Does this patient have a family history of cancer? An evidence-based analysis of the accuracy of family cancer history

Harvey J. Murff, MD, MPH; David R. Spigel, MD; Sapna Syngal, MD, MPH

JAMA. 2004;292:1480-1489.

Context  A family history of certain cancers is associated with an increased risk of developing cancer. Both cancer screening and genetic services referral decisions are often based on self-reported pedigree information.

Objective  To determine the accuracy of self-reported family cancer history information.

Data Sources  English-language articles were retrieved by searching MEDLINE (1966-June 2004) using Medical Subject Headings family, genetic predisposition to disease, medical history taking, neoplasm, and reproducibility of results. Additional articles were identified through bibliography searches.

Study Selection  Original studies in which investigators validated self-reported family history by reviewing the identified relatives' medical records, death certificate, or cancer registry information were included, as well as studies that evaluated breast, colon, ovarian, endometrial, and prostate cancers.

Data Extraction  Two of the 3 investigators independently reviewed and abstracted data for estimating the likelihood ratios (LRs) of self-reported family cancer history information. Only data from studies that evaluated both positive and negative family cancer histories were included within the analyses. A total of 14 studies met the search criteria and were included in the review.

Data Synthesis  For patients without a personal history of cancer, the positive and negative LRs of a family history of the following cancers in a first-degree relative were 23.0 (95% confidence interval [CI], 6.4-81.0) and 0.25 (95% CI, 0.10-0.63) for colon cancer; 8.9 (95% CI, 5.4-15.0) and 0.20 (95% CI, 0.08-0.49) for breast cancer; 14.0 (95% CI, 2.2-83.4) and 0.68 (95% CI, 0.31-1.52) for endometrial cancer; 34.0 (95% CI, 5.7-202.0) and 0.51 (95% CI, 0.13-2.10) for ovarian cancer; and 12.3 (95% CI, 6.5-24.0) and 0.32 (95% CI, 0.18-0.55) for prostate cancer, respectively. Positive predictive values tended to be better in articles concerning first-degree relatives compared with second-degree relatives.

Conclusions  Patient-reported family cancer histories for first-degree relatives are accurate and valuable for breast and colon cancer risk assessments. Negative family history reports for ovarian and endometrial cancers are less useful, although the prevalence of these malignancies within families is low.

     

Colonoscopic surveillance for family history of colorectal cancer: are NHMRC guidelines being followed?

OBJECTIVES: To assess whether referrals for surveillance colonoscopy and subsequent follow-up recommendations for patients with a family history of colorectal cancer concurred with the published National Health and Medical Research Council (NHMRC) guidelines. DESIGN: A prospective audit of patients with a family history of colorectal cancer referred for surveillance colonoscopy. Follow-up recommendations were assessed retrospectively. SETTING AND SUBJECTS: All patients referred to a major teaching hospital for surveillance colonoscopy on the basis of a family history of colorectal cancer from 2 January 2000-15 April 2001. MAIN OUTCOME MEASURES: Concurrence of referrals and recommendations with NHMRC guidelines. RESULTS: Of 340 patients referred because of a family history of colorectal cancer, 202 (83 men, 119 women) were asymptomatic. Their mean age was 50 years (95% CI, 48.3-51.6 years). The family history of 95 (47%) of these patients satisfied the NHMRC criteria for colonoscopic surveillance. Another 20 patients (17%) satisfied the criteria, but were referred before the recommended age to commence surveillance. Analysis by referral source showed that the proportion of referrals meeting NHMRC guidelines was higher from specialists than from general practitioners (75% v 45%), and this difference was significant. Follow-up recommendations, when made, concurred with NHMRC guidelines in 81% of cases. CONCLUSIONS: Further education of the medical community is required to increase understanding of colorectal screening strategies and ensure appropriate resource allocation.     

Progression of esophageal cancer in endoscopic therapy

Esophageal cancer is the 6th most frequent cause of cancer-related death all over the world[1], and in China there is a high risk for esophageal cancer. With the development of operative technique, the postoperative 5-year survival rate may reach to 30%, but it is still unsatisfactory. In recent decade, with the rapid development of endoscopic equipment,     

Can young woman with vaginal or cervical adenosis take oral contraceptives?

Question: Is there evidence to suggest that oral contraceptive therapy is contraindicated in young women with vaginal or cervical adenosis, whose mothers were treated with diethylstilbestrol during pregnancy? Answer: At the present time there is no vidence to contraindicate the use of oral contraceptives in women who have vaginal or cervical adenosis. Since progestins exert antiestrogenic effects on certain target organs, clinical studies are presently underway to study the effect of these progestins on apparently estrogen-induced adenosis. It should be noted that the oral contraceptives contain progestins and estrogens that are steroidal. The malignant tumors and adenosis have been associated with the maternal ingestion of nonsteroidal estrogens - stilbesrol or one of its closely related compounds. No evidence has been presented to indicate that steroidal estrogens affect adenosis either favorably or deleteriously.     

