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Change in family history affects cancer screening

Friday July 15, 2011
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Among the most important determinants of an individual's risk of cancer is family history, and the details of that history can affect recommendations for screening examinations such as colonoscopies and mammograms. Now a multi-institutional research team has reported that changes in family history significant enough to alter screening recommendations are common in adults ages 30 to 50.

"We wanted to find out whether changes in a person's family history of cancer, over time, would affect the screening schedule and tests recommended by standard guidelines," Dianne Finkelstein, PhD, of the Massachusetts General Hospital Biostatistics Center, said in a news release. "The results of our study could guide how often healthcare providers should update their patients' family histories."

The study investigators are all members of the National Cancer Institute-funded Cancer Genetics Network (CGN), which involves 14 academic medical centers in the U.S. Established in 1998, the CGN is a registry of thousands of individuals with a personal or family history of cancer. The researchers analyzed both the detailed family history information participants reported upon enrollment in the network — which reflected their cancer risk up until that time — and the updated information they provided on an annual basis over an average of eight years.

Sufficient data to determine risk of those colorectal, breast and prostate cancer tumors were available for more than 11,000 CGN participants. Examining both the retrospective and prospective information reported by participants revealed that, between ages 30 and 50, the percentage of participants whose risk of colorectal cancer increased enough to affect screening recommendations more than tripled. Similarly the percentage of women in that age group with a change in breast cancer risk that would call for breast MRI increased almost 60%. A smaller but still significant increase in prostate cancer risk was seen in men ages 30 to 50.

The investigators noted that, in addition to taking comprehensive family histories of new patients, primary care physicians or other healthcare providers should update those histories every five to 10 years, particularly for patients between the ages of 30 and 50.

"As most healthcare 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," senior author Sharon Plon, MD, PhD, of Baylor College of Medicine, said in the news release.

Plon noted that patients can also take it upon themselves to inform their providers of significant changes: "Many patients make lists of questions for the doctor before their appointments, and we hope they add changes to their family history to those lists. Our results are relevant for all patients, since anyone may have a change that would affect their cancer screening recommendations."

The report appears in the July 13 issue Journal of the American Medical Association: http://jama.ama-assn.org/content/306/2/172.abstract.

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