University of California–Irvine, USA.
JAMA. 2011 Jul 13;306(2):172-8. doi: 10.1001/jama.2011.955.
Knowledge of family cancer history is important for assessing cancer risk and guiding screening recommendations.
To quantify how often throughout adulthood clinically significant changes occur in cancer family history that would result in recommendations for earlier or intense screening.
Descriptive study examining baseline and follow-up family history data from participants in the Cancer Genetics Network (CGN), a US national population-based cancer registry, between 1999 and 2009.
Adults with a personal history, family history, or both of cancer enrolled in the CGN through population-based cancer registries. Retrospective colorectal, breast, and prostate cancer screening-specific analyses included 9861, 2547, and 1817 participants, respectively; prospective analyses included 1533, 617, and 163 participants, respectively. Median follow-up was 8 years (range, 0-11 years). Screening-specific analyses excluded participants with the cancer of interest.
Percentage of individuals with clinically significant family histories and rate of change over 2 periods: (1) retrospectively, from birth until CGN enrollment and (2) prospectively, from enrollment to last follow-up.
Retrospective analysis revealed that the percentages of participants who met criteria for high-risk screening based on family history at ages 30 and 50 years, respectively, were as follows: for colorectal cancer, 2.1% (95% confidence interval [CI], 1.8%-2.4%) and 7.1% (95% CI, 6.5%-7.6%); for breast cancer, 7.2% (95% CI, 6.1%-8.4%) and 11.4% (95% CI, 10.0%-12.8%); and for prostate cancer, 0.9% (95% CI, 0.5%-1.4%) and 2.0% (95% CI, 1.4%-2.7%). In prospective analysis, the numbers of participants who newly met criteria for high-risk screening based on family history per 100 persons followed up for 20 years were 2 (95% CI, 0-7) for colorectal cancer, 6 (95% CI, 2-13) for breast cancer, and 8 (95% CI, 3-16) for prostate cancer. The rate of change in cancer family history was similar for colorectal and breast cancer between the 2 analyses.
Clinically relevant family history of colorectal, breast, and prostate cancer that would result in recommendations for earlier or intense cancer screening increases between ages 30 and 50 years, although the absolute rate is low for prostate cancer.
了解家族癌症史对于评估癌症风险和指导筛查建议很重要。
量化在成年期内癌症家族史发生何种程度的变化，才会导致更早或更强烈的筛查建议。
描述性研究，对 1999 年至 2009 年间参加癌症遗传学网络（Cancer Genetics Network，CGN）的参与者的基线和随访家族史数据进行了分析，CGN 是一个美国全国性的基于人群的癌症登记处。
通过基于人群的癌症登记处参加 CGN 的患有癌症的个人、家族史或兼有癌症的成年人。回顾性的结直肠癌、乳腺癌和前列腺癌筛查特异性分析分别纳入了 9861、2547 和 1817 名参与者；前瞻性分析分别纳入了 1533、617 和 163 名参与者。中位随访时间为 8 年（范围为 0-11 年）。筛查特异性分析排除了患有目标癌症的参与者。
根据家族史确定有临床意义的家族史的个体百分比和在 2 个时期内的变化率：（1）回顾性地，从出生到 CGN 入组；（2）前瞻性地，从入组到最后一次随访。
回顾性分析显示，分别在 30 岁和 50 岁时，符合家族史高危筛查标准的参与者百分比如下：结直肠癌为 2.1%（95%置信区间[CI]，1.8%-2.4%）和 7.1%（95% CI，6.5%-7.6%）；乳腺癌为 7.2%（95% CI，6.1%-8.4%）和 11.4%（95% CI，10.0%-12.8%）；前列腺癌为 0.9%（95% CI，0.5%-1.4%）和 2.0%（95% CI，1.4%-2.7%）。在前瞻性分析中，在每 100 例随访 20 年的参与者中，根据家族史新出现的高危筛查标准的参与者人数为结直肠癌为 2（95% CI，0-7），乳腺癌为 6（95% CI，2-13），前列腺癌为 8（95% CI，3-16）。在这两种分析中，结直肠癌和乳腺癌的癌症家族史变化率相似。
结直肠癌、乳腺癌和前列腺癌的临床相关家族史，会导致更早或更强烈的癌症筛查建议，这种变化在 30 岁至 50 岁之间发生，尽管前列腺癌的绝对发生率较低。
