associations of 36 menarche- and 21 menopause-SNPs with TDLU counts, acini counts/TDLU, and the product of these two measures, adjusting for age and study site. Fourteen percent of evaluated SNPs (eight SNPs) were associated with TDLU counts at p < 0.05, suggesting an enrichment of associations with TDLU counts. However, only menopause-SNPs had >50 % that were either significantly or nonsignificantly associated with TDLU measures in the directions consistent with their relationships shown in GWAS. Among ten SNPs that were statistically significantly associated with at least one TDLU involution measure (p < 0.05), seven SNPs (rs466639: RXRG; rs2243803: SLC14A2; rs2292573: GAB2; rs6438424: 3q13.32; rs7606918: METAP1D; rs11668344: TMEM150B; rs1635501: EXO1) were associated in the consistent directions. Our data suggest that the loci associated with ages at menarche and menopause may influence TDLU involution, suggesting some shared genetic mechanisms. However, larger studies are needed to confirm the results.
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Affiliation(s)
- Hannah Oh
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA.
| | - Clara Bodelon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Maya Palakal
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Nilanjan Chatterjee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Mark E Sherman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA.,Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Laura Linville
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | | | | | | | | | - Daphne Papathomas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Deesha A Patel
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Jackie Xiang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Susan E Clare
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel W Visscher
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Carolyn Mies
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Genomic Health, Inc., Redwood City, CA, USA
| | - Stephen M Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Anna Maria V Storniolo
- Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - Chunyan He
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA.,Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - Montserrat Garcia-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Jonine D Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA.,Usher Institute of Population Health Sciences and Informatics, Institute of Genomics and Molecular Medicine, Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
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14
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Huynh L, Yermakov S, Davis M, Campbell R, Cleveland M, Farraye FA, Yenikomshian M. Cost-analysis model of colonoscopy preparation using split-dose reduced-volume oral sulfate solution (OSS) and polyethylene glycol with electrolytes solution (PEG-ELS). J Med Econ 2016; 19:356-63. [PMID: 26610148 DOI: 10.3111/13696998.2015.1125907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The study aimed to (1) develop a cost model for colonoscopy preparation among patients referred for colonoscopy using split-dose reduced-volume oral sulfate solution (OSS) and generic polyethylene glycol with electrolytes solution (PEG-ELS), (2) examine cost savings associated with OSS vs PEG-ELS, and (3) assess the robustness of the cost model. METHODS Efficacy of each agent was based on the results of a 541-patient clinical trial comparing OSS to PEG-ELS. Cleansing agent and colonoscopy procedure costs were calculated from OptumHealth Reporting & Insights claims data for 2010-Q12013. In the model, patients' colonoscopies were tracked over a 25 or 35 year time period until the patients reached age 75. The difference per patient per year (PPPY) in total cleansing agent and colonoscopy procedure costs over the time horizon between the OSS and PEG-ELS cohort was calculated. One-way sensitivity analyses were conducted to test the robustness of the cost model. RESULTS The model showed lower cost for OSS patients over the time horizon. Total PPPY costs were $280.34 for the OSS cohort and $296.36 for the PEG-ELS cohort, resulting in a cost saving of $16.01 PPPY for the OSS cohort. This was due primarily to OSS patients having fewer colonoscopies (OSS: 0.158 vs PEG-ELS: 0.170 PPPY). Over the time horizon, cost savings of $4 763 335 were observed among 10, 000 OSS patients. Cost savings switched from OSS to PEG-ELS cohort in four cases: (1) base-case cost of a completed colonoscopy decreased by 75%, (2) base-case cost of OSS increased to over $143 per usage, (3) all non-completers were lost to follow-up, and (4) OSS bowel preparation quality dropped below PEG-ELS to 70%. CONCLUSIONS From a payer's perspective, the model showed that the use of OSS as the cleansing agent resulted in potential cost savings compared with PEG-ELS. Cost savings under OSS remained under various sensitivity analyses.
