Mitchell R J, Brewster D, Campbell H, Porteous M E M, Wyllie A H, Bird C C, Dunlop M G
Public Health Sciences, Department of Community Health Sciences, University of Edinburgh, Edinburgh, Scotland, UK.
Gut. 2004 Feb;53(2):291-5. doi: 10.1136/gut.2003.027896.
Family history is used extensively to estimate the risk of colorectal cancer but there is considerable potential for recall bias and inaccuracy. Hence we systematically assessed the accuracy of family history reported at interview compared with actual cancer experience in relatives.
Using face to face interviews, we recorded family history from 199 colorectal cancer cases and 133 community controls, totalling 5637 first and second degree relatives (FDRs/SDRs). We linked computerised cancer registry data to interview information to determine the accuracy of family history reporting.
Cases substantially underreported colorectal cancer arising both in FDRs (sensitivity 0.566 (95% confidence interval (CI) 0.433, 0.690); specificity 0.990 (95% CI 0.983, 0.994)) and SDRs (sensitivity 0.271 (95% CI 0.166, 0.410); specificity 0.996 (95% CI 0.992, 0.998)). There was no observable difference in accuracy of reporting family history between case and control interviewees. Control subjects similarly underreported colorectal cancer in FDRs (sensitivity 0.529 (95% CI 0.310, 0.738); specificity 0.995 (95% CI 0.989, 0.998)) and SDRs (sensitivity 0.333 (95% CI 0.192, 0.512); specificity 0.995 (95% CI 0.991, 0.995)). To determine practical implications of inaccurate family history, we applied family history criteria before and after record linkage. Only two of five families reported at interview to meet surveillance criteria did so after validation, whereas only two of six families that actually merited surveillance were identified by interview.
This study has quantified the inaccuracy of interview in identifying people at risk of colorectal cancer due to a family history. Colorectal cancer was substantially underreported and so family history information should be interpreted with caution. These findings have considerable relevance to identifying patients who merit surveillance colonoscopy and to epidemiological studies.
家族史被广泛用于评估结直肠癌风险，但存在相当大的回忆偏倚和不准确的可能性。因此，我们系统地评估了访谈中报告的家族史与亲属实际患癌情况相比的准确性。
通过面对面访谈，我们记录了199例结直肠癌病例和133名社区对照的家族史，共计5637名一级和二级亲属（FDRs/SDRs）。我们将计算机化的癌症登记数据与访谈信息相链接，以确定家族史报告的准确性。
病例组对FDRs中发生的结直肠癌报告严重不足（敏感性0.566（95%置信区间（CI）0.433，0.690）；特异性0.990（95%CI 0.983，0.994）），对SDRs中发生的结直肠癌报告也严重不足（敏感性0.271（95%CI 0.166，0.410）；特异性0.996（95%CI 0.992，0.998））。病例组和对照组访谈对象在报告家族史的准确性方面没有明显差异。对照组对FDRs中结直肠癌的报告同样不足（敏感性0.529（95%CI 0.310，0.738）；特异性0.995（95%CI 0.989，0.998）），对SDRs中结直肠癌的报告也不足（敏感性0.333（95%CI 0.192，0.512）；特异性0.995（95%CI 0.991，0.995））。为了确定不准确家族史的实际影响，我们在记录链接前后应用了家族史标准。在访谈中报告符合监测标准的五个家庭中，只有两个在验证后符合标准，而在实际值得监测的六个家庭中，只有两个通过访谈被识别出来。
本研究量化了访谈在识别因家族史而有患结直肠癌风险人群时的不准确程度。结直肠癌报告严重不足，因此家族史信息应谨慎解读。这些发现对于识别值得进行监测结肠镜检查的患者以及流行病学研究具有重要意义。
