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Results suggest that family histories should be updated every 5 to 10 years
Ziogas A. JAMA. 2011;306;172-178.
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Researchers attempting to determine how often clinically significant changes occur in a patient’s family history of cancer throughout adulthood found that there were substantial changes in family history of colorectal, breast and prostate cancers between the ages of 30 and 50 years.
Based on those findings, the researchers said a patient’s family history should be updated every 5 to 10 years to “appropriately inform recommendations for cancer screening.”
Ziogas and colleagues examined family history data collected from participants enrolled in the Cancer Genetics Network, a national registry of people in the United States with a personal or family history of cancer. Researchers examined data collected from 1999 to 2009.
Retrospective analysis included 9,861 patients with colorectal cancer, 2,547 with breast cancer and 1,817 with prostate cancer. Prospective analysis included 1,533 patients with colorectal cancer, 617 with breast cancer and 163 with prostate cancer. Participants had a personal history with cancer, a family history or both.
Retrospective analysis showed that, based on family history, the percentages of participants who met criteria for high-risk screening increased from 2.1% at age 30 years to 7.1% at age 50 years for breast cancer, 7.2% to 11.4% for colorectal cancer and 0.9% to 2% for prostate cancer.
Researchers said the low incidence of prostate cancer recorded could reflect the relative rarity of diagnoses before 65 years of age.
Prospective analysis showed that the 10-year rate of women newly meeting criteria for more intensive screening was highest for those aged 40 to 49 years, at 4 per 100. The rate was zero per 100 for women aged 30 to 39 years and three per 100 for women aged 50 to 59 years.
The 10-year rate for newly meeting criteria for more intensive colorectal cancer screening was two per 100 for men aged in their 30s compared with one per 100 for men aged in their 40s.
For prostate cancer, 10-year rate for newly meeting criteria for more intensive screening was seven per 100 for men aged younger than 30 years compared with five per 100 for men aged in their 30s and three per 100 for men aged in their 40s.
In an accompanying editorial, Louise S. Acheson, MD, MS, with Case Western Reserve University School of Medicine in Cleveland, wrote that the researchers found a 5% chance that a patient’s colorectal cancer screening recommendation would change between the ages of 30 and 50 years based on new family history and a 4% chance that women would be newly identified as candidates for breast MRI. Acheson said the age-specific prevalence of family history-based risk provided useful information, but researchers designing studies examining screening must take into account the associated risks, benefits, costs and lead time issues.
“It is plausible but still unknown whether family history increases the likelihood that breast cancers, prostate cancers, or colon adenomas found by screening are clinically significant,” she wrote. “An increase in the incidence of false-positive results and test-associated complications is a cost and potential harm of increased screening based on familial risk. Although some prospective data on the benefits of cancer screening based on familial risk are available, many estimates rely on extrapolation from small studies of patients with high-penetrance hereditary cancer susceptibility or from screening older patients at equivalent levels of risk.”
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