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15
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Bethea TN, Rosenberg L, Castro-Webb N, Lunetta KL, Sucheston-Campbell LE, Ruiz-Narváez EA, Charlot M, Park SY, Bandera EV, Troester MA, Ambrosone CB, Palmer JR. Family History of Cancer in Relation to Breast Cancer Subtypes in African American Women. Cancer Epidemiol Biomarkers Prev 2015; 25:366-73. [PMID: 26721669 DOI: 10.1158/1055-9965.epi-15-1068] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 12/10/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The evidence on the relation of family history of cancers other than breast cancer to breast cancer risk is conflicting, and most studies have not assessed specific breast cancer subtypes. METHODS We assessed the relation of first-degree family history of breast, prostate, lung, colorectal, ovarian, and cervical cancer and lymphoma or leukemia, to the risk of estrogen receptor-positive (ER(+)), ER(-), and triple-negative breast cancer in data from the African American Breast Cancer Epidemiology and Risk Consortium. Multivariable logistic regression models were used to calculate ORs and 95% confidence intervals (CI). RESULTS There were 3,023 ER(+) and 1,497 ER(-) breast cancer cases (including 696 triple-negative cases) and 17,420 controls. First-degree family history of breast cancer was associated with increased risk of each subtype: OR = 1.76 (95% CI, 1.57-1.97) for ER(+), 1.67 (1.42-1.95) for ER(-), and 1.72 (1.38-2.13) for triple-negative breast cancer. Family history of cervical cancer was associated with increased risk of ER(-) (OR = 2.39; 95% CI, 1.36-4.20), but not ER(+) cancer. Family history of both breast and prostate cancer was associated with increased risk of ER(+) (3.40; 2.42-4.79) and ER(-) (2.09; 1.21-3.63) cancer, but family history of both breast and lung cancer was associated only with ER(-) cancer (2.11; 1.29-3.46). CONCLUSIONS A family history of cancers other than breast may influence the risk of breast cancer, and associations may differ by subtype. IMPACT Greater surveillance and counseling for additional screening may be warranted for women with a family history of cancer.
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Affiliation(s)
- Traci N Bethea
- Slone Epidemiology Center at Boston University, Boston, Massachusetts.
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Nelsy Castro-Webb
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | | | | | | | | | - Song-Yi Park
- University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Elisa V Bandera
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Melissa A Troester
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina
| | | | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
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16
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Randazzo M, Müller A, Carlsson S, Eberli D, Huber A, Grobholz R, Manka L, Mortezavi A, Sulser T, Recker F, Kwiatkowski M. A positive family history as a risk factor for prostate cancer in a population-based study with organised prostate-specific antigen screening: results of the Swiss European Randomised Study of Screening for Prostate Cancer (ERSPC, Aarau). BJU Int 2015; 117:576-83. [PMID: 26332304 DOI: 10.1111/bju.13310] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess the value of a positive family history (FH) as a risk factor for prostate cancer incidence and grade among men undergoing organised prostate-specific antigen (PSA) screening in a population-based study. SUBJECTS AND METHODS The study cohort comprised all attendees of the Swiss arm of the European Randomised Study of Screening for Prostate Cancer (ERSPC) with systematic PSA level tests every 4 years. Men reporting first-degree relative(s) diagnosed with prostate cancer were considered to have a positive FH. Biopsy was exclusively PSA triggered at a PSA level threshold of 3 ng/mL. The primary endpoint was prostate cancer diagnosis. Kaplan-Meier and Cox regression analyses were used. RESULTS Of 4 932 attendees with a median (interquartile range, IQR) age of 60.9 (57.6-65.1) years, 334 (6.8%) reported a positive FH. The median (IQR) follow-up duration was 11.6 (10.3-13.3) years. Cumulative prostate cancer incidence was 60/334 (18%, positive FH) and 550/4 598 (12%, negative FH) [odds ratio 1.6, 95% confidence interval (CI) 1.2-2.2, P = 0.001). In both groups, most prostate cancer diagnosed was low grade. There were no significant differences in PSA level at diagnosis, biopsy Gleason score or Gleason score on pathological specimen among men who underwent radical prostatectomy between both groups. On multivariable analysis, age (hazard ratio [HR] 1.04, 95% CI 1.02-1.06), baseline PSA level (HR 1.13, 95% CI 1.12-1.14), and FH (HR 1.6, 95% CI 1.24-2.14) were independent predictors for overall prostate cancer incidence (all P < 0.001). Only baseline PSA level (HR 1.14, 95% CI 1.12-1.16, P < 0.001) was an independent predictor of Gleason score ≥7 prostate cancer on prostate biopsy. The proportion of interval prostate cancer diagnosed in-between the screening rounds was not significantly different. CONCLUSION Irrespective of the FH status, the current PSA-based screening setting detects the majority of aggressive prostate cancers and missed only a minority of interval cancers with a 4-year screening algorithm. Our results suggest that men with a positive FH are at increased risk of low-grade but not aggressive prostate cancer.
