Physician Assessment of Family Cancer History and Referral for Genetic Evaluation in Colorectal Cancer Patients
Physician Assessment of Family Cancer History and Referral for Genetic Evaluation in Colorectal Cancer Patients
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DOI：
10.1016/s1542-3565(04)00352-0
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发表时间：
2004-09-01
影响因子：
12.6
通讯作者：
Syngal, Sapna
中科院分区：
文献类型：
--
作者：
Grover, Shilpa;Stoffel, Elena M.;Syngal, Sapna
背景与目的：准确的家族史是癌症风险评估的重要组成部分。我们的目的是确定医生所做的家族史评估与患者自我报告的一致性，以及高危结直肠癌（CRC）患者转诊进行遗传评估的频率。方法：对387例连续的CRC患者在首次就诊时自行填写癌症家族史问卷。回顾第一次就诊的医生记录，以确定家族癌症病史与患者自述病史的一致性。满足Bethesda遗传结肠癌指南的个体患病率与实际转诊率进行了比较。回归分析用于确定与医生对家族史进行综合评估相关的因素。结果：肿瘤学家记录了59%（311名患者中的184名）的一级或二级亲属患有癌症的患者有全面的家族史。诊断时年龄小和一级亲属患有结直肠癌与更全面的家族史评估无关。每个家庭癌症数量的增加是一个较不全面的家族史评估的有力预测因子（优势比= 0.63;P < 0.0001）。387例CRC患者中有75例（19%）符合Bethesda遗传评估指南，然而，75例中只有13例（17%）被参考。结论：家族史复杂性的增加导致家族史准确性的降低，提示需要系统的方法来促进家族史评估。家族性癌症风险在很大程度上仍未被认识，CRC综合征遗传评估的转诊率很低。
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.