The effects of intravesical therapy with elemene in preventing postoperative recurrence of bladder cancer

The effects of intravesical therapy with elemene in preventing postoperative recurrence of bladder cancer@李传刚$2nd Affil Hosp,Dalian Med Univ,Dalian 116023     

Quantitative detection of amplification of proto-oncogenes in breast cancer.

In the present study, dot-blot hybridization, serial dilution analysis and densitomctric scanning were used to detect amplification of proto- oncogenes including c-erbB2, c-myc, int-2 and c-Ha-ras in 104 paraffin-embedded breast cancers. Expression of c-erbB2 was also examined by immunohistochemistry. Amplification of c-erbB2. c-myc and int-2 genes was found in 34.7%, 17.8% and 11.9% of breast cancers respectively. However amplification of c-Ha-ras was not detected in all cases. In 11.9% of cases co-amplification of two or more oncogenes was observed. Positive immunostain-ing of c-erbB2 was seen in 23.8% of the cases and it was significantly associated, but not always corresponding to the amplification of the gene. There was no difference between primary and metastatic breast cancer in the alterations of proto-oncogenes examined in this study, which suggested that the amplification and overexpression of these proto-oncogenes occured prior to and maintained in the process of metastasis of breast cancer. S     

Cytotoxic activity of FK973 against human oral and breast cancer cells.

FK973 (11-acetyl-8-carbamoyloxymethyl-4-formyl-14-oxa-1, 11-diazatetracyclo [7.4.1.0.0] tetradeca-2, 4, 6-trien-6, 9-diyl diacetate), an analogue of mitomycin C (MMC), was tested against human oral squamous cancer cell lines Ca 9-22, HSC-2, HSC-3, breast adenocarcinoma cell lines MCF-7, BT-20 and breast ductal carcinoma cell line T-47D using MTT assay. FK973 showed cytotoxic effects against six tested cell lines and much wider effective dose range than MMC, adriamycin (ADM), and cisplatin (CDDP). FK973 was the most potent of the four drugs tested against the growth of the three squamous cancer cell lines derived from oral cavity. However, in breast cancer cell lines, FK973 was less potent than MMC and ADM. FK973 was time and dose dependent. The combination effects of FK973 with 5-Fluorouracil (5FU) or CDDP were synthetical. It may be a promising candidate for the treatment of oral and breast cancer.

     

Current status of breast cancer in Hong Kong.

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Management of patients with breast cancer: are we ready in India for sentinel lymph node biopsy?

Breast cancer is the commonest cancer among women worldwide. Surgery plays an important role in its management. Axillary lymph node dissection has been the standard of care for staging, prognostication and control of axillary disease for almost a century. However, this time-tested paradigm is shifting gradually in the western world, because of the increasing use of screening mammography resulting in the detection of a large proportion of node-negative early breast cancers and a significant incidence of axillary lymph node dissection-related arm morbidity. Minimally invasive and less morbid procedures such as sentinel lymph node biopsy are being used more commonly in the West. However, the western experience cannot be directly extrapolated to the Indian scenario because of the differences in patient profile, treatment standards and expertise available. There is a need to critically analyse these issues before the Indian medical community advocates sentinel lymph node biopsy as a routine procedure for managing patients with breast cancer.     

Atypical femoral shaft fracture in a patient with non-metastatic prostate cancer on zoledronic acid therapy: effect of therapy or coincidence?

There have been recent concerns of atypical non-spinal fractures in patients with osteoporosis who are on long-term bisphosphonate therapy. These fractures are less commonly reported in cancer patients on zoledronic acid therapy, where it is used in higher doses as compared to patients with osteoporosis. We report the case of a 70-year-old man with non-metastatic prostate cancer who was on androgen deprivation therapy following bilateral orchiectomy. He was on bone protection with intravenous zoledronic acid 4 mg monthly for a period of two years. He presented with spontaneous acute right mid-thigh pain. Radiograph of the right femur showed an atypical femoral shaft fracture, which was treated with intramedullary nailing and teriparatide. This case report raises concerns of atypical fractures in cancer patients who receive high doses of zoledronic acid. Patients receiving bisphosphonates who present with thigh or groin pain must undergo radiographic examination of the femur to rule out atypical femoral fractures.     