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Affiliation(s)
- Marco Randazzo
- Department of Urology, University Hospital Zürich, Zürich, Switzerland.,Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Alexander Müller
- Department of Urology, University Hospital Zürich, Zürich, Switzerland
| | - Sigrid Carlsson
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Urology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Daniel Eberli
- Department of Urology, University Hospital Zürich, Zürich, Switzerland
| | - Andreas Huber
- Department of Laboratory Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Rainer Grobholz
- Department of Pathology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Lukas Manka
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Ashkan Mortezavi
- Department of Urology, University Hospital Zürich, Zürich, Switzerland
| | - Tullio Sulser
- Department of Urology, University Hospital Zürich, Zürich, Switzerland
| | - Franz Recker
- Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Maciej Kwiatkowski
- Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland.,Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
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17
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Fedewa SA, Cullati S, Bouchardy C, Welle I, Burton-Jeangros C, Manor O, Courvoisier DS, Guessous I. Colorectal Cancer Screening in Switzerland: Cross-Sectional Trends (2007-2012) in Socioeconomic Disparities. PLoS One 2015; 10:e0131205. [PMID: 26147803 PMCID: PMC4492507 DOI: 10.1371/journal.pone.0131205] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 05/30/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite universal health care coverage, disparities in colorectal cancer (CRC) screening by income in Switzerland have been reported. However, it is not known if these disparities have changed over time. This study examines the association between socioeconomic position and CRC screening in Switzerland between 2007 and 2012. METHODS Data from the 2007 (n = 5,946) and 2012 (n = 7,224) population-based Swiss Health Interview Survey data (SHIS) were used to evaluate the association between monthly household income, education, and employment with CRC screening, defined as endoscopy in the past 10 years or fecal occult blood test (FOBT) in the past 2 years. Multivariable Poisson regression was used to estimate prevalence ratios (PR) and 95% Confidence Intervals (CI) adjusting for demographics, health status, and health utilization. RESULTS CRC screening increased from 18.9% in 2007 to 22.2% in 2012 (padjusted: = 0.036). During the corresponding time period, endoscopy increased (8.2% vs. 15.0%, padjusted:<0.001) and FOBT decreased (13.0% vs. 9.8%, padjusted:0.002). CRC screening prevalence was greater in the highest income (>$6,000) vs. lowest income (≤$2,000) group in 2007 (24.5% vs. 10.5%, PR:1.37, 95%CI: 0.96-1.96) and in 2012 (28.6% vs. 16.0%, PR:1.45, 95%CI: 1.09-1.92); this disparity did not significantly change over time. CONCLUSIONS While CRC screening prevalence in Switzerland increased from 2007 to 2012, CRC screening coverage remains low and disparities in CRC screening by income persisted over time. These findings highlight the need for increased access to CRC screening as well as enhanced awareness of the benefits of CRC screening in the Swiss population, particularly among low-income residents.
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Affiliation(s)
- Stacey A. Fedewa
- Emory University, Department of Epidemiology, Atlanta, GA, United States of America
- American Cancer Society, Atlanta, GA, United States of America
| | - Stéphane Cullati
- Unit of population epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Christine Bouchardy
- Geneva Cancer Registry, Global Health Institute, University of Geneva, Geneva, Switzerland
| | - Ida Welle
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Orly Manor
- Unit of population epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
- School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel
| | | | - Idris Guessous
- Emory University, Department of Epidemiology, Atlanta, GA, United States of America
- Unit of population epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
- Division of Chronic Disease, University Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
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18
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Schubauer-Berigan MK, Anderson JL, Hein MJ, Little MP, Sigurdson AJ, Pinkerton LE. Breast cancer incidence in a cohort of U.S. flight attendants. Am J Ind Med 2015; 58:252-66. [PMID: 25678455 PMCID: PMC4566958 DOI: 10.1002/ajim.22419] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Flight attendants may have elevated breast cancer incidence (BCI). We evaluated BCI's association with cosmic radiation dose and circadian rhythm disruption among 6,093 female former U.S. flight attendants. METHODS We collected questionnaire data on BCI and risk factors for breast cancer from 2002-2005. We conducted analyses to evaluate (i) BCI in the cohort compared to the U.S. population; and (ii) exposure-response relations. We applied an indirect adjustment to estimate whether parity and age at first birth (AFB) differences between the cohort and U.S. population could explain BCI that differed from expectation. RESULTS BCI was elevated but may be explained by lower parity and older AFB in the cohort than among U.S. women. BCI was not associated with exposure metrics in the cohort overall. Significant positive associations with both were observed only among women with parity of three or more. CONCLUSIONS Future cohort analyses may be informative on the role of these occupational exposures and non-occupational risk factors.
