Family cancer history needs updating more frequently
MedWire News: A person's family history of cancer often changes in a clinically relevant way between the ages of 30 and 50 years, to the extent that it could affect recommendations for screening frequency and intensity, shows an analysis of US data.
"If a patient's family history is not updated during early and middle adulthood, the opportunity may be missed to intervene with earlier or more intensive screening that maximizes the likelihood of detecting cancer at an early, treatable stage," report Dianne Finkelstein (Harvard University, Boston, Massachusetts) and co-investigators.
Their study, which involved both a retrospective and a prospective analysis of data for more than 10,000 individuals, revealed that the percentage of people recommended for high-risk screening for breast and colorectal cancer on the basis of family history increases 1.5-3.0 fold between the ages of 30 and 50 years.
"We therefore recommend that family history should be updated at least every 5 to 10 years to appropriately inform recommendations for cancer screening," say the researchers in JAMA.
The team used information from the Cancer Genetics Network registry to evaluate patients' reported family history retrospectively (from birth until enrollment on the register) and prospectively (from enrollment to time of last follow-up survey).
The focus of analysis, based on a median 8-year follow-up, was on changes in family history that would render individuals candidates for early and more intensive screening for colorectal, breast, and prostate cancer. The respective numbers of individuals with data available for these cancers were 9861, 2547, and 1817 for the retrospective analysis, and 1533, 617, and 163 for the prospective analysis.
The retrospective analysis showed that at age 30 years, 2.1% of individuals would have met criteria for early colonoscopy screening, but by 50 years of age, this percentage had increased to 7.1%, peaking at 70 years, at 11%.
In the prospective analysis, 15 registrants reported changes in family history that altered colorectal cancer risk. These changes resulted in one additional person per 100 participants followed-up for 10 years becoming eligible for enhanced screening.
The results for breast cancer were similar to colorectal cancer, with steady increases in the number of women who would have met criteria for magnetic resonance imaging (MRI), from 7.2% of women at age 30 years, to 11.4% at age 50 years. This percentage leveled off after 60 years, at approximately 13%.
Prospective analysis showed that the overall rate of women newly meeting criteria for MRI scanning was three additional women per 100 followed-up for 10 years, with rates of zero for those aged 35-39 years, four for those aged 40-49 years, and three for those aged 50-59 years.
"As most health care systems are moving toward the use of electronic health records, there is tremendous potential to ensure that people at higher risk of cancer are being screened earlier and using the best methods," concluded co-investigator Sharon Plon (Baylor College of Medicine, Houston, Texas).
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By Sarah Guy