Prognostic significance of MDR-1 P-glycoprotein expression in breast cancer

Objective: To investigate the expression of MDR-1 P-glycoprotein(MDR-1 Pgp) in breast cancer and analyze its correlation to the biological behavior and prognosis of the disease. Methods:The expression of MDR-1 Pgp was examined in 75 cases of breast cancer patients by using three different monoclonal antibodies(JSB1, C219 and C494) with S-P immunohistochemisty. These patients were followed up for 5 years, and the correlation between MDR-1 Pgp expression, survival rate and lymph metastasis was analyzed. Results: Positive detection of MDR-1 Pgp by JSB1, C219 and C494 in 75 cases of breast cancer was 86.7%, 48% and 85.3%, respectively. MDR-1 Pgp expression was not related to ages of patients (P > 0.05). JSB1-detected expression of MDR-1 Pgp was related to lymph node metastasis(P < 0.05); while C219 and C494 were not(P > 0.05). The patients with MDR-1 Pgp expression positively detected by either two of the three antibodies, had five-year survival rate that was significantly higher than those positively detected by all the three antibodies(P < 0.05). Conclusion:Three antibodies should be used simultaneously to detect MDR-1 Pgp expression in breast cancer. Positive MDR-1 Pgp expression in breast cancer detected by all the three antibodies may represent a poor prognosis; while positive MDR-1 Pgp detection by JSB1 and C494 is associated with lymph metastasis.     

Do the unmet needs affect the quality of life in breast cancer patients?

OBJECTIVE: Breast cancer is an important disease and one where healthcare services have the potential to improve the quality of life. The aim of this study was to assess the relationship between unmet needs and the quality of life (QoL) of breast cancer patients. SUBJECTS AND METHODS: This study comprised one hundred breast cancer patients who attended the Oncology Outpatient Clinic in Cukurova University between April and June 2001. Three questionnaires were used: questionnaires for demographic details, unmet needs and Functional Assessment of Cancer Therapy-General Questionnaire QoL. RESULTS: There was significant correlation between QoL score and unmet needs score (r = 0.263, p = 0.008) and between QoL score and Napier logarithm (monthly income) (r = 0.257, p = 0.011). There was a significant difference in QoL score by occupation (p = 0.007). CONCLUSION: It is important to assess patients psychologically so as to make interventions about their psychosocial needs which affect QoL. This will require the re-evaluation of doctor-patient communication and interventions for improvement of this relationship.     

Double-positive in triple-negative? How significant is basal cytokeratin expression in breast cancer?

BackgroundBasal-like breast cancer has an unfavorable prognosis. Immunohistochemically, they are predominantly estrogen receptor (ER), progesterone receptor (PR) and CerbB2 receptor (HER2)-negative, show expression of Cytokeratins (CKs) 5/6, CK14, CK 17 and P-cadherin and are associated with germline BRCA1 mutations. Immunohistochemistry (IHC) is an easily available and relatively inexpensive technique that can detect this cancer subtype, and patients can benefit from aggressive management protocols. The aim of this study was to evaluate the expression of CK 5/6 and CK14 in breast cancer and its correlation with age, tumor grade, tumor size, histomorphological pattern, nodal status, ER, PR, HER2/neu, and Ki-67 index.MethodsFifty treatment-naїve patients of breast carcinoma who underwent surgery constituted the study group. No core cut biopsy specimens were considered. Histopathological examination along with IHC was performed for CK5/6, CK14, ER, PR, HER2/neu, and Ki-67. Comparison between the expression of CK5/6 and CK14 with age, tumor size, tumor grade, histological subtype, nodal status, ER, PR, HER2/neu, and Ki-67 expression was performed using SPSS 20 version software.ResultsTwenty-six percent of cases showed expression of CK5/6 and CK14. CK5/6 and CK14 expression correlated strongly with ER/PR negativity, young age, and Ki-67 proliferative index greater than 15%. No significant association with HER2/neu negativity was demonstrated. Contrasting results were obtained between CK5/6 and CK14 expression with respect to tumor grade and lymph node status.ConclusionIHC can be used to identify patients with basal phenotype breast cancer with good sensitivity and specificity, and such patients can benefit from aggressive management.     

Postmastectomy radiation in supraclavicular and internal mammary regions of patients with breast cancer of stage Ⅱ/Ⅲ

Adjuvant radiotherapy plays a vital role in the treatment of breast cancer, but irradiated area was not standardized. The ipsilateral chest wall and supraclavicular regions with or without internal mammary lymph nodes were reported in patients receiving postmastectomy radiotherapy. In our study, 133 consecutive patients with breast cancer of stage Ⅱ/Ⅲ who had received postmastectomy radiotherapy of supraclavicular and internal mammary regions at Cancer Hospital of Fudan University were analyzed for their survival and locoregional control as well as their relative prognostic predicator.