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Affiliation(s)
- Mary K. Schubauer-Berigan
- National Institute for Occupational Safety and Health, Division of Surveillance, Hazard Evaluations and Field Studies, Industrywide Studies Branch, Cincinnati, Ohio
| | - Jeri L. Anderson
- National Institute for Occupational Safety and Health, Division of Surveillance, Hazard Evaluations and Field Studies, Industrywide Studies Branch, Cincinnati, Ohio
| | - Misty J. Hein
- National Institute for Occupational Safety and Health, Division of Surveillance, Hazard Evaluations and Field Studies, Industrywide Studies Branch, Cincinnati, Ohio
| | - Mark P. Little
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, Bethesda, Maryland
| | - Alice J. Sigurdson
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, Bethesda, Maryland
| | - Lynne E. Pinkerton
- National Institute for Occupational Safety and Health, Division of Surveillance, Hazard Evaluations and Field Studies, Industrywide Studies Branch, Cincinnati, Ohio
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19
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Vertosick EA, Poon BY, Vickers AJ. Relative value of race, family history and prostate specific antigen as indications for early initiation of prostate cancer screening. J Urol 2014; 192:724-8. [PMID: 24641912 DOI: 10.1016/j.juro.2014.03.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2014] [Indexed: 11/15/2022]
Abstract
PURPOSE Many guidelines suggest earlier screening for prostate cancer in men at high risk, with risk defined in terms of race and family history. Recent evidence suggests that baseline prostate specific antigen is strongly predictive of the long-term risk of aggressive prostate cancer. We compared the usefulness of risk stratifying early screening by race, family history and prostate specific antigen at age 45 years. MATERIALS AND METHODS Using estimates from the literature we calculated the proportion of men targeted for early screening using family history, black race or prostate specific antigen as the criterion for high risk. We calculated the proportion of prostate cancer deaths that would occur in those men by age 75 years. RESULTS Screening based on family history involved 10% of men, accounting for 14% of prostate cancer deaths. Using black race as a risk criterion involved 13% of men, accounting for 28% of deaths. In contrast, 44% of prostate cancer deaths occurred in the 10% of men with the highest prostate specific antigen at age 45 years. In no sensitivity analysis for race and family history did the ratio of risk group size to number of prostate cancer deaths in that risk group approach that of prostate specific antigen. CONCLUSIONS Basing decisions for early screening on prostate specific antigen at age 45 years provided the best ratio between men screened and potential cancer deaths avoided. Given the lack of evidence that race or family history affects the relationship between prostate specific antigen and risk, prostate specific antigen based risk stratification would likely include any black men or men with a family history who are destined to experience aggressive disease. Differential screening based on risk should be informed by baseline prostate specific antigen.
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Affiliation(s)
- Emily A Vertosick
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Bing Ying Poon
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Andrew J Vickers
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.
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20
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Chatterjee N, Wheeler B, Sampson J, Hartge P, Chanock SJ, Park JH. Projecting the performance of risk prediction based on polygenic analyses of genome-wide association studies. Nat Genet 2013; 45:400-5, 405e1-3. [PMID: 23455638 PMCID: PMC3729116 DOI: 10.1038/ng.2579] [Citation(s) in RCA: 258] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 02/08/2013] [Indexed: 12/15/2022]
Abstract
We report a new model to project the predictive performance of polygenic models based on the number and distribution of effect sizes for the underlying susceptibility alleles and the size of the training dataset. Using estimates of effect-size distribution and heritability derived from current studies, we project that while 45% of the variance of height has been attributed to common tagging Single Nucleotide Polymorphisms (SNP), a model trained on one million people may only explain 33.4% of variance of the trait. Current studies can identify 3.0%, 1.1%, and 7.0%, of the populations who are at two-fold or higher than average risk for Type 2 diabetes, coronary artery disease and prostate cancer, respectively. Tripling of sample sizes could elevate the percentages to 18.8%, 6.1%, and 12.2%, respectively. The utility of future polygenic models will depend on achievable sample sizes, underlying genetic architecture and information on other risk-factors, including family history.
