Original articles
Physician assessment of family cancer history and referral for genetic evaluation in colorectal cancer patients

https://doi.org/10.1016/S1542-3565(04)00352-0Get rights and content

Background & Aims: An accurate family history is an essential component of cancer risk assessment. Our aim was to determine the concordance of family history assessments made by physicians with patients’ self-reports and the frequency of referral for genetic evaluation in high-risk colorectal cancer (CRC) patients. Methods: A self-administered family cancer history questionnaire was completed by 387 consecutive CRC patients at their first visit to a gastroenterology cancer clinic. Physician notes from the first visit were reviewed to determine the concordance of the family cancer history with patients’ self-reported history. Prevalence of individuals that satisfied the Bethesda guidelines for hereditary colon cancer were compared with actual rates of referral. Regression analyses were used to determine factors associated with a comprehensive physician evaluation of family history. Results: Oncologists documented a comprehensive family history in 59% (184 of 311) of patients with a first- or second-degree relative with cancer. Young age at diagnosis and a first-degree relative with CRC were not associated with a more comprehensive family history assessment. An increasing number of cancers per family was a strong predictor of a less comprehensive family history assessment (odds ratio = 0.63; P < 0.0001). Seventy-five of 387 (19%) CRC patients met Bethesda guidelines for genetics assessment, however, only 13 of 75 (17%) were referred. Conclusions: Increased complexity in family cancer history leads to a decrease in accuracy of family history, suggesting the need for systematic approaches to facilitate family history assessment. Familial cancer risk remains largely unrecognized and referral rates for genetic evaluation for CRC syndromes are low.

Section snippets

Materials and methods

All patients with a diagnosis of CRC whose first visit to a multidisciplinary gastrointestinal cancer clinic was between June 2001 and May 2002 received a standardized family history questionnaire before their visit. The 2-page family history questionnaire elicited information about the type of cancers diagnosed in relatives and the age at cancer diagnoses. The questionnaire specifically asked patients to indicate the number of siblings and children they had. Family history of colorectal,

Results

A family history questionnaire was completed by 98% (387 of 395) of patients seen for their first oncology visit at the gastrointestinal cancer clinic between June 2001 and May 2002. We retrospectively reviewed the records of 387 consecutive CRC patients who had completed the questionnaire for demographic and family history information. Patient characteristics are provided in Table 1. Patients were seen by 1 of 9 staff oncologists with a median age of 41 years (range, 37–59 yr). The average

Discussion

The results of our study show that although family history of cancer is frequently obtained during medical evaluations, its accuracy is often limited. When compared with patient self-reported information provided by CRC patients on a written questionnaire, nearly one third of cancers in first-degree relatives were not documented by physicians in patients’ medical records. Of interest, the accuracy of cancer history decreased with an increase in the number of cancer diagnoses in the family. From

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    Supported in part by a National Institutes of Health grant K07CA08453 for studying identification and cancer screening in hereditary colon cancer families (to S.S.).

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