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Familial risk of cancer not limited to early onset in parents
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Late-onset cancer in a parent is associated with increased risks of the same cancer in offspring, according to results of a prospective study.
Early-onset cancers have a more pronounced hereditary component compared with late-onset cancer. Though the greatest risk factor for developing cancer is aging, little is known about whether any familial component exists in cancers that occur in old age, according to background information in the study.
Elham Kharazmi, MD, of the division of molecular genetic epidemiology at the German Cancer Research Center in Heidelberg, Germany, and colleagues conducted the investigation to determine whether history of late-onset cancer in parents is associated with an increased risk of familial cancer in their children.
The researchers examined all Swedish parents and their offspring born after 1931 who were included in the Swedish Family-Cancer Database. The investigation included data on more than 12.2 million parents, and investigators detected more than 1.1 million cases of first primary cancer.
The offspring of parents diagnosed at an early age showed the highest familial risks, according to study results.
Kharazmi and colleagues found significantly increased familial risks for colorectal, lung, breast, prostate and urinary bladder cancers, melanoma, squamous cell carcinoma of the skin and non-Hodgkin’s lymphoma in parents diagnosed after age 69 years.
The risk of concordant cancer in offspring significantly increased for parents who were at advanced age (older than 90 years) when they were diagnosed with squamous cell carcinoma of the skin (HR=1.9; 95% CI, 1.4-2.7), colorectal cancer (HR=1.6; 95% CI, 1.2-2.0), breast cancer (HR=1.3; 95% CI, 1.0-1.6) and prostate cancer (HR=1.3; 95% CI, 1.1-1.6).
“Our study suggests that the bulk of familial cancers of advanced ages are included in the moderate risk category, which does demand increased clinical surveillance and further investigations to identify factors that affect cancer susceptibility at advanced ages,” Kharazmi and colleagues wrote.
Family members may benefit from knowing the adjustable risk factors associated with particular cancers, the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to TopPauline Funchain, MD and Charis Eng, MD, PhD, FACP
The study by Kharazmi and colleagues widens our perspective of cancer predisposition syndromes from the oft-held concept of a pedigree containing multiple early-onset cancers. In a large Swedish Registry study, Kharazmi et al show that — for multiple common cancers — parents who are diagnosed at advanced ages still impart an increased risk of the same type of cancer in their children. Despite the frequently quoted estimate that 1 in 3 members of a given family will have sporadic, nonhereditary cancers, we often see families with no cancer at all except for the referred individual.
Although early-onset cancer has gotten the most attention and has the most "low-hanging fruit" from a research perspective, families with multiple cancers diagnosed at an older age are equally likely to have as-of-yet undiscovered cancer susceptibility genes. They provide rich fodder for the genes that interact with a lifetime of environmental exposures, which could result in older-onset cancers. In summary, accurate knowledge is gold in medicine, and we do our best as physicians to offer our patients opportunities to know more about their genetic makeup and how to utilize this gift of genetic information to tailor management.
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