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Affiliation(s)
- Nilanjan Chatterjee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Human and Human Services, Rockville, Maryland, USA
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21
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Ozanne EM, O'Connell A, Bouzan C, Bosinoff P, Rourke T, Dowd D, Drohan B, Millham F, Griffin P, Halpern EF, Semine A, Hughes KS. Bias in the reporting of family history: implications for clinical care. J Genet Couns 2012; 21:547-56. [PMID: 22237666 DOI: 10.1007/s10897-011-9470-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 12/08/2011] [Indexed: 12/22/2022]
Abstract
Family history of cancer is critical for identifying and managing patients at risk for cancer. However, the quality of family history data is dependent on the accuracy of patient self reporting. Therefore, the validity of family history reporting is crucial to the quality of clinical care. A retrospective review of family history data collected at a community hospital between 2005 and 2009 was performed in 43,257 women presenting for screening mammography. Reported numbers of breast, colon, prostate, lung, and ovarian cancer were compared in maternal relatives vs. paternal relatives and in first vs. second degree relatives. Significant reporting differences were found between maternal and paternal family history of cancer, in addition to degree of relative. The number of paternal family histories of cancer was significantly lower than that of maternal family histories of cancer. Similarly, the percentage of grandparents' family histories of cancer was significantly lower than the percentage of parents' family histories of cancer. This trend was found in all cancers except prostate cancer. Self-reported family history in the community setting is often influenced by both bloodline of the cancer history and the degree of relative affected. This is evident by the underreporting of paternal family histories of cancer, and also, though to a lesser extent, by degree. These discrepancies in reporting family history of cancer imply we need to take more care in collecting accurate family histories and also in the clinical management of individuals in relation to hereditary risk.
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Affiliation(s)
- Elissa M Ozanne
- Institute for Health Policy Studies, Department of Surgery, University of California, San Francisco, CA, USA.
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Moghimi-Dehkordi B, Safaee A, Vahedi M, Pourhoseingholi MA, Pourhoseingholi A, Ashtari S. History of upper gastrointestinal cancers in relatives: a community-based estimate. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2012; 5:100-5. [PMID: 24834208 PMCID: PMC4017460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 01/18/2012] [Indexed: 11/24/2022]
Abstract
AIM The present study aimed to evaluate the prevalence of positive family history of these cancers in a large population-based sample of Tehran province, capital of Iran. BACKGROUND Upper gastrointestinal (UGI) cancers (gastric and esophagus cancer) constitute a major health problem worldwide. A family history of cancer can increase the risk for developing cancer and recognized as one of the most important risk factors in predicting personal cancer risk. PATIENTS AND METHODS This study designed as a cross-sectional survey in general population (2006-2007) of Tehran province. Totally 7,300 persons (age > = 20 years) sampled by random sampling on the basis of the list of postal, of whom 6,700 persons agreed to participate (response rate 92%). Respondents were asked if any first-degree (FDR) or second-degree (SDR) relatives had gastric or esophageal cancer. RESULTS Totally, 6,453 respondents (48% male) entered to the study. The mean age of responders with positive FH was significantly higher than those with negative FH (P < 0.05). In total, 341 respondents (5.3%) reporting a history of UGI cancers in their relatives, 134(2.1%) in FDRs, and 207(3.2%) in SDRs. CONCLUSION Our findings showed that the reported prevalence of FH of UGI cancers was relatively low and varied by specific respondent characteristics such as age and sex. However, the estimates of prevalence presented here are likely to be conservative compared with actual prevalence because of self-reported data gathering.
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Affiliation(s)
| | - Azadeh Safaee
- Gastroenterology ward, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Vahedi
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Tehran University of Medical Science, Tehran, Iran
| | | | - Asma Pourhoseingholi
- Department of Biostatistics, Faculty of Paramedical, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Sarah Ashtari
- Gastroenterology ward, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Klingler C. Re: The Influence of Family History on Prostate Cancer Risk: Implications for Clinical Management. Eur Urol 2011; 59:881-2. [DOI: 10.1016/j.eururo.